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West Virginia WIC Policy & Procedure 6.11 Effective Date: 08/01/11
6.11
Purchasing Regulations
1 of 2 POLICY:
The Local Agency must adhere to the purchasing regulations of its Parent Agency unless those regulations violate USDA Regulations or guidance issued by the State Agency.
PROCEDURE:
A. Purchases Requiring Prior State Agency Approval
1. Any purchase of $5,000 or more. The number of items per request must be clarified.
2. Any purchase for the purpose of automated data processing (computers, software, printers, etc.).
3. All Request for Proposals (RFP) must be reviewed and approved by the State Central Finance Office prior to release.
4. It is suggested that all Request for Quotations be reviewed by the State Central Finance Office prior to release.
Note: The State Agency will not approve any request received after August 31 of the grant year (Federal fiscal year) from which the purchase is to be made.
B. Purchases Requiring Prior State Agency and USDA Approval
1. Any purchase in excess of $25,000.
2. Any purchase of automated data processing equipment in excess of $99,999.
Note: The State Agency will not submit the request to USDA after August 25 of the grant year (Federal fiscal year) from which the purchase is to be made.
C. Method to Obtain USDA Approval of a Purchase
The Local Agency must write to the State Agency requesting the State Agency to approve and then seek USDA approval on behalf of the Local Agency. The Local Agency must describe the item(s) to be approved, the cost, justification for the purchase and a minimum of three (3) obtained bids. A “no bid” is not considered an obtained bid. It is suggested that the Local Agency solicit five (5) or more bids in order to obtain the three (3) required bids.
D. Capital Expenditures Requiring Prior State and USDA Approval
1. Capital expenditures for land or buildings are unallowable as a direct cost except with the prior approval of the State Agency and USDA.
West Virginia WIC Policy & Procedure 6.11 Effective Date: 08/01/11
6.11
Purchasing Regulations
2 of 2 2. Capital expenditures for improvements to land, buildings, or equipment which materially increases value or useful life costing more than $5,000 are unallowable as a direct cost except with the prior approval of the State Agency and USDA.
E. Method to Obtain USDA Approval of a Capital Expenditure
A written narrative must be submitted by the Local Agency to the State Agency for any purchase or improvements to real property.
1. The worksheet(s) (see Attachment #1 6.11 and/or Attachment #2 6.11) will provide guidance for these narratives.
2. All questions on the worksheet(s) must be answered in the body of the narrative in an essay format.
REFERENCES:
1. SFP 93-126, WIC Program - Allowable Costs - Real Property 2. SFP 07-043, WIC Advance Planning Document (APD) Policy Changes 3. SFP 98-041, Non-computer Equipment Purchases Less Than $25,000.
ATTACHMENTS:
1. Worksheet for Requests to Purchase Real Property 2. Worksheet for Requests to Renovate or Repair Real Property 3. SFP 10-017 Updated Prior Approval Guidance
Crossroads Software Maintenance and Enhancement Services VDH PAGE I Contract # VDH-21-707-0156
Office of Procurement and General Services 109 Governor Street Richmond, Virginia 23219
CROSSROADS SOFTWARE MAINTENANCE AND ENHANCEMENT SERVICES
Contract # VDH-21-707-0156
between
Virginia Department of Health and GCOM Software LLC
Note: This public body does not discriminate against faith-based organizations in accordance with the Code of Virginia, § 2.2-4343.1 or against a bidder or offeror because of race, religion, color, sex, national origin, age, disability, sexual orientation, gender identity, political affiliation, or veteran status or any other basis prohibited by state law relating to discrimination in employment. Faith-based organizations may request that the issuing agency not include subparagraph 1.f in General Terms and Condition C. Such a request shall be in writing and explain why an exception should be made in that invitation to bid or request for proposal. DocuSign Envelope ID: D69B105E-7A47-46ED-8B09-C0071CE057F5 DocuSign Envelope ID: 33024638-F519-4808-AF31-3DA182A2CE1E
Crossroads Software Maintenance and Enhancement Services VDH PAGE 2 Contract # VDH-21-707-0156
INFORMATION TECHNOLOGY CONTRACT TABLE OF CONTENTS 1. PURPOSE AND SCOPE .................................................................................................................................... 6 2. DEFINITIONS ................................................................................................................................................ 6 A. Agency ................................................................................................................................................ 6 B. Agent ................................................................................................................................................... 6 C. Acceptance ................................................................................................................................................ 6 D. Authorized User ................................................................................................................................ 6 E. Claim ................................................................................................................................................... 6 F. Code .................................................................................................................................................... 6 G. Commercial Off-The-Shelf (“COTS”) Software .............................................................................. 6 H. Commonwealth ................................................................................................................................. 6 I. Commonwealth Indemnified Parties .................................................................................................... 6 J. Component ........................................................................................................................................ 6 K. Computer Virus .................................................................................................................................. 7 L. Concurrent Users .............................................................................................................................. 7 M. Confidential Information ................................................................................................................... 7 N. Contract .............................................................................................................................................. 7 O. Contractor ................................................................................................................................................. 7 P. Deliverable ......................................................................................................................................... 7 Q. Documentation .................................................................................................................................. 7 R. Effective Date .................................................................................................................................... 7 S. Escrow Agent ........................................................................................................................................... 8 T. Federal Tax Information (“FTI”) ..................................................................................................... 8 U. Maintenance Coverage Period (“MCP”) ................................................................................... 8 V. Maintenance Level ............................................................................................................................ 8 W. Maintenance Services ....................................................................................................................... 8 X. Party .................................................................................................................................................... 8 Y. Receipt ................................................................................................................................................ 8 Z. Requirements .................................................................................................................................... 8 AA. Services .............................................................................................................................................. 8 BB. Software .............................................................................................................................................. 8 CC. Software Enhancements ................................................................................................................... 8 DD. Software Publisher ............................................................................................................................ 9 EE. Solution .............................................................................................................................................. 9 FF. Subcontractor ........................................................................................................................................... 9 GG. Supplier ...................................................................................................................................................... 9 HH. Supplier Personnel.................................................................................................................................. 9 II. SWaM .................................................................................................................................................. 9 JJ. Term .................................................................................................................................................... 9 KK. Transition Out Plan .......................................................................................................................... 9 LL. Transition Period .............................................................................................................................. 9 MM. Warranty Period ............................................................................................................................... 9 NN. Work Product ..................................................................................................................................... 9
3. TERM AND TERMINATION ......................................................................................................................... 9 DocuSign Envelope ID: D69B105E-7A47-46ED-8B09-C0071CE057F5 DocuSign Envelope ID: 33024638-F519-4808-AF31-3DA182A2CE1E
Crossroads Software Maintenance and Enhancement Services VDH PAGE 3 Contract # VDH-21-707-0156
A. Contract Term ........................................................................................................................................... 9 B. Termination for Convenience ........................................................................................................ 10 C. Termination for Cause .................................................................................................................... 10 D. Termination for Non-Appropriation of Funds ............................................................................. 10 E. Effect of Termination ...................................................................................................................... 10 F. Termination by Supplier ................................................................................................................. 10 G. Transition of Services .................................................................................................................... 10 H. Contract Kick-Off Meeting ............................................................................................................. 11 I. Transition Out Plan .............................................................................................................................. 11 J. Contract Closeout ........................................................................................................................... 11 4. SUPPLIER PERSONNEL ........................................................................................................................... 11 A. Selection and Management of Supplier Personnel .................................................................... 11 B. Key Personnel .................................................................................................................................. 11 C. Subcontractors ................................................................................................................................ 11 5. NEW TECHNOLOGY ................................................................................................................................. 12 A. Access to New Technology ........................................................................................................... 12 B. New Service Offerings Not Available from Supplier ................................................................. 12 6. GENERAL WARRANTY ............................................................................................................................ 12 A. Coverage Period .............................................................................................................................. 12 B. Component Warranty ..................................................................................................................... 12 C. Interoperability Warranty ................................................................................................................ 12 D. Performance Warranty .................................................................................................................... 12 E. Documentation and Deliverables .................................................................................................. 12 F. Malicious Code ............................................................................................................................... 13 G. Open Source ......................................................................................................................................... 13 H. Supplier’s Viability ......................................................................................................................... 13 I. Supplier’s Past Experience ........................................................................................................... 13 7. RESERVED 8. RIGHTS TO WORK PRODUCT ................................................................................................................. 13 A. Work Product ................................................................................................................................... 13 B. Ownership ........................................................................................................................................ 14 C. Pre-existing Rights .......................................................................................................................... 14 D. Return of Materials ……………………………………………………………………………………….14 9. RESERVED ................................................................................................................................................. 14 10. DELIVERY AND INSTALLATION ............................................................................................................. 14 A. Scheduling ....................................................................................................................................... 14 B. Deployment of Solution ................................................................................................................. 14 C. Documentation of Software Configuration ................................................................................. 14 11. ACCEPTANCE AND CURE PERIOD ........................................................................................................ 15 A. Services Acceptance Criteria ........................................................................................................ 15 B. Services Cure Period ...................................................................................................................... 15
12. WARRANTY AND MAINTENANCE SERVICES ...................................................................................... 15 A. Known Defects ................................................................................................................................ 15 B. New Releases .................................................................................................................................. 15 C. Coverage .......................................................................................................................................... 15 D. Service Levels ................................................................................................................................. 16 E. Software Evolution .......................................................................................................................... 16 F. Escalation Procedures ................................................................................................................... 16 DocuSign Envelope ID: D69B105E-7A47-46ED-8B09-C0071CE057F5 DocuSign Envelope ID: 33024638-F519-4808-AF31-3DA182A2CE1E
Crossroads Software Maintenance and Enhancement Services VDH PAGE 4 Contract # VDH-21-707-0156
13. FEES, ORDERING, AND PAYMENT PROCEDURE ............................................................................... 16 A. Fees and Charges ........................................................................................................................... 16 B. Reproduction Rights for Supplier-Provided Software ............................................................... 16 C. Ordering ........................................................................................................................................... 16 D. Performance Work Statement (PWS) .............................................................................................. 17 E. Purchase Payment Terms ............................................................................................................. 17 F. Reimbursement of Expenses ....................................................................................................... 17 G. Disputed Charges …………………………………………………………………………………………. 18 14. REPORTING ............................................................................................................................................... 18 A. Small Business Procurement and Subcontracting Spend ....................................................... 18 15. SUPPLIER PERFORMANCE METRICS ................................................................................................... 19 16. STATUS MEETINGS .................................................................................................................................. 19 17. STEERING COMMITTEE ........................................................................................................................... 19 18. POLICIES AND PROCEDURES GUIDE ....................................................................................................... 19 19. TRAINING AND DOCUMENTATION ........................................................................................................ 19 A. Training ............................................................................................................................................. 19 B. Documentation ................................................................................................................................ 19 20. VDH SELF-SUFFICIENCY ......................................................................................................................... 20 21. COMPETITIVE PRICING............................................................................................................................ 20 22. CONFIDENTIALITY .................................................................................................................................... 20 A. Treatment and Protection .............................................................................................................. 20 B. Return or Destruction ..................................................................................................................... 20 C. Confidentiality Statement.............................................................................................................. 21 D. Freedom of Information Act Acknowledgement ....................................................................... 21 23. INDEMNIFICATION .................................................................................................................................... 21 A. Indemnification Generally ............................................................................................................ 21 B. Defense of Claims ........................................................................................................................... 21 C. Duty to Replace or Reimburse ...................................................................................................... 21 D. Supplier Dispute of Obligation to Indemnify .............................................................................. 21 24. LIABILITY .................................................................................................................................................... 21 A. Supplier Liability ............................................................................................................................. 21 B. Limitation of Liability ...................................................................................................................... 22 25. INSURANCE ............................................................................................................................................... 22 26. SECURITY COMPLIANCE ......................................................................................................................... 22 27. IMPORT/EXPORT ....................................................................................................................................... 22 28. BANKRUPTCY ........................................................................................................................................... 22 29. GENERAL PROVISIONS ........................................................................................................................... 23 A. Relationship Between VDH and Supplier .................................................................................... 23 B. Licensing Within the Commonwealth .......................................................................................... 23 C. Incorporated Contractual Provisions ........................................................................................... 23 D. Compliance with the Federal Lobbying Act ........................................................................................ 23 E. Ethics in Public Contracting .......................................................................................................... 23 F. Governing Law.............................................................................................................................................. 24 G. Assignment ...................................................................................................................................... 24 H. Severability ....................................................................................................................................... 24 I. Survival ............................................................................................................................................. 24 J. Force Majeure .................................................................................................................................. 24 K. No Waiver ......................................................................................................................................... 24 L. Remedies .......................................................................................................................................... 24 DocuSign Envelope ID: D69B105E-7A47-46ED-8B09-C0071CE057F5 DocuSign Envelope ID: 33024638-F519-4808-AF31-3DA182A2CE1E
Crossroads Software Maintenance and Enhancement Services VDH PAGE 5 Contract # VDH-21-707-0156
M. Right to Audit ................................................................................................................................... 24 N. Taxes ................................................................................................................................................. 25 O. Currency ........................................................................................................................................... 25 P. Advertising and Use of Proprietary Marks ..................................................................................... 25 Q. Notices .............................................................................................................................................. 25 R. Contract Administration ................................................................................................................ 25 S. Captions ........................................................................................................................................... 25 T. Entire Contract ................................................................................................................................. 25 U. Order of Precedence ...................................................................................................................... 26 V. Counterparts and Electronic Signatures .................................................................................... 26 W. Opportunity to Review ................................................................................................................... 26 X. Equal Employment Opportunity ....................................................................................................... 26 Y. Clean Air and Federal Water Pollution Control Act ............................................................... 26
AA. Anti-Lobbying Act ..................................................................................................................... 27 BB. Americans with Disabilities Act ............................................................................................. 27 CC. Drug-Free Workplace Statement ............................................................................................. 27 DD. Royalty Free Rights to Use Software or Documentation Developed .................................. 28 EE. Debarment and Suspension .................................................................................................... 28 FF. Renewal of Contract ................................................................................................................. 28 DocuSign Envelope ID: D69B105E-7A47-46ED-8B09-C0071CE057F5 DocuSign Envelope ID: 33024638-F519-4808-AF31-3DA182A2CE1E
Crossroads Software Maintenance and Enhancement Services VDH PAGE 6 Contract # VDH-21-707-0156
Crossroads Software Maintenance and Enhancement Services This Crossroads Software Maintenance and Enhancement Services CONTRACT (“Contract”) is entered into by and between the Virginia Department of Health (“VDH”), pursuant to § 2.2-2012 of the Code of Virginia (“Code”) and on behalf of the Commonwealth of Virginia (“Commonwealth”), and GCOM Software LLC (“Supplier”), a corporation headquartered at 9175 Guilford Road, Suite 101, Columbia, MD 21046, to be effective as of September 30, 2023 (“Effective Date”).
1. PURPOSE AND SCOPE This Contract sets forth the terms and conditions under which Supplier shall provide Crossroads Software Maintenance and Enhancement Services as described in:
EXHIBIT A – FUNCTIONAL REQUIREMENTS/PERFORMANCE WORK STATEMENT.
2. DEFINITIONS Capitalized terms used in this Contract have the meaning as provided (i) where each term is used in the Contract unless the term is (ii) set forth in this “Definitions” section below which lists the capitalized terms used in this Contract and provides a definition for the term.
A. Agency The Virginia Department of Health (VDH), of the Commonwealth of Virginia pursuant to the Code of Virginia Title 32.1 (§§ § 32.1 et seq.), or any successor agency. B. Agent Any third party independent agent of VDH. C. Acceptance: The written acknowledgement by the Agency of successful delivery and performance by the Supplier of its contractual commitments at the location(s) designated in the Contract, including completed and successful acceptance testing in conformance with the Requirements as determined by the Agency and set forth in the Contract. D. Authorized User: Any appropriately cleared individual as defined in the Crossroads User Group Charter (Exhibit F) with a requirement to access the system to complete necessary job functions or for performing maintenance or assisting with the system in a lawful purpose. E. Claim Any and all losses, damages, claims, demands, proceedings, suits and actions, including any related liabilities, obligations, losses, damages, assessments, fines, penalties (whether criminal or civil), judgments, settlements, expenses (including attorneys’ and accountants’ fees and disbursements), and costs. Collectively, “Claims”. F. Code The Code of Virginia, as amended, and all laws in the titles, chapters, articles and sections contained therein. G. Commercial Off-The-Shelf (“COTS”) Software Software that is general in nature, not broad enterprise applications, which can be purchased and used immediately “as is,” without modification, in the same form in which it was sold in the commercial marketplace. Standard options are not considered modifications. H. Commonwealth The Commonwealth of Virginia. I. Commonwealth Indemnified Parties Means, collectively and individually, the Commonwealth, VDH and their officers, directors, agents, and employees. J. Component Any part or service of the Solution, Software, or Deliverable delivered by Supplier under this Contract, including SOWs. DocuSign Envelope ID: D69B105E-7A47-46ED-8B09-C0071CE057F5 DocuSign Envelope ID: 33024638-F519-4808-AF31-3DA182A2CE1E
Crossroads Software Maintenance and Enhancement Services VDH PAGE 7 Contract # VDH-21-707-0156
K. Computer Virus Any malicious code, program, malware or other internal component (e.g., computer virus, computer worm, computer time bomb, or similar component), which could damage, destroy, alter or disrupt any computer program, firmware, or hardware or which could, in any manner, reveal, damage, destroy, alter or disrupt any data or other information accessed through or processed by such software in any manner. L. Concurrent Users The maximum number of concurrent active users utilizing the Software at a given point in time. M. Confidential Information Non-public proprietary or trade secret information of VDH and Supplier, whether the information is in written, graphic, machine readable or other tangible form, and which at the time of disclosure to any other Party is either (i) marked as being “Confidential” or “Proprietary”; (ii) Health Records;(iii) Personally Identifiable Information, including information about VDH’s employees, contractors, and customers, or Sensitive Data, including PHI; or (iv) information that is protected by statute or other applicable law. “Confidential Information” also includes any (a) information to which the Supplier has access in VDH facilities or VDH’s systems, (b) Work Product and information pertaining to the Work Product, (c) VDH data, VDH software, and systems access codes, and (d) information concerning VDH’s and any other VDH’s operations, plans, employees, contractors or third party suppliers The term “Confidential Information” does not include information that is: i. in the public domain through no fault of the receiving Party or of any other person or entity that is similarly contractually or otherwise obligated; ii. obtained independently from a third-party without an obligation of confidentiality to the disclosing Party and without breach of this Contract; iii. developed independently by the receiving Party without reference to the Confidential Information of the other Party; or iv. required to be disclosed under The Virginia Freedom of Information Act (§§2.2-3700 et seq. of the Code of Virginia) or similar laws or pursuant to a court order. N. Contract This agreement, including all exhibits, schedules, and attachments, including any modifications or amendments thereto, entered into by VDH and Supplier. O. Contractor The use of the term “Contractor” in any of the following terms, conditions, links, or IRS Publication 1075 means the same as the term “Supplier” as defined and used in this Contract. P. Deliverable Software, Documentation, Components, plans, reports, data, Work Product, and any other materials, items or events, in each case described or itemized as something that is developed, prepared or created and delivered or required to be developed, prepared or created and delivered or made available to VDH as part of the Services, Maintenance Services, Licensed Services, application, Solution, product, Software, System Software, or Supplier product, , including the development or creation of Work Product. Q. Documentation Those materials (including user manuals, training materials, guides, product descriptions, technical manuals, product specifications, and supporting materials) detailing the information and instructions needed in order to allow VDH and its Authorized Users to make productive use of the application, Software, Solution, product, Service, Licensed Services or Deliverable, including any and all components, and to implement and develop self-sufficiency with regard to the application, Software, Solution, product, Service, Licensed Services or Deliverable, including any and all components, provided by Supplier in fulfilling its obligations under the Contract. R. Effective Date The date this Contract goes into full force and effect as set forth in the preamble of this Contract above.
DocuSign Envelope ID: D69B105E-7A47-46ED-8B09-C0071CE057F5 DocuSign Envelope ID: 33024638-F519-4808-AF31-3DA182A2CE1E
Crossroads Software Maintenance and Enhancement Services VDH PAGE 8 Contract # VDH-21-707-0156
S. Escrow Agent The person or entity that holds and maintains all Software source code and related technical and user Documentation, along with a signed copy of the Escrow Agreement attached to this Contract as Exhibit E, in trust for the Parties as set forth in the “Escrow Agreement” section of this Contract below. T. Federal Tax Information (“FTI”) FTI consists of federal tax returns and return information (and information derived from it) that is in the possession or control of VDH, which is covered by the confidentiality protections of the Internal Revenue Code (“IRC”) and subject to the IRC § 6103(p)(4) safeguarding requirements including IRS oversight. FTI is categorized as “Sensitive” but “Unclassified” information and may contain personally identifiable information.
U. Maintenance Coverage Period (“MCP”) The period of time during which Supplier is obligated to provide Maintenance Services for a unit of Software or product. V. Maintenance Level The defined parameters of Maintenance Services, including the times during which, and time-frames in which, Supplier shall respond to a request for Maintenance Services. The available Maintenance Levels are defined in Exhibit I to this Contract. W. Maintenance Services Those services, preventive and remedial, provided or performed by Supplier under the Contract, as defined in Exhibit A – Functional Requirements – Performance Work Statement (PWS) and Exhibit A-1 Functional Requirement, in order to ensure continued operation of the product, Hardware, or Software, Enhancements. Maintenance Services include support services. Maintenance Services for Software may include the development of Work Product, if so authorized in the Contract. X. Party Supplier, VDH Y. Receipt VDH has physically received or has unfettered access to any Deliverable at the correct “ship-to” location. Z. Requirements The functional, performance, operational, compatibility, acceptance testing criteria, and other parameters and characteristics of the product, Software, Solution, Service(s), Application and Licensed Services and Deliverables, including any and all components, as authorized by any combination of the Contract, as set forth in Exhibit A or the applicable SOW, and such other parameters, characteristics, or performance standards that may be agreed upon in writing by the Parties. AA. Services Any work performed or service provided by Supplier – including the design and development of software and modifications, software updates, solution, products, implementation, installation, maintenance, support, testing, training, or other provision – in meeting the Requirements and fulfilling its obligations under the Contract. “Services” includes all functions, responsibilities, activities, and tasks of the Supplier that are an inherent, necessary, or customary part of the Services, or are required for the proper performance or provision of the Services. As permitted by the scope of the Contract, “Services” may include the discovery, creation, or development of Work Product. This definition does not include Licensed Services. BB. Software The programs and code provided by Supplier under the Contract as component(s) of any Deliverable or component of any Solution, and any subsequent modification of such programs and code. For COTS Software, “Software” means the programs and code, and any subsequent releases, provided by Supplier under this Contract as set forth in Exhibit B. If this Contract is for Software Maintenance, “Software” also includes the programs and code provided by Supplier under the Contract.
CC. Software Enhancements The software modifications described as enhancements in Exhibit A – Functional Requirements –
DocuSign Envelope ID: D69B105E-7A47-46ED-8B09-C0071CE057F5 DocuSign Envelope ID: 33024638-F519-4808-AF31-3DA182A2CE1E
Crossroads Software Maintenance and Enhancement Services VDH PAGE 9 Contract # VDH-21-707-0156
Performance Work Statement (PWS) and Exhibit A-1 Functional Requirement. DD. Software Publisher The third-party licensor of the Software, other than the Supplier, provided by Supplier under this Contract. EE. Solution The Supplier’s contractually committed technical approach for solving an information technology business objective and associated Requirements as defined and authorized by the scope of the Contract. Solution means all Supplier and Supplier’s third-party providers’ components making up the Solution, including but not limited to Software, product, configuration design, implementation, Supplier-developed interfaces, Services and Work Product. FF. Subcontractor Any entity to which Supplier (or other Subcontractor of any tier) has subcontracted for performance of, or delegated any of its responsibilities under the Contract, including an affiliate of the Supplier. GG. Supplier The entity set forth in the preamble of this Contract and any entity that controls, is controlled by, or is under common control with Supplier. HH. Supplier Personnel Any and all of Supplier’s employees, agents, contractors, or subcontractors performing under this Contract. II. SWaM Any entity certified by the Commonwealth’s Department of Small Business and Supplier Diversity as a small, women-owned, minority-owned, or service disabled veteran-owned business, as defined in Code §§ 2.2-2000.1 and 2.2-4310, or a certified micro business as defined in Executive Order Number 35 (2019). JJ. Term The period of time beginning with the Effective Date and lasting for the length of time set forth in the “Contract Term” section below during which this Contract will be in full force and effect. KK. Transition Out Plan The written plan developed by Supplier addressing the transition of Supplier’s contractual obligations, in whole or in part, away from the Supplier and to VDH, or its designee, after the expiration or termination of the Contract. LL. Transition Period The period of time after the expiration or termination of the Contract that Supplier is obligated to continue providing assistance to VDH so as to transition the Supplier’s contractual obligations, or any portion thereof, to any other supplier. MM. Warranty Period The period of time during which Supplier is obligated to provide maintenance for a unit of Software or product. The Supplier will maintain, support, and provide warranty services of the Software or product for the duration of the contract. NN. Work Product Inventions, combinations, machines, methods, formulae, techniques, processes, improvements, software enhancements, updates, designs, computer programs, strategies, specific computer-related know-how, data and original works of authorship discovered, created, or developed by Supplier, or jointly by Supplier and VDH in the performance of this Contract. Work Product does not include configuration of software, nor does it include anything developed by Supplier prior to, or outside of, this Contract.
3. TERM AND TERMINATION A. Contract Term This Contract is effective and legally binding as of the Effective Date and, unless terminated as provided for in this section, will be effective and legally binding for a period of 36 months (“Term”). VDH, in its sole discretion, may extend this Contract for up to five (5) additional one (1) year periods after the expiration of the initial Term. VDH will issue a written notification to the Supplier stating DocuSign Envelope ID: D69B105E-7A47-46ED-8B09-C0071CE057F5 DocuSign Envelope ID: 33024638-F519-4808-AF31-3DA182A2CE1E
Crossroads Software Maintenance and Enhancement Services VDH PAGE 10 Contract # VDH-21-707-0156
VDH’s intention to exercise the extension period no less than 90 calendar days prior to the expiration of any current term. B. Termination for Convenience VDH may terminate this Contract, in whole or in part, at any time and for any reason upon not less than 30 calendar days’ prior written notice to Supplier.
C. Termination for Cause In the event of breach by the Supplier, VDH will have the right to terminate this Contract, in whole or in part. Supplier will be deemed in breach in the event that Supplier fails to meet any material obligation set forth in this Contract. Any termination under the provisions of this section will be deemed a “Termination for Cause”. If VDH deems the Supplier to be in breach, VDH shall provide Supplier with notice of breach and allow Supplier 15 business days to cure the breach. If Supplier fails to cure the breach as required, VDH may immediately terminate this Contract in whole or in part. In addition, if Supplier is found by a court of competent jurisdiction to be in violation of or to have violated 31 U.S.C. § 1352, or if Supplier becomes a party excluded from Federal Procurement and Non-procurement Programs, VDH may immediately terminate this Contract, in whole or in part, for breach, and VDH shall provide written notice to Supplier of such termination. Supplier shall provide prompt written notice to VDH if Supplier is charged with violation of 31 U.S.C. § 1352, or if federal debarment proceedings are instituted against Supplier. D. Termination for Non-Appropriation of Funds All payment obligations from public bodies under this Contract are subject to the availability of legislative appropriations at the federal, state, or local level for this purpose. In the event of non- appropriation of funds, irrespective of the source of funds, for the items under this Contract, VDH may terminate this Contract, in whole or in part, for those goods or services for which funds have not been appropriated. Written notice will be provided to the Supplier as soon as possible after legislative action is completed. E. Effect of Termination Upon termination, neither the Commonwealth, nor VDH, will have any future liability except for Deliverables accepted by VDH or Services (including any applicable Licensed Services and Maintenance Services) rendered by Supplier and accepted by VDH prior to the termination date. In the event of a Termination for Breach, Supplier shall accept return of any Deliverable that was not accepted by the VDH, and Supplier shall refund any monies paid by VDH for the unaccepted Deliverable. Supplier will bear all costs of de-installation and return of Deliverables. F. Termination by Supplier In no instance will termination by Supplier be considered. Failure by VDH to make timely payments owed to Supplier for its performance under this Contract will constitute a breach by VDH. Supplier’s remedy for a breach is limited to the remedies set forth in Code § 2.2-4363. G. Transition of Services At the request of VDH prior to or upon expiration or termination of this Contract, Supplier shall provide all assistance as VDH may reasonably require to transition the Supplier’s contractual obligations, or any portion thereof, to any other supplier with whom VDH contracts for provision of same. This Transition Period obligation may extend beyond expiration or termination of the Contract for a period of six (6) months. If this Contract includes Supplier's provision of licensed products, Supplier shall take no action to restrict or terminate the use of such licensed products after the date of expiration or termination of the Contract or during any Transition Period, or both. VDH shall pay for any additional maintenance or licensing fees during any Transition Period at the hourly rate or at a fee agreed upon by Supplier and VDH. Supplier shall provide all reasonable transition assistance requested by VDH to allow for the expired or terminated portion of the Services to continue without interruption or adverse effect, and to facilitate the orderly transfer of such Services to VDH. The transition assistance will be deemed by the parties to be governed by the terms and conditions of this Contract, except for those terms or conditions that do not reasonably apply to transition assistance. Further, any Transition Period will not affect VDH’s rights in regard to any purchased Software perpetual licenses which are paid in full.
DocuSign Envelope ID: D69B105E-7A47-46ED-8B09-C0071CE057F5 DocuSign Envelope ID: 33024638-F519-4808-AF31-3DA182A2CE1E
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H. Contract Kick-Off Meeting Within 30 calendar days of the notice to proceed, Supplier may be required to attend a contract orientation meeting, along with the VDH contract manager/administrator, VDH project manager(s) or authorized representative(s), and any other significant stakeholders who have part in the successful performance of this Contract. The purpose of this meeting will be to review all contractual obligations for both parties, all administrative and reporting requirements, and to discuss any other relationship, responsibility, communication and performance criteria set forth in the Contract. I. Transition Out Plan Within three (3) months of the Effective Date, Supplier will develop and distribute to VDH a Transition Out Plan. The Supplier will maintain the Transition Out Plan throughout the Term and update the Transition Out Plan as needed and subject to VDH’s approval. J. Contract Closeout Prior to the Contract’s expiration date, Supplier may be provided contract closeout documentation by VDH. If contract closeout documentation is provided, then Supplier shall complete, sign, and return to VDH Administrative Services Division any required documentation within 30 calendar days of receipt to ensure completion of closeout administration and to maintain a positive performance reputation with the Commonwealth. Any required closeout documentation not received within 30 calendar days of Supplier’s receipt of the Commonwealth's request will be documented in the contract file as Supplier non-compliance. Supplier’s non-compliance may affect any pending payments due to the Supplier, including final payment, until the documentation is returned to VDH.
4. SUPPLIER PERSONNEL A. Selection and Management of Supplier Personnel Supplier shall ensure that all Supplier Personnel performing under this Contract are competent and knowledgeable of the contractual arrangements between VDH and Supplier. Supplier acknowledges that Supplier is the employer of all Supplier employees and shall have the sole responsibility to supervise, counsel, discipline, review, evaluate, set the pay rates of, provide (to the extent required by law) health care and other benefits for, and terminate the employment of Supplier employees. Supplier shall be solely responsible for the supervision and conduct of Supplier Personnel, including all acts, omissions, gross negligence, and willful misconduct of Supplier Personnel. Additionally, Supplier shall ensure that Supplier Personnel comply with VDH’s site security, information security and personnel conduct rules, as well as applicable federal, state and local laws, including export regulations. VDH reserves the right to require the immediate removal from VDH’s premises of any Supplier Personnel whom VDH believes has failed to comply with the above or whose conduct or behavior is unacceptable or unprofessional or results in a security or safety breach. B. Key Personnel Supplier may designate certain Supplier’s personnel as “Key Personnel” or “Project Managers”. Supplier’s obligations with respect to Key Personnel and Project Managers will be described in Exhibits C and J of the Contract. Any changes to Key Personnel must be mutually agreed to in writing by Supplier and VDH. Failure of Supplier to perform in accordance with such obligations may be deemed a breach of this Contract. C. Subcontractors Supplier shall not use Subcontractors to perform its contractual obligations pursuant to the Contract unless specifically authorized in writing to do so by VDH. If this Contract is supported in whole or in part with federal funds, Supplier may not subcontract to any Subcontractor that is a party excluded from Federal Procurement and Non-procurement Programs. In no event may Supplier subcontract to any Subcontractor that is debarred by the Commonwealth or that owes back taxes to the Commonwealth and has not made arrangements with the Commonwealth for payment of such back taxes. If Supplier subcontracts the provision of any performance obligation under this Contract to any other party, Supplier shall (i) act as prime contractor and will be the sole point of contact with regard to all obligations under this Contract; and (ii) represent and warrant that any authorized Subcontractors shall perform in accordance with the warranties set forth in this Contract. DocuSign Envelope ID: D69B105E-7A47-46ED-8B09-C0071CE057F5 DocuSign Envelope ID: 33024638-F519-4808-AF31-3DA182A2CE1E
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5. NEW TECHNOLOGY A. Access to New Technology Supplier will bring to VDH’s attention any new products or services within the scope of the Contract that Supplier believes will be of interest to VDH and will work to develop proposals for the provision of any such products or services as VDH requests. B. New Service Offerings Not Available from Supplier If new or replacement product or service offerings become available and cannot be competitively provided by the Supplier under the scope of this Contract, VDH will have the right to purchase the new or replacement products or services from a third party. If VDH elects to use such new or replacement product or service offerings, Supplier will reasonably assist VDH to migrate to such products or services. If VDH elects to acquire new products or services as described in the paragraph above and such services replace existing Supplier-provided services, discount tiers and any commitments (as applicable per the Contract) will be reduced to reflect reductions in purchases of the replaced products or services.
6. GENERAL WARRANTY THE OBLIGATIONS OF SUPPLIER UNDER THIS GENERAL WARRANTY SECTION ARE MATERIAL. EXCEPT AS PROVIDED IN ARTICLES 6. GENERAL WARRANTY AND 11. WARRANTY AND MAINTENANCE SERVICES THIS CONTRACT AND ARTICLE 15. CLOUD SERVICES WARRANTY OF EXHIBIT K CLOUD SERVICES ADDITIONAL CONTRACT TERMS AND CONDITIONS, SUPPLIER MAKES NO OTHER WARRANTIES, EXPRESS OR IMPLIED, INCLUDING WITHOUT LIMITATION ANY CONCERNING MERCHANTABILITY OR FITNESS FOR ANY OTHER PARTICULAR PURPOSE. Supplier warrants and represents to VDH that Supplier will fulfill its contractual obligations and meet all Requirements as described in Exhibit A. Supplier warrants and represents to VDH that:
A. Ownership Supplier has the right to perform and provide all contractual obligations and provide all needed services or products without violating or infringing any law, rule, regulation, copyright, patent, trade secret, or other proprietary right of any third party. B. Coverage Period Supplier warrants that any Deliverables provided by Supplier under this Contract will meet or exceed the Requirements. Supplier shall correct, at no additional cost to VDH, all errors identified during the warranty period that result in supplier’s failure to meet the Requirement, or its contractual obligations. C. Component Warranty For any Component, the applicable warranty period shall be the period from written acceptance of the Component until Contract termination. D. Interoperability Warranty Supplier warrants that each Component, regardless of the origin of the Component, delivered under this Contract shall be interoperable with other Components so as to meet or exceed the performance specified in the Requirements. E. Performance Warranty With respect to Supplier’s performance under this Contract: i. Supplier shall perform all contractual obligations with the care, skill and diligence, consistent with or above applicable professional standards currently recognized in Supplier's profession, and Supplier shall be responsible for the professional quality, technical accuracy, completeness, and coordination of all plans, information, specifications, Deliverables, and Services furnished under this Contract; and ii. Supplier shall ensure that any contractually-obligated Services or Deliverables, or both, meet or exceed the Requirements and that any Product will function in conformance with the Requirements. F. Documentation and Deliverables Any required Documentation Supplier is obligated to provide under this Contract will be sufficient in detail and content to allow an appropriately trained user/programmer to understand and fully utilize, as applicable, the Deliverables without reference to any other materials or information. DocuSign Envelope ID: D69B105E-7A47-46ED-8B09-C0071CE057F5 DocuSign Envelope ID: 33024638-F519-4808-AF31-3DA182A2CE1E
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iii. All Deliverables provided or delivered pursuant to this Contract are at the current release level unless VDH specifies an older version. iv. No Maintenance Services, engineering change, or revision made to any Supplier-provided Deliverables will v. (a) degrade the performance of any Deliverable or its components to a level below that defined in the Requirements or the product manufacturer's or Software Publisher's published specifications, as applicable; (b) cause any other warranty to be breached; or (c) require VDH to acquire additional hardware equipment or software. G. Malicious Code Supplier has used commercially reasonable efforts through quality assurance procedures to verify that there are no Computer Viruses or undocumented features in any of the Deliverables, as obligated and provided by Supplier, at the time of delivery to VDH. Supplier has used the best available means to scan any media provided to VDH. Supplier warrants that the Deliverables, as obligated and provided by Supplier, do not contain any embedded device or code (e.g., time bomb) that is intended to obstruct or prevent VDH’s use of the Deliverables. Notwithstanding any rights granted under this Contract or at law, Supplier waives, under any and all circumstances, any right it has or may have in the future to exercise its license termination rights by electronic means. Supplier agrees that VDH may pursue all remedies provided under law in the event of a breach or threatened breach of this section, including injunctive or other equitable relief. H. Open Source Supplier will notify VDH if any Deliverables, as obligated and provided by Supplier, contain any Open Source code and identify the specific Open Source License that applies to any embedded code dependent on Open Source code, provided by Supplier under this Contract. I. Supplier’s Viability Supplier has the financial capacity to perform and continue to perform its obligations under this Contract. Supplier has no constructive or actual knowledge of a potential legal proceeding being brought against Supplier that could materially adversely affect the performance of this Contract. Further, Supplier is not prohibited by any contract, or order by any court of competent jurisdiction from entering into this Contract. J. Supplier’s Past Experience Supplier has met similar contractual obligations and fulfilled the Requirements as set forth in Exhibit A and in this Contract, in similar or greater complexity, to other customers without significant problems due to Supplier’s performance and without causing a contractual breach or default claim by any customer.
7. RESERVED
8. RIGHTS TO WORK PRODUCT Any license to pre-existing work will be held, and all rights in, title to, and ownership of Work Product will vest, pursuant to the terms of the “Licensing Within the Commonwealth” section of this Contract below. A. Work Product VDH and Supplier mutually acknowledge that performance of this Contract will result in Work Product. The Parties shall document all Work Product specifications and these specifications will be set forth in Exhibit A and incorporated into this Contract. Supplier shall promptly and fully disclose to the Commonwealth or VDH any and all Work Product generated, conceived, reduced to practice, or learned by Supplier or any Supplier Personnel, either solely or jointly with others, during the term or performance of this Contract, which in any way relates to the business of the Commonwealth or VDH. Supplier and Supplier Personnel shall not make use of, or disclose to others, any proprietary information relating to the Work Product, other than as is required in the performance of this Contract. All Services performed pursuant to this Contract will include delivery of all source and object code and all executables and documentation for all Work Product. At no time may Supplier deny VDH access to the Work Product, regardless of form. DocuSign Envelope ID: D69B105E-7A47-46ED-8B09-C0071CE057F5 DocuSign Envelope ID: 33024638-F519-4808-AF31-3DA182A2CE1E
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B. Ownership All Work Product discovered, created, or developed under this Contract is and will remain the sole property of the Commonwealth and its assigns, or VDH and its assigns, regardless of whether the Services are considered “works made for hire” or “hired to invent”. Except as specifically set forth in writing and signed by both VDH and Supplier, Supplier agrees that the Commonwealth or VDH will have all rights with respect to any Work Product discovered, created or developed under this Contract, without regard to the origin of the Work Product. Supplier irrevocably transfers, grants, conveys, assigns and relinquishes exclusively to the Commonwealth or VDH any and all right, title and interest it now has or may hereafter acquire in and to the Work Product under patent, copyright, trade secret and trademark law in perpetuity, or for the longest period otherwise permitted by law. If any moral rights are created, Supplier expressly waives all moral rights created in the Work Product. Supplier shall assist the Commonwealth or VDH in every reasonable way to obtain and, from time to time, enforce patents, copyrights, trade secrets and other rights and protection relating to the Work Product.
Upon the reasonable request by the Commonwealth or VDH with respect to the Work Product, Supplier and any required Supplier Personnel shall execute all documents necessary for use in applying for and obtaining patents, copyrights, and other rights and protection, and in protecting trade secrets with respect to the Work Product.
Supplier agrees that the provisions of this section will survive any termination of this Contract by VDH. Supplier also agrees that in the event of a breach of this Contract by VDH, Supplier’s remedy will not include any right to rescind, revoke, or otherwise invalidate the provisions of this section. C. Pre-existing Rights If, and to the extent that, any pre-existing rights are embodied or reflected in the Work Product, Supplier grants to the Commonwealth or VDH the irrevocable, perpetual, non-exclusive, worldwide, royalty-free right and license to (i) use, execute, reproduce, display, perform, distribute copies of, and prepare derivative works based upon such pre-existing rights and any derivative works thereof; and (ii) authorize others to do any or all of the foregoing. Supplier will retain all ownership rights in any pre-existing works. D. Return of Materials Upon termination of this Contract, Supplier shall immediately return to VDH all copies, in whatever form, of any and all Confidential Information, Work Product and other properties provided by VDH that are in Supplier's possession, custody, or control.
9. RESERVED
10. DELIVERY AND INSTALLATION A. Scheduling Scheduling of Software Maintenance Supplier shall complete performance of the Maintenance Services according to the delivery dates set forth in Exhibit A or as mutually agreed by Supplier and VDH. Installation of Software Enhancements Software Enhancements will be deemed to be installed when all Acceptance criteria as specified in the Contract have been met. Upon Supplier completion of the Software Enhancements and successful Acceptance testing, Agency shall provide to Supplier written notice of Acceptance. B. Deployment of Solution – Not Applicable C. Documentation of Software Configuration If the Solution includes configuration of Software by Supplier, Supplier shall provide Documentation containing a description of the configuration to VDH. The Documentation must be of sufficient detail so that any appropriately trained employee or Agent of VDH may reconstruct the configuration of the Software.
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11. ACCEPTANCE AND CURE PERIOD Services Acceptance Criteria Service(s) will be deemed accepted when Agency determines that the Service(s) meet(s) the Requirements set forth in the applicable order or SOW. Supplier shall ensure any individual Deliverable functions properly with any other Deliverables provided pursuant to the order or SOW. In the event that a previously Accepted Deliverable requires further modification in order to work properly with any other Deliverable, Supplier shall be responsible for all costs associated with the modification. Agency shall commence Acceptance testing within ten (10) calendar days after Receipt of the Service, or within such other period as set forth in the applicable order or SOW Acceptance testing will last no longer than thirty (30) calendar days, unless otherwise agreed to in writing between Agency and Supplier, for each Deliverable, or for the first instance of each Service type set forth in Exhibit B. Supplier shall provide Agency any assistance and advice as Agency may reasonably require, at no additional cost, during Acceptance testing. Agency shall provide Supplier written notice of Acceptance upon completion of installation and successful Acceptance testing. In the event that Agency fails to provide Supplier written notice of successful or unsuccessful Acceptance testing within five (5) business days following the Acceptance testing period, the Service will be deemed Accepted. Services Cure Period Supplier shall correct any non-conformities identified during Acceptance testing and re-submit the non- conforming Service for re-testing within fifteen (15) calendar days of Supplier’s receipt of written notice of non-conformance, unless otherwise agreed to between Agency and Supplier in the applicable order or SOW. Should Supplier fail to cure the non-conformity or deliver a Service which meets the Requirements, Agency may, in its sole discretion: i. reject the Service in its entirety, and any other Service(s) rendered unusable due to the non-conforming Service, and recover amounts previously paid to Supplier for all such Services; ii. issue a “partial Acceptance” of the Service with an equitable adjustment in the price to account for such deficiency; or iii. conditionally accept the applicable Service while reserving its right to revoke Acceptance if Supplier fails to make a timely correction.
Failure of a Service to meet, in all material respects, the Requirements after the second set of acceptance tests may constitute a breach by Supplier. In the event of such breach, Agency may, at its sole discretion, terminate its order or SOW, in whole or in part, for the Services to be provided by Supplier.
12. WARRANTY AND MAINTENANCE SERVICES At any time during the Warranty Period or MCP, as applicable, Supplier shall provide the following warranty or maintenance services (including unlimited telephonic support and all necessary travel and labor) to maintain the Solution in accordance with the Requirements. A. Known Defects Supplier shall promptly notify VDH in writing of any defects or malfunctions in the Solution or Documentation of which it learns from any source. Defects and incidents will be addressed in accordance with Exhibit I Service Level Requirements (SLR) B. New Releases No later than the first day of general release, Supplier shall provide to VDH copies of the Software and Documentation revised to reflect any enhancements, including all new releases, upgrades, and access modes, to the Software made by Supplier, including, without limitation, modifications to the Software which can increase the speed, efficiency or base of operation of the Software or add additional capabilities to or otherwise improve the functionality of the Software. C. Coverage Supplier shall provide all reasonably necessary telephone or written consultation requested by VDH in connection with use, problems, and operation of the Solution. Supplier is obligated to provide coverage under this provision on a 24 hours per day, seven days per week basis.
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D. Service Levels Supplier shall respond to problems with the Solution identified by VDH in accordance with Exhibit I – Supplier Service Level Requirements E. Software Evolution In the event that Supplier or Software Publisher merge or splinter the Software previously provided to VDH, Supplier shall not charge VDH additional support fees in order to receive enhancements, releases, upgrades, or support for the Software. If Supplier or Software Publisher reduces or replaces functionality contained in a licensed Software product and provides the same or substantially similar functionality as or within a separate or renamed Software product, then the Commonwealth or VDH will be entitled to license such Software product at no additional license or maintenance fee, and subject to the terms and conditions in this Contract. If Supplier or Software Publisher releases an option, future Software product, or other release that has substantially the same functionality as the Software products provided under this Contract, and the Software Publisher, or Supplier, or both, ceases to provide Maintenance Services for the older Software product, then Supplier shall offer the Commonwealth or VDH the option to exchange licenses for such replacement Software product or function at no additional charge. F. Escalation Procedures The escalation process is based on the premise that each Party will strive to resolve a dispute at the lowest level empowered to make a decision with escalation to a higher tier if there is a situation beyond their level of delegated authority or the Party’s representatives at that level reach an impasse. Escalation will continue until an issue is resolved or it has been escalated to the top of the governance structure. The first tier is the respective project managers. The second tier is the respective project directors. The third tier is the respective project executives. The fourth tier is the respective executive sponsor or, for Contractor, a C-level officer.
13. FEES, ORDERING, AND PAYMENT PROCEDURE A. Fees and Charges In consideration for the Supplier’s performance obligations under this Contract, VDH shall pay Supplier the fee(s) owed pursuant to the schedule of fees and charges as set forth on Exhibit B attached to this Contract. Supplier will only be entitled to those fees owed for Supplier’s performance obligations and any additional Products and Services provided to VDH in accordance with the scope of this Contract and the Requirements, as authorized by Exhibit A, of the Contract. The fees, and any associated discounts, will be applicable throughout the Term of this Contract unless modified pursuant to the terms and conditions below. In the event the fees or discounts apply for any period less than the entire Term, Supplier agrees that it will not increase the fees during the first twelve (12) month period following the Effective Date, and will not increase the fees more than once in any subsequent twelve (12) month period thereafter. No increase in fee amounts will exceed the lesser of three percent (3%) or the annual increase in the Consumer Price Index for All Urban Consumers (CPI-U), U.S. City Average, All Items, Not Seasonally Adjusted, as published by the Bureau of Labor Statistics of the Department of Labor (http://www.bls.gov/cpi/home.htm) for the period ending 60 to 90 days prior to the effective date of the increase compared with the same index one (1) year prior. Supplier must submit any change in price in writing to VDH in accordance with the above and will not become effective for 60 calendar days thereafter. Supplier agrees to offer price reductions to ensure compliance with the “Competitive Pricing” section of this Contract below. B. Reproduction Rights for Supplier-Provided Software At VDH’s request, Supplier shall provide VDH with a reproducible, portable data storage device (e.g. CD-ROM or USB flash drive) of Software. VDH will be responsible for making copies and distributing the Software and Updates as required. C. Ordering Notwithstanding VDH’s rights to license or purchase Supplier’s products or services under this Contract, Supplier shall accept any order placed by VDH through the Commonwealth’s electronic procurement website portal, eVA (http://www.eva.virginia.gov/). Supplier shall not accept any Purchase Order from VDH if the Purchase Order is to be funded, in whole or in part, by federal funds and if, at the time the Purchase Order is placed, Supplier is not eligible to be the recipient of federal funds as may be noted on any of the Lists of Parties Excluded DocuSign Envelope ID: D69B105E-7A47-46ED-8B09-C0071CE057F5 DocuSign Envelope ID: 33024638-F519-4808-AF31-3DA182A2CE1E
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from Federal Procurement and Non-procurement Programs. D. Performance Work Statement (PWS) The Performance Work Statement (PWS), in the format provided for in Exhibit A and Exhibit A-1 attached to this Contract, outlines the services pursuant to this Contract. Supplier shall perform any and all contractual obligations at the times and locations set forth in the applicable PWS and at the rates set forth in Exhibit B to this Contract. Any change to the PWS must be described in a written change request. Change requests will be subject to written approval of the other Party before it becomes part of this Contract. Invoice Procedures.
Supplier shall remit each invoice to the “bill-to” address provided with the order promptly after all Supplier’s performance obligations have been accepted and in accordance with the milestone payment schedule in the Contract or as otherwise described in this Contract. Payment for any support services, as authorized in the Contract, will be as stated in this Contract. Supplier shall invoice for each Transition In Period (Month) following the end of the month through the duration of the Transition In Period (Three [3] Months). Supplier shall invoice for Software Maintenance and Enhancement Services monthly based on a proration of the total annual cost. Supplier shall invoice for Estimated Enhancements monthly based on the number of hours utilized in the prior month. Supplier shall invoice for Service Orders monthly based on actual hours utilized in the prior month, in accordance with the Change Control Process. Supplier shall invoice for Hosted Environments monthly based on a proration of the total cost. Supplier will invoice each member of the Crossroads User Group in accordance with the Crossroads User Group Charter. For the avoidance of doubt, VDH is not responsible for paying costs that are the responsibility of another member of the Crossroads User Group. No invoice may include any costs other than those identified in this Contract, and those costs must be in accordance with the schedule of fees listed on Exhibit B. Without limiting the foregoing, all shipping costs are the Supplier’s responsibility except to the extent shipping charges are identified in Exhibit B and noted in this Contract. Supplier shall issue invoices that identify, at a minimum: i. Dates/periods that invoice covers, including any service or subscription periods, as applicable. ii. Line item description of the Deliverable(s) applicable to this Contract, including any components or service type, and, if applicable, the project milestone. iii. Quantity, charge and extended pricing for each line item iv. Applicable date of the Contract v. This Contract number vi. Supplier’s Federal Employer Identification Number (“FEIN”) Any terms included on Supplier’s invoice will have no force or effect and will in no way bind VDH. E. Purchase Payment Terms Supplier is responsible for the accuracy of its billing information. Supplier may not issue invoices pursuant to this Contract until all of Supplier's performance obligations have been accepted and are in accordance with the milestone payment schedule in the applicable order or SOW, or until after services have been rendered. Charges for Deliverables, Components or Services accepted more than 90 calendar days prior to receipt of a valid invoice may not be paid. In the event Supplier repeatedly over-bills VDH, VDH may assess a one percent (1%) charge for the amount over-billed for each month that such over-billing continues. F. Reimbursement of Expenses VDH shall pay, or reimburse Supplier, for all reasonable and actual travel-related expenses for greater than 30 miles from portal to portal incurred by Supplier during the relevant period. VDH will only be liable to pay for Supplier’s travel-related expenses, including transportation, meals, lodging and incidental expenses that have been authorized by VDH in advance. The travel- related expenses will be reimbursable at the then-current per diem amounts as published by the Virginia Department of Accounts (http://www.doa.virginia.gov/).
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All reimbursed expenses will be billed to VDH on a pass-through basis without any markup by Supplier. At VDH’s request, Supplier shall provide copies of receipts for all travel expenses over US$30.00.
G. Disputed Charges If, during invoice review, VDH identifies an invoice discrepancy, VDH will notify the Supplier in writing of the details and amount of the disputed charge and has the right to withhold the disputed amount until the dispute is resolved. Supplier shall respond in writing to VDH’s notification of a disputed charge acknowledging Supplier’s receipt of the dispute within five (5) business days. Any charges disputed by VDH will be resolved (whether by credit or explanation of the charge to VDH’s satisfaction) in VDH’s required format within two (2) billing cycles (60 calendar days) following VDH’s written notification. In the absence of the Supplier’s written evidence identifying the merit of the disputed amounts, VDH will not be obligated to pay the disputed amounts and may consider the matter concerning the specific identified amounts closed. VDH will not pay any disputed amounts that remain unresolved after 120 calendar days. If a disputed charge is reversed, Supplier shall reverse all associated surcharges, regulatory charges and taxes.
14. REPORTING Supplier shall submit to VDH a monthly report containing data on: Small Business Procurement and Subcontracting Spend This report must be submitted in accordance with the instructions and further detailed requirements, and on the templates set forth below. Supplier’s failure to comply with all reporting, payment, and other requirements in this section may be deemed by VDH, in its sole discretion, to be a breach of the Contract. A. Small Business Procurement and Subcontracting Spend Supplier shall provide to VDH a report of monthly subcontracting spend data. This data must include Supplier's total spend to all Subcontractors who provide direct performance for obligations under this Contract. Supplier’s monthly subcontracting spend data must be submitted at: SWAM@VDH.Virginia.gov. In addition, every six (6) months following the Effective Date, Supplier shall submit to VDH a “SWaM Subcontracting Certification of Compliance” (“SSCC”) certifying that Supplier has fully complied with the Contract’s Supplier Procurement and Subcontracting Plan ("Plan"). A copy of Supplier’s Plan is attached to this Contract as Exhibit H, and is incorporated by reference. The SSCC must include a written explanation of any variances of greater than 20% between the Plan and the actual subcontractor spend by Supplier. Supplier’s SSCC will be maintained by VDH in the Supplier’s procurement file. Supplier must submit the SSCC to the following address: SWAM@VDH.virginia.gov. In the event that Supplier fails to comply with its contractually obligated Plan spend or fails to report its contractually obligated Plan spend, VDH may, at its sole discretion, prohibit or delay any renewals or extensions of the Contract, withhold any final payments due, or both. Supplier’s failure to comply will be considered in the prospective award of any future contracts with Supplier.
15. SUPPLIER PERFORMANCE METRICS VDH has developed a set of supplier service level requirements (“SLR”) relating to Supplier’s performance under this Contract and which are attached hereto and incorporated by reference as Exhibit I. Supplier agrees to be bound by and perform its obligations under this Contract pursuant to the SLR. The remedies for Supplier’s failure to meet the SLR are set forth in Exhibit I. The cumulative SLR remedies for any month shall not exceed 20% of Supplier’s invoice for the applicable month. While SLR remedies may decrease Supplier’s invoice amount, no remedy will have the effect of denying, preventing, or delaying payment that was otherwise due under the Contract. Supplier and VDH agree to meet within 30 calendar days of the Effective Date of this Contract to set forth the methodology and designated personnel of each Party to provide, collect, monitor, and report the SLA performance data and mutually agreed-to incentives and remedies. Supplier agrees to provide to VDH a report of its performance against the SLAs as stated in Exhibit I throughout the Term. Supplier’s report must include a comparison of its SLA performance against the agreed-to targets and, in the event of any shortfall by Supplier, proposed remediation measures. Any instances of Supplier non-compliance will be recorded in Supplier’s Contract file and shared with Contract stakeholders. Supplier further agrees that any degradation or failure of Supplier’s performance obligations may result in failure to renew the DocuSign Envelope ID: D69B105E-7A47-46ED-8B09-C0071CE057F5 DocuSign Envelope ID: 33024638-F519-4808-AF31-3DA182A2CE1E
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Contract, termination for convenience of the Contract or termination for breach of the Contract. VDH will have all rights and remedies available at law.
16. STATUS MEETINGS Supplier will be prepared to conduct monthly stewardship meetings with VDH to provide a broad review of all services, projects and ongoing operations. Supplier should also be prepared to conduct semi-annual meetings/presentations to discuss new products and services and their potential benefit to VDH.
17. STEERING COMMITTEE In order to facilitate mutually beneficial contractual relationships with suppliers, VDH has procedures for establishing a steering committee (“Steering Committee”), consisting of senior management personnel, including personnel involved in the contractual relationship, from VDH and Supplier. Roles of the Steering Committee include but are not be limited to (a) identifying potential issues which may arise during the performance of a contract; (b) discussing and assigning roles and responsibilities; (c) establishing methods for quickly resolving potential disputes; (d) setting rules for communication and decision making; (e) monitoring and measuring the business relationship between the parties; and (f) acting as a final decision board for escalated problems. A meeting of the Steering Committee is intended to be a forum for brainstorming and sharing ideas, emphasizing respect, cooperation, and access, with the end goal of developing relationships to avoid conflict. A facilitator may, but is not required to, conduct a meeting of the Steering Committee. A Steering Committee for this Contract will be formed at VDH’s option. Meetings may be held at any time during the Contract term, should VDH, at its sole discretion, determine that a meeting(s) would be beneficial to the contractual relationship, and Supplier agrees to participate in any scheduled meeting(s). In addition, Supplier may at any time submit a written request to VDH for a meeting of the Steering Committee, which VDH will not unreasonably deny. Supplier will ensure the availability of the appropriate personnel to meet with the VDH contract management team. Additional Steering Committee meetings involving representatives from VDH, the Supplier, may be required prior to or during performance on any specific SOW issued pursuant to this Contract.
18. POLICIES AND PROCEDURES GUIDE Within 30 calendar days of the Effective Date of the Contract, Supplier will provide VDH with a policy and procedures guide that describes how the Supplier and VDH will work together and how performance, including Deliverables and Services, is to be measured. The guide will provide process diagram details, working activities, and interface points with VDH and Supplier deliverables. Updated versions of the guide will be provided by Supplier to VDH when Supplier and VDH agree that a change is required, but at a minimum, every six (6) months during the Term, including any extensions, of the Contract.
19. TRAINING AND DOCUMENTATION A. Training In addition to any online tutorial training Supplier may make available, Supplier’s fee, unless expressly excluded, includes all costs for any and all virtual/remote training as agreed upon for the training of VDH. In order to allow VDH the full benefit of the applicable Deliverable, the training will cover the use and operation of the Deliverable provided to VDH, including instruction in any necessary conversion, manipulation, or movement of VDH’s data. Supplier shall provide personnel sufficiently experienced and qualified to conduct such training at a time and location mutually agreeable to Supplier and VDH. Available additional and optional training, and applicable pricing and discounts, are described in Exhibit B. B. Documentation Supplier shall deliver to VDH complete copies of any Documentation applicable to the Deliverable(s) provided to VDH, in a quantity and media format as agreed upon by the Parties. Should Supplier revise or replace the Documentation, or should Documentation be modified to reflect Updates, Supplier shall deliver to VDH copies of the updated or replacement Documentation, in the same quantity and media format as originally requested by VDH, or as agreed upon between the Parties. VDH will have the right, as part of any license grant, to make as many additional copies of the DocuSign Envelope ID: D69B105E-7A47-46ED-8B09-C0071CE057F5 DocuSign Envelope ID: 33024638-F519-4808-AF31-3DA182A2CE1E
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Documentation, in whole or in part, for its own use as required. This Documentation must include, but is not limited to, overview descriptions of all major functions, detailed step-by-step installation and operating procedures for each screen and activity, and technical reference manuals. Such Documentation must be revised to reflect any modifications, fixes or updates made by Supplier. VDH, at its own discretion, will have the right, as part of the license granted by Supplier, to modify or completely customize all or part of the Documentation in support of the authorized use of the licensed Application or Software. VDH may also duplicate such Documentation and include it in VDH’s User's document or platform. VDH shall continue to include Supplier's copyright notice.
20. VDH SELF-SUFFICIENCY At VDH's request, and pursuant to an order or SOW for Supplier's Services issued under this Contract, Supplier shall provide all assistance reasonably required by VDH to develop VDH's self- sufficiency in operating and managing any combination of the Solution, Software, products, or Services that Supplier provided to VDH under the Contract. During or after the Transition Period, VDH may, at its sole discretion, elect to order or continue Maintenance Services from Supplier, if authorized under the scope of the Contract, for any of the Software or hardware product, Components, or Solution Components delivered to VDH by Supplier.
21. COMPETITIVE PRICING Supplier warrants that each of the prices, charges, economic or product terms, or warranties granted under this Contract are fair, reasonable, and commensurate with the price, charge, economic or product term or warranty being offered by Supplier to other government customers that purchase substantially similar services or products, at similar volumes, and under substantially similar terms and conditions. Supplier shall notify VDH of any new services or products that become generally available to all government customers during the Term of this Contract. New products and services are subject to the commercial terms associated with those products and services and must be formally added to this Contract before they can be purchased. Supplier shall also offer VDH commercially available national government products and services promotions and rates available at the time of purchase under the terms of those promotions.
22. CONFIDENTIALITY A. Treatment and Protection Each Party shall: i. hold in strict confidence all Confidential Information of any other Party; ii. use the Confidential Information solely to perform or to exercise its rights under this Contract; and iii. not transfer, display, convey or otherwise disclose or make available all or any part of the other Party’s Confidential Information to any third-party. VDH may, however, disclose the Confidential Information as delivered by Supplier to subcontractors, contractors, or agents of VDH that are bound by non-disclosure agreements with VDH. Each Party shall take the same measures to protect against the disclosure or misuse of the Confidential Information as it takes to protect its own proprietary or confidential information, but in no event will such measures be less than reasonable care.
B. Return or Destruction Upon the termination or expiration of this Contract, or upon the earlier request of VDH, Supplier shall, at its own expense, i. promptly return all tangible Confidential Information (and all copies thereof except the record required by law) to VDH; or ii. upon written request from VDH, destroy any Confidential Information in Supplier’s possession or control, and provide VDH with written certification of the destruction. Additionally, Supplier shall cease all further use of VDH’s Confidential Information, whether in tangible or intangible form. VDH shall retain and dispose of Supplier’s Confidential Information in accordance with the Commonwealth’s records retention policies or, if VDH is not subject to the Commonwealth’s policies, in accordance with VDH’s own records retention policies. DocuSign Envelope ID: D69B105E-7A47-46ED-8B09-C0071CE057F5 DocuSign Envelope ID: 33024638-F519-4808-AF31-3DA182A2CE1E
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C. Confidentiality Statement All Supplier Personnel performing Services pursuant to this Contract are required to sign a confidentiality statement or non-disclosure agreement. Any violation of the statement or agreement will be deemed a breach of this Contract and may result in termination of the Contract. D. Freedom of Information Act Acknowledgement All Supplier documents now or later comprising the Contract may be released in their entirety under the Virginia Freedom of Information Act, and Supplier agrees that any confidentiality or similar stamps or legends that are attached to any future documents or information may be ignored to the extent they claim confidentiality beyond that permitted by the Virginia Freedom of Information Act.
23. INDEMNIFICATION A. Indemnification Generally Supplier shall defend, indemnify, and hold harmless all Commonwealth Indemnified Parties from and against any third-party Claims to the extent the Claims in any way relate to, arise out of, or result from: i. any negligent act, negligent omission, intentional or willful misconduct or recklessness of the Supplier or any Supplier Personnel in the performance of this Contract; ii. a breach of any representation, warranty, covenant, or obligation of Supplier contained in this Contract; iii. any defect in the Supplier-provided products or services; or iv. any actual or alleged infringement or misappropriation of any third party’s intellectual property rights by any of the Supplier-provided products or services. v. any Claims by any Subcontractor resulting from Supplier’s failure to pay such Subcontractor. B. Defense of Claims Supplier will be solely responsible for all costs and expenses associated with the defense of all third-party Claims against Commonwealth Indemnified Parties that are within the indemnification obligation defined in section 23.A. above. C. Duty to Replace or Reimburse In the event of a Claim pursuant to any actual or alleged infringement or misappropriation of any third party’s intellectual property rights by any of the Supplier-provided products or services, or Supplier’s performance, Supplier shall, at its expense and option, either (a) procure the right to continue use of such infringing products or services, or any components thereof; or (b) replace or modify the infringing products or services, or any components thereof, with non-infringing products or services satisfactory to VDH. In the event VDH cannot use the affected Deliverable, product, Licensed Services, or Services, including any Components, then Supplier shall reimburse VDH for the reasonable costs incurred by VDH in obtaining an alternative product or service.
D. Supplier Dispute of Obligation to Indemnify If a Claim is commenced against any Commonwealth Indemnified Parties by a third party alleging an infringement of the third party’s intellectual property rights and Supplier is of the opinion that the allegations in the third-party Claim, in whole or in part, are not covered by the indemnification provision in this Contract, then In the event that Supplier disputes any of its obligations to defend or indemnify any Commonwealth Indemnified Party, then Supplier shall immediately notify VDH in writing and shall, nonetheless, take all reasonable steps to protect the rights, remedies, and interests of the Commonwealth Indemnified Parties in the defense of the Claim, including to secure a continuance to permit VDH to appear and defend their interests in cooperation with Supplier as is appropriate, including any jurisdictional defenses VDH may have.
24. LIABILITY A. Supplier Liability Except for liability arising from any combination of: i. the intentional or willful misconduct, fraud, or recklessness of the Supplier or of any DocuSign Envelope ID: D69B105E-7A47-46ED-8B09-C0071CE057F5 DocuSign Envelope ID: 33024638-F519-4808-AF31-3DA182A2CE1E
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employee of the Supplier; or ii. Claims for bodily injury, including death, and damage to real property or tangible property resulting from the negligence of the Supplier or any employee of the Supplier Supplier’s indemnification obligations and liability shall not exceed, in aggregate, twice the value of the Contract. B. Limitation of Liability Subject to the provisions of 24.A. Supplier Liability, Supplier will be liable for damages caused by its employees, agents, or subcontractors. Except for liability arising out of a Party’s intentional or willful misconduct, fraud, or recklessness, neither Party will be liable to the other Party for any indirect, incidental, consequential, or punitive damages, including (without limitation) loss of profit, income, or savings, even if advised of the possibility of these damages.
25. INSURANCE In addition to the insurance coverage required by law as referenced in the “Incorporated Contractual Provisions” section of this Contract below, Supplier shall carry: Errors and omissions insurance coverage in the amount of $5,000,000 per occurrence.
26. SECURITY COMPLIANCE Supplier shall comply with all provisions of the then-current Commonwealth security procedures, published by VITA and which may be found at: VITA POLICIES, STANDARDS & GUIDELINES any successor URL(s) as are pertinent to Supplier's operation. Further, Supplier shall comply with all applicable provisions of VDH’s then-current security procedures as are pertinent to Supplier's operation and that have been provided to Supplier by VDH. Supplier shall also comply with all applicable federal, state, and local laws and regulations. Any unauthorized release of any Confidential Information, or Commonwealth proprietary or personal information, by the Supplier or Supplier Personnel constitutes a breach of Supplier’s obligations under the Contract. Supplier shall notify VDH within 24 hours of discovery of, or when Supplier should have discovered, any breach of “unencrypted” and “un-redacted” personal information, as those terms are defined in Code § 18.2-186.6, and other confidential or personal identifying information provided to the Supplier by VDH. To the extent permitted by law, Supplier shall provide VDH the opportunity to participate in the investigation of the breach and to exercise control over reporting the unauthorized disclosure. Supplier shall ensure performance of an audit of Supplier’s environment at least annually to provide assurance of “Controls Relevant to Security, Availability, Processing Integrity, Confidentiality or Privacy” in accordance with the then-current standards set forth by the American Institute of CPAs. Supplier shall indemnify, defend, and hold the Commonwealth, VITA, their officers, directors, employees and agents harmless from and against any and all Claims, including reasonable expenses suffered by, accrued against, or charged to or recoverable from the Commonwealth, VITA, their officers, directors, agents or employees, on account of the failure of Supplier to perform its obligations pursuant this section. VDH reserves the right to review Supplier's information security program prior to the commencement of Licensed Services and at least once annually during the Term of this Contract. During the performance of the Licensed Services, and on an annual basis, VDH will be entitled, at its own expense, to perform, or to have performed, an on-site audit of Supplier's information security program. In lieu of an on-site audit, upon request by VDH, Supplier shall implement any reasonably required safeguards as identified by any program audit.
27. IMPORT/EXPORT Supplier shall comply with all data export laws and regulations. In addition, VDH policy requires that any data deemed “restricted” or “sensitive” by either federal or state authorities, may only be collected, developed, analyzed, or otherwise used or obtained by persons or entities working within the boundaries of the United States.
28. BANKRUPTCY If Supplier becomes insolvent, takes any step leading to its cessation as a going concern, fails to pay its debts as they become due, or ceases business operations continuously for longer than 15 business days, then VDH may immediately terminate this Contract on notice to Supplier unless Supplier immediately DocuSign Envelope ID: D69B105E-7A47-46ED-8B09-C0071CE057F5 DocuSign Envelope ID: 33024638-F519-4808-AF31-3DA182A2CE1E
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gives VDH adequate assurance of the future performance of this Contract. If this Contract has not been otherwise terminated and bankruptcy proceedings are commenced with respect to Supplier, then VDH may suspend all further performance of this Contract until Supplier assumes this Contract and provides adequate assurance of its performance of Supplier’s contractual obligations or rejects this Contract pursuant to Section 365 of the Bankruptcy Code or any similar or successor provision, it being agreed by VDH and Supplier that this is an executory contract. Any suspension of further performance by VDH pending Supplier’s assumption or rejection will not be a breach of this Contract, and will not affect the rights of VDH to pursue or enforce any of its rights under this Contract or otherwise.
29. GENERAL PROVISIONS A. Relationship Between VDH and Supplier Supplier has no authority to contract for, bind or commit to any agreement of any kind, or to assume any liabilities of any nature in the name of or on behalf of VDH. Under no circumstances will Supplier, or any Supplier Personnel, hold itself out as or be considered an agent or an employee of VDH and neither VDH will have any duty to provide or maintain any insurance or other employee benefits on behalf of Supplier or any Supplier Personnel. Supplier represents and warrants that it is an independent contractor for purposes of federal, state, and local employment taxes, and agrees that VDH is not responsible to collect or withhold for Supplier any federal, state, or local employment taxes, including, but not limited to, income tax withholding and social security contributions. Supplier shall pay or withhold any and all taxes, interest or penalties (including, but not limited to, any federal, state, or local withholding or employment taxes, and any penalties related to health care or employee benefits laws) that are imposed, assessed, or levied as a result of this Contract or Services performed pursuant to this Contract. Supplier shall reimburse VDH in the event that any taxes, interest or penalties are assessed against and paid by VDH as a result of this Contract. B. Licensing Within the Commonwealth Any and all licenses granted or provided pursuant to this Contract, whether to Work Product, System Software, COTS Software, or any other Software will be held by: i. the Commonwealth of Virginia, as VDH is an agency as defined by Code § 2.2-2006 C. Incorporated Contractual Provisions In addition to the terms, conditions, and obligations of this Contract, Supplier agrees to the “Mandatory Contract Terms” which consist of: • “Core Contractual Terms”;
• “RequiredD eVA Terms and Conditions”; and • “Mandatory Internal Revenue Service (IRS) Publication 1075 (required for FTI data only)” Each of these Mandatory Contract Terms are incorporated into this Contract by reference. Terms are located at https://www.vita.virginia.gov/procurement/contracts/mandatory-contract-terms/. Supplier agrees that non-compliance with the above-referenced Mandatory Contract Terms and IRS Publication 1075 may be deemed, solely by VDH, as a material breach of the applicable order or SOW or of the Contract. Supplier is responsible for verifying the correct and current version of this IRS publication and related safeguarding terms language and acknowledges that VDH will be held harmless. The terms and conditions set forth in documents posted at the URL above, and any successor URL(s), are subject to change pursuant to action by the legislature of the Commonwealth, change in VITA policy, adoption of revised eVA business requirements, or change to IRS Publication 1075. If a change is made to any of the Mandatory Contract Terms documents, a new effective date will be noted in the applicable document title. Supplier is advised to check the URLs, or their successors, periodically. D. Compliance with the Federal Lobbying Act Supplier’s signed certification of compliance with 31 U.S.C.§ 1352 (entitled "Limitation on use of appropriated funds to influence certain Federal Contracting and financial transactions") or by the regulations issued from time to time thereunder is incorporated as Exhibit G to this Contract. E. Ethics in Public Contracting By signing this Contract, Supplier warrants that its assent to this Contract is made without collusion DocuSign Envelope ID: D69B105E-7A47-46ED-8B09-C0071CE057F5 DocuSign Envelope ID: 33024638-F519-4808-AF31-3DA182A2CE1E
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or fraud, and that Supplier has not offered or received any kickbacks or inducements from any other bidder, supplier, manufacturer or subcontractor in connection with their proposal or the terms of this Contract. Further, Supplier warrants that it has not conferred any payment, loan, subscription, advance, deposit of money, services, or anything of more than nominal value, present or promised, on any public employee having official responsibility for this procurement transaction, unless consideration of substantially equal or greater value was exchanged. In addition, Supplier warrants that it will notify VDH if it becomes aware of a potential conflict of interest in the future. F. Governing Law This Contract is governed by and will be construed in accordance with the laws of the Commonwealth of Virginia without regard to that body of law controlling choice of law. Any and all litigation relating to this Contract must be brought in the circuit courts of the Commonwealth of Virginia. The English language version of this Contract prevails when interpreting this Contract. The United Nations Convention on Contracts for the International Sale of Goods and all other laws and international treaties or conventions relating to the sale of goods are expressly disclaimed. The Uniform Computer Information Transactions Act applies to this Contract only to the extent required by Code § 59.1- 501.15. G. Assignment This Contract is binding upon and will inure to the benefit of the permitted successors and assigns of VDH and Supplier. Supplier may not assign, subcontract, delegate or otherwise convey this Contract or any of its rights and obligations under this Contract, to any entity without the prior written consent of VDH, and any attempted assignment or subcontracting without consent will be void. VDH may assign this Contract to any entity, so long as the assignee agrees in writing to be bound by all the terms and conditions of this Contract. If any law limits the right of VDH or Supplier to prohibit assignment or nonconsensual assignments, the effective date of the assignment will be 30 calendar days after the Supplier gives VDH prompt written notice of the assignment, signed by authorized representatives of both the Supplier and the assignee. Any payments made prior to receipt of such notification will not be covered by this assignment.
H. Severability Invalidity of any term of this Contract, in whole or in part, will not affect the validity of any other term. VDH and Supplier further agree that in the event such provision is an essential part of this Contract, they shall immediately begin negotiations for a suitable replacement provision. I. Survival Any provisions of this Contract regarding Software License, Rights To Work Product, Warranty, Escrow, Confidentiality, Content Privacy and Security, Liability, Indemnification, Transition of Services, the right to purchase Maintenance Services, and the General Provisions will survive the expiration or termination of this Contract. J. Force Majeure No Party will be responsible for the delay or failure to meet its obligations under this Contract if the delay or failure arises from causes beyond the reasonable control and without the fault or negligence of the obligated Party. If any performance date under this Contract is postponed or extended pursuant to this Section for longer than 30 calendar days, VDH, by written notice given during the postponement or extension, may terminate Supplier’s right to render further performance after the effective date of termination without liability for that termination, and in addition an VDH may terminate any order or SOW affected by such postponement or delay. K. No Waiver Any failure to enforce any terms of this Contract will not constitute a waiver. L. Remedies The remedies set forth in this Contract are intended to be cumulative. In addition to any specific remedy, VDH reserves any and all other remedies that may be available at law or in equity. M. Right to Audit VDH reserves the right to audit those Supplier records that relate to this Contract or any SOW or orders issued here-under. VDH's auditing rights are limited as follows: i. three (3) years from termination of the Contract; DocuSign Envelope ID: D69B105E-7A47-46ED-8B09-C0071CE057F5 DocuSign Envelope ID: 33024638-F519-4808-AF31-3DA182A2CE1E
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ii. at VDH’s expense; iii. no more than once per every twelve (12) month period; iv. performed at Supplier's premises, during normal business hours at mutually agreed upon times; and v. access to Supplier cost information is excluded. In no event will Supplier have the right to audit, or require to have audited, VDH. N. Taxes The Commonwealth is exempt from Federal excise and all State and Local taxes and any such taxes may not be included in Contract prices. Tax certificates of exemption, Form ST-12 can be obtained from VDH upon request. Deliveries against this Contract shall be free of Federal excise and transportation taxes. The Commonwealth’s excise tax exemption registration number is 54-73-0076K. O. Currency All prices, costs, or fees in this Contract and exhibits, schedules, orders, or SOWs are in United States dollars. P. Advertising and Use of Proprietary Marks No Party may use the name of the other Party or refer to the other Party, directly or indirectly, in any press release or formal advertisement without receiving prior written consent of the other Party. In no event may any Party use a proprietary mark of the other Party without receiving the prior written consent of the other Party. Q. Notices Any notice required or permitted to be given under this Contract must be in writing and will be deemed to have been sufficiently given if delivered in person, or if deposited in the U.S. mails, postage prepaid, for mailing by registered, certified mail, or overnight courier service addressed:
i. To VDH and to Supplier, if Supplier is incorporated or formed pursuant to the laws of the Commonwealth, to the addresses shown on the signature page. ii. To Supplier, if Supplier is incorporated or formed outside the Commonwealth, to the address shown on the signature page and to the Registered Agent registered with the Virginia State Corporation Commission. Pursuant to Title13.1 of the Code, VDH or Supplier may change its address for notice purposes by giving the other Party notice of such change in accordance with this Section. Administrative contract renewals, modifications or non-claim related notices are excluded from the above requirement. Such written, or signed, or both, contract administration actions may be processed by the assigned VDH and Supplier points of contact for this Contract and may be given in person, via U.S. mail, courier service or electronically. R. Contract Administration Supplier agrees that at all times during the term of this Contract an account executive, at Supplier's senior management level, will be assigned and available to VDH. Supplier reserves the right to change such account executive upon reasonable advance written notice to VDH. S. Captions The captions of sections and subsections of this Contract are for convenience and in no way define, limit, or enlarge the scope of this Contract or any of its sections. T. Entire Contract The following exhibits, including all subparts thereof, are attached to this Contract and are made a part of this Contract for all purposes: Exhibit A – Functional Requirements – Performance Work Statement (PWS) and the Supplier’s proposal response as provided in: Exhibit A-1- Functional Requirement (Excel Format) Exhibit A-2 – Supplier’s entire proposal as negotiated Exhibit B – Pricing DocuSign Envelope ID: D69B105E-7A47-46ED-8B09-C0071CE057F5 DocuSign Envelope ID: 33024638-F519-4808-AF31-3DA182A2CE1E
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Exhibit B-1 – Pricing Methodology. Exhibit C – Reserved Exhibit D – Crossroads User Group Change Control Process Exhibit F – Crossroads User Group Charter Exhibit G – Certification Regarding Lobbying (check VITA website under Forms) Exhibit H – Supplier Procurement and Subcontracting Plan Exhibit I – Supplier Service Level Requirements (SLR) Exhibit J – Glossary of Terms and Definitions Exhibit K - Additional Cloud Services Terms and Conditions
This Contract, its exhibits, and any prior non-disclosure agreement constitute the entire agreement between VDH and Supplier and supersede any and all previous representations, understandings, discussions or agreements between VDH and Supplier as to the subject matter of this Contract. Any and all terms and conditions contained in, incorporated into, or referenced by the Supplier’s proposal are deemed invalid. The provisions of the Virginia Department of General Services, Division of Purchases and Supply Vendor’s Manual will not apply to this Contract or any order issued pursuant to the Contract. This Contract may only be amended by an instrument in writing signed by VDH and Supplier. U. Order of Precedence In the event of a conflict, the following order of precedence shall apply: this Contract document, Exhibit K - Additional Cloud Services Terms and Conditions, Exhibit I - Service Level Requirements (SLR), Exhibit A, Exhibit A-1, Exhibit A-2, Exhibit B, Other Exhibits incorporated by reference, then any project specific order. In the event of a conflict or inconsistency between the negotiated terms of this Contract and any provision incorporated by reference into the Contract (e.g., a section of a License Agreement), the negotiated terms of this Contract will take precedence. For purposes of this section, a “conflict” exists with respect to a subject that has been comprehensively addressed in the Contract when supplementary terms contained in a provision incorporated by reference would alter the rights and obligations of the Parties set forth in the Contract. V. Counterparts and Electronic Signatures This Contract may be executed in multiple counterparts, each of which, when assembled to include an original signature for each of Supplier and VDH, will constitute a complete and fully executed original. All fully executed original counterparts will collectively constitute a single agreement. Signatures transmitted by fax or electronic mail (in portable data format (“PDF”)) are also permitted as binding signatures to this Contract. W. Opportunity to Review VDH and Supplier each acknowledge that it has had the opportunity to review this Contract and to obtain appropriate legal review if it so chose.
X. Equal Employment Opportunity Except as otherwise provided under 41 CFR Part 60, all contracts that meet the definition of federally assisted construction contract in 41 CFR Part 60-1.3 must include the equal opportunity clause provided under 41 CFR 60- 1.4(b), in accordance with Executive Order 11246, “Equal Employment Opportunity” (30 FR 12319, 12935, 3 CFR Part, 1964-1965 Comp., p. 339), as amended by Executive Order 11375, “Amending Executive Order 11246 Relating to Equal Employment Opportunity,” and implementing regulations at 41 CFR part 60, “Office of Federal Contract Compliance Programs, Equal Employment Opportunity, Department of Labor.” (2 CFR 200, Subpart F, Appendix II)
Y. Clean Air and Federal Water Pollution Control Act Clean Air Act (42 U.S.C. 7401-7671q.) and the Federal Water Pollution Control Act (33 U.S.C. 1251- 1387), as amended. Contracts and subgrants of amounts in excess of $150,000 must contain a provision that requires the non-Federal award to agree to comply with all applicable standards, orders or regulations issued pursuant to the Clean Air Act (42 U.S.C. 7401-7671q) and the Federal Water Pollution Control Act as amended (33 U.S.C. 1251- 1387). Violations must be reported to the Federal DocuSign Envelope ID: D69B105E-7A47-46ED-8B09-C0071CE057F5 DocuSign Envelope ID: 33024638-F519-4808-AF31-3DA182A2CE1E
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awarding agency and the Regional Office of the Environmental Protection Agency (EPA). (2 CFR 200, Subpart F, Appendix II)
AA. Anti-Lobbying Act Recipients of Federal contracts, grants, and loans are prohibited from using appropriated funds for lobbying the Executive or Legislative branches of the Federal government in connection with a specific contract, grant, or loan. As required by Section 1352, Title 31 of the U.S. Code and implemented at 2 CFR 200, Subpart F, Appendix II, for persons entering into a grant or cooperative agreement over $100,000, as defined at 31 U.S.C. 1352, the applicant certifies that:
a. No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any agency, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress in connection with the making of any federal grant, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any federal grant or cooperative agreement; b. If any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a
member of Congress, an officer or employee of Congress, or an employee of a member of Congress in connection with this federal grantor o cooperative agreement, the undersigned shall complete and submit Standard Form – LLL, “Disclosure Form to Report Lobbying,” in accordance with its instructions; c. The undersigned shall require that the language of this certification be include in the award documents for all sub-awards at all tiers (including sub-grants, contracts under grants and cooperative agreements, and subcontracts) and that all sub-recipients shall certify and disclose accordingly
BB. Americans with Disabilities Act This Act (28 CFR Part 35, Title II, Subtitle A) prohibits discrimination on the basis of disability in all services, programs, and activities provided to the public and State and local governments, except public transportation services.
CC. Drug-Free Workplace Statement In addition to the Drug-Free Workplace requirements outlined in the Core Contractual Terms incorporated by reference, the Federal government implemented 41 U.S. Code § 8103, Drug-free workplace requirements for Federal grant recipients in an attempt to address the problems of drug abuse on the job. It is a fact that employees who use drugs have less productivity, a lower quality of work, and a higher absenteeism, and are more likely to misappropriate funds or services. From this perspective, the drug abuser may endanger other employees, the public at large, or themselves. Damage to property, whether owned by this entity or not, could result from drug abuse on the job. All these actions might undermine public confidence in the services this entity provides.
Therefore, in order to remain a responsible source for government contracts, the following guidelines have been adopted: 1. The unlawful manufacture, distribution, dispensation, possession or use of a controlled substance is prohibited in the work place. 2. Violators may be terminated or requested to seek counseling from an approved rehabilitation service. 3. Employees must notify their employer of any conviction of a criminal drug statue no later than five days after such conviction. 4. Contractors of federal agencies are required to certify that they will provide drug-free workplaces for their employees.
Transactions subject to the suspension/debarment rules (covered transactions) include grants, subgrants, cooperative agreements, and prime contracts under such awards. Subcontracts are not included.
DocuSign Envelope ID: D69B105E-7A47-46ED-8B09-C0071CE057F5 DocuSign Envelope ID: 33024638-F519-4808-AF31-3DA182A2CE1E
Crossroads Software Maintenance and Enhancement Services VDH PAGE 28 Contract # VDH-21-707-0156
DD. Royalty Free Rights to Use Software or Documentation Developed CFR 200.315 Intangible property.
a) Title to intangible property (see §200.59 Intangible property) acquired under a Federal award vests upon acquisition in the non-Federal entity. The non-Federal entity must use that property for the originally-authorized purpose, and must not encumber the property without approval of the Federal awarding agency. When no longer needed for the originally authorized purpose, disposition of the intangible property must occur in accordance with the provisions in §200.313 Equipment paragraph (e). b) The non-Federal entity may copyright any work that is subject to copyright and was developed, or for which ownership was acquired, under a Federal award. The Federal awarding agency reserves a royalty-free, nonexclusive and irrevocable right to reproduce, publish, or otherwise use the work for Federal purposes, and to authorize others to do so. c) The non-Federal entity is subject to applicable regulations governing patents and inventions, including government wide regulations issued by the Department of Commerce at 37 CFR Part 401, “Rights to Inventions Made by Nonprofit Organizations and Small Business Firms Under Government Awards, Contracts and Cooperative Agreements.” d) The Federal Government has the right to: Obtain, reproduce, publish, or otherwise use the data produced under a Federal award;
and e) Authorize others to receive, reproduce, publish, or otherwise use such data for Federal purposes.
EE. Debarment and Suspension Debarment and Suspension (Executive Orders 12549 and 12689)—A contract award (see 2 CFR 180.220) must not be made to parties listed on the government wide exclusions in the System for Award Management (SAM), in accordance with the OMB guidelines at 2 CFR 180 that implement Executive Orders 12549 (3 CFR part 1986 Comp., p. 189) and 12689 (3 CFR part 1989 Comp., p. 235), “Debarment and Suspension.” SAM Exclusions contains the names of parties debarred, suspended, or otherwise excluded by agencies, as well as parties declared ineligible under statutory or regulatory authority other than Executive Order 12549. (2 CFR 200, Subpart F, Appendix II)
FF. Renewal of Contract: This contract may be renewed by the Commonwealth upon written agreement of both parties for five (5) successive one-year (1-yr) periods, under the terms and conditions of the current contract, and at a reasonable time (approximately 90 days) prior to the expiration.
[SIGNATURE PAGE(S) TO FOLLOW] DocuSign Envelope ID: D69B105E-7A47-46ED-8B09-C0071CE057F5 DocuSign Envelope ID: 33024638-F519-4808-AF31-3DA182A2CE1E
Contract # VDH-21-707-0156 VDH Page 29 Crossroads Software Maintenance and Enhancement Services
Signed by the undersigned authorized representatives of VDH and Supplier and effective as of the Effective Date set forth in the preamble of this Contract above.
SUPPLIER NAME Virginia Department of Health (VDH)
By:
By:
(Signature)
(Signature)
Name:
Name:
(Print)
(Print)
Title:
Title:
Date:
Date:
Address for Notice: Address for Notice:
Attention: Supplier Contact Attention: Contract Administrator DocuSign Envelope ID: D69B105E-7A47-46ED-8B09-C0071CE057F5 Lisa Mascolo CEO Columbia Maryland 21046 9175 Guilford Road lisa.mascolo@gcomsoft.com Lisa Mascolo 9/28/2023 | 5:56:35 PM EDT GCOM Software LLC DocuSign Envelope ID: 33024638-F519-4808-AF31-3DA182A2CE1E Richmond, VA 23219 arden.lynn@vdh.virginia.gov 109 Governor Street Megan Nason email: megan.nason@vdh.virginia.gov 9/29/2023 | 10:21:23 AM EDT State Health Commissioner Karen Shelton, MD
Attachment #3 6.1 1 United States Department of Date: 02-22-201 0 Food and Nutrition Service Re: SFP 10-017 Mid-Atlantic Region 300 Corporate Blvd Subject: Updated Prior Approval Guidance Robbinsville, NJ 08691 -1 598 To: All WIC State Agencies There are different approval requirements for various items of cost incurred by WIC State agencies. States have indicated that clearer guidance on approval requirements is necessary, particularly in regard to non-computer equipment, computer equipment, and other capital expenditures. The purpose of this memo is to clarify the existing guidance for these items, as well as breast pumps, since they may also require prior approval from FNS. This policy supersedes the prior approval guidance provided in SFP 02-096. Non-Computer Equipment WIC State agencies may charge the full acquisition cost of non-computer equipment costing less than $25,000 per unit, including medical equipment, without obtaining prior FNS approval, and may allow local agencies under their oversight to do likewise. FNS Regional Offices retain the discretion to apply a lower dollar threshold to an individual State agency and to the local agencies under its oversight, provided certain requirements apply and the State agency receives written notice. At this time, we require expenditures over $25,000 to be submitted to the Regional Office for prior approval. The requests for prior approval must include: o A description of needlexplanation of purchase. o Copies of at least three price quotations, bids, or proposals, as appropriate. o Cost allocation plan (if applicable). State agencies required to make procurements by non-competitive proposals, such as a State approvedlmandatory sole source list, are required to submit their proposed procurement to FNS for prior approval with justification as to why the item is only available from a single source, along with a description of need, a price quote, and a cost allocation plan (if applicable).
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Breast Pumps Because advance purchases or rentals of pumps may represent a significant expenditure of food funds late in the funding and budget cycle, States must request and receive prior approval fiom FNS to purchase or rent pumps with year-end unspent food funds. For purchases or rentals of breast pumps with year-end unspent food funds, prior approval requests must include: o An estimate of the number of breastfeeding women who will participate in the State's WIC Program the following fiscal year. o An estimate of the percentage of its projected breastfeeding women participants the State expects to provide a breast pump in the following fiscal year. o The number, type, and cost of breast pumps purchased with current year NSA funds. o The number of breast pumps in current inventory that the State expects to have on hand for use in the following fiscal year. o The number (rounded to the nearest case lot), type and cost of breast pumps to be purchased or rented with year-end unspent current fiscal year food funds. Prior approval must also be requested if a State plans to request that expenditures for breast pump purchases or rentals be moved fiom the NSA to food fund category at the end of the fiscal year. Bona Fide Needs Rule Volume I of the Principles of Federal Appropriations Law indicates the following: The bona fide needs rule indicates that a fiscal year appropriation may be obligated only to meet a legitimate, or bona fide, need arising in, or in some cases arising prior to but continuing to exist in, the fiscal year for which the appropriation was made. Where an obligation is made toward the end of a fiscal year and it is clear from the facts and circumstances that the need relates to the following fiscal year, the bona fide needs rule has been violated. We do not mean to suggest that an agency may purchase only those supplies that it will actually use during the fiscal year. Agencies normally maintain inventories of common use items. The bona fide needs rule does not prevent maintaining a legitimate inventory at reasonable and historical levels, the "need" being to maintain the inventory level so as to avoid disruption of operations. The problem arises when the inventory crosses the line from reasonable to excessive. References State agencies may use the following references in regard to non-computer equipment, computer equipment, other capital expenditures, and breast pumps: SFP 93-126: WIC Program-Allowable Costs-Real Property: Provides State agencies with specific guidance for submitting requests to purchase, renovate, or repair real property with WIC Program funds. It includes definitions, policy, and worksheets. SFP 98-041: Non-Computer Equipment Purchases Less Than $25,000: Provides guidance to State agencies on prior approval requirements for non-computer equipment purchases as well as capital assets such as buildings, land, and improvements to buildings or land.
SFP 99-145: Breast Pumps as a Food Cost: Provides guidance concerning the use of food funds to purchase or rent breast pumps for WIC participants. SFP 00-013: Clarification of SFP 99-145: Breast Pumps as a Food Cost: Provides clarification on previous guidance provided on the use of food funds to purchase or rent breast pumps. SFP 07-043: WIC Advance Planning Document (APD) Policy Changes: Provides prior approval requirements for WIC automation projects and acquisitions. This memo updates the approval thresholds set forth in SFP 97-099. FNS Handbook 901: Advance Planning Document Handbook: Provides requirements and guidance for State agencies in the automation process of delivering benefits. GAO-04-261SP: Principles of Federal Appropriations Law: Third Edition, Volume I 7 CFR 3016.3: Provides definitions, including the following for real property and equipment: o Real Property: Land and whatever is erected on or affixed to the land (i.e. buildings) including land improvements. o Equipment: Tangible, non-expendable, personal property having a useful life of more than one year and an acquisition cost of $5,000 or more per unit. 7 CFR 3016.31: Provides guidance regarding real property. 7 CFR 3016.32: Provides guidance regarding equipment. 7 CFR 3016.36: Provides requirements for procuring property and services. If you have any questions, please contact Kirk Groomes at (609) 259-51 74. DIANA LIMBACHER Regional Director Supplemental Food Programs Attachments
West Virginia Contingency Plan 2025 If statewide network connectivity were to be lost by our Internet Service Provider (ISP), the WIC clinics would have to process WIC participants off-line and notify participants when food benefits had been uploaded once the statewide network became available in order to access the Crossroads application. If a single clinic loses internet connectivity (unexpectedly), the clients can be served by another site. Since we are an EBT state this can be accomplished very easily by nutrition counseling over the phone to the site that is down. The client’s record can be updated and benefits issued remotely.
WV ONS and OAS MIS are researching possible iCloud solutions or vendor hosted solutions to eliminate disruption of statewide disruption of certification and issuance.
West Virginia WIC Policy & Procedure 1.26 Effective Date: 3/20/2018 1.26 Security Policy
1 of 12 POLICY:
State and local agencies are responsible for the security of all ADP projects being developed and operational systems involved in the administration of FNS programs. State agencies shall determine appropriate ADP security requirements based on recognized industry standards of standards governing security of Federal ADP systems and information processing.
SCOPE:
All State and Local agency WIC personnel will adhere to the policies and procedures herein described as well as those already established by the State of West Virginia Office of Technology Policies: http://www.technology.wv.gov/security/Pages/policies-issued-by-the-cto.aspx • Information Security Policy • Internet Usage Policy • Email Use Standards • Acceptable Use of Portable and/or Wireless Devices along with Chapter 61, Article 3C. West Virginia Computer Crime and Abuse Act., http://www.legis.state.wv.us/wvcode/ChapterEntire.cfm?chap=61&art=3C
PROCEDURE:
The State Agency (SA) will maintain a program for conducting periodic risk assessments to ensure that appropriate, cost-effective safeguards are incorporated into new and existing systems. A risk assessment shall be performed whenever significant system changes occur.
The SA will review the ADP system security of 20% of all WIC clinic sites on a biennial basis. The review shall evaluate physical and data security, operating procedures, and personnel practices. The SA will determine compliance with requirements and provide a written summary of all findings to both the local agency and FNS after the completion of the ADP System Security Review. The SA will submit a plan of corrective action to the Local Agency with dates of scheduled milestones, when completed, will correct any security weaknesses.
The State Agency will provide one copy of all IT Policies initially to each local clinic site. These policies will be kept on-site for review and new staff training. The Local Agency will be notified of changes to the IT Policies on the web sites. It will be the responsibility of each local clinic site to update these separate policies.
A. Administrative/Management Security Controls
1. The SA will delegate a staff member who will act as the WIC Security Officer. The roles of the WIC Security Officer are outlined under the Personnel Security section of this policy. The WIC Security Officer will track all system breaches and monitor and test for vulnerability of security safeguards at irregular intervals but at least once a year.
B. Computer Security Controls
1. Access Control
West Virginia WIC Policy & Procedure 1.26 Effective Date: 3/20/2018 1.26 Security Policy
2 of 12 Controls are to be established by the SA to prevent unauthorized persons from reading from and writing to programs and data files. The SA and the Local Agency (LA) Director will submit to the WIC Security Officer a Network Logon form for all staff that leaves employment immediately. The LA Director will also submit a new form for all new hires. Staff under no circumstances shall share network/Crossroads/MMIS/E- WIC passwords and logon ID’s. Invalid login attempts will lock user out of the network after five (5) attempts. Crossroads will lock out the user after two (2) unsuccessful attempts. For security reasons, all passwords cannot be seen. The network automatically locks the computer after 5 minutes of inactivity. All staff are instructed to lock computer screens whenever leaving their computer unattended. Should a particular PC be used by multiple persons within the clinic site, each person must log out prior to another person’s use of the PC. The WIC Security Officer shall maintain a current list of all system users.
2. Identification and Authentication
Both the WIC network and the Crossroads application use the same network ID and password. Crossroads users are added to the application with their network ID’s and given the appropriate roles to the clinics they need access to. Network IDs are approved and processed by the WIC security as stated above. The WIC Helpdesk adds the roles for the user in Crossroads providing for a separation of duty at the state office.
Wide Area Network a. All sensitive telecommunications equipment will be guarded from unauthorized physical access.
b. All connections from remote systems will be subject to authentication. In addition, all remote connections to WAN equipment will display the following banner: ************************************************************************
WARNING: This system is for the use of authorized clients only. Individuals using the computer network system without authorization, or in excess of their authorization, are subject to having all their activity on this computer network system monitored and recorded by system personnel. To protect the computer network system from unauthorized use and to ensure the computer network system is functioning properly, system administrators monitor this system. Anyone using this computer network system expressly consents to such monitoring and is advised that if such monitoring reveals possible conduct of criminal activity, system personnel may provide the evidence of such activity to law enforcement officers. Access is restricted to authorized users only. Unauthorized access is a violation of state and federal, civil and criminal laws.
Department of Health & Human Resources WIC. ****************************************************************** Local Area Network a. Policies will be in place on all PCs connected to the LAN requiring validation from the network server in order to access Windows.
b. All SA and LA Clinic personnel are required to have a unique network logon ID.
West Virginia WIC Policy & Procedure 1.26 Effective Date: 3/20/2018 1.26 Security Policy
3 of 12 c. Passwords for logon IDs will expire and must be changed every sixty days.
d. Any network logon account unused for ninety days will be disabled.
CROSSROADS
WIC Clinic and State office staff will have the same USER ID as the network as stated previously.
a. Local Agency Directors or their designee will instruct the WIC Security Officer and WIC Help Desk where the user will be working and what duties they will be performing. After the WIC Security Officer approves the network login and OT has completed the Network Login setup, WIC Help Desk will add the user to the Crossroads application.
b. Local Agency Directors or their designee is also responsible for making sure people are deleted from the system by filling out an OT Network Deprovision form online and assigning it to the WIC Security Officer for approval. This shall be performed within 24-48 hours or less after personnel leave employment.
c. Crossroads passwords are encrypted and cannot be seen on the screen. Passwords also expire every sixty days at the same time that the network passwords expire. Crossroads has a link to the active directory to verify passwords. So the passwords expire and are the same for both systems. Crossroads does have a separate login screen but uses the network login and passwords information. If a user mistypes, the password twice logging into Crossroads, the system automatically also locks the network password.
d. When staff leave their desks for any length of time, they should lock their computer screen.
3. Audits
Audits should be available in the system to track problems and look at security issues within Crossroads
Crossroads has security files, automated error logs, time and date stamps on records.
a. User IDs are assigned to records automatically to record who is doing a particular function in Crossroads. These areas are Income and Residency, Blood Work, Height and Weight, and Food Package Assignment, risk assessment, Benefit Issuance, Care Plans, and Nutrition Education at a minimum.
b. Security files are kept that include when passwords are to expire, number of unsuccessful attempts.
c. The security file also limits what a user can do depending on flags that are set when they are added to the system. If a function is not permitted to the user,
West Virginia WIC Policy & Procedure 1.26 Effective Date: 3/20/2018 1.26 Security Policy
4 of 12 the menu will be faded and not accessible for that function.
d. A file is also available to track logon error and violations.
4. Configuration Management
The Crossroads System Manager, SA Equipment Coordinator and MIS Project Leader must approve every change made to documentation, hardware and software. As new equipment is added to sites, a ghost image is made which is copied to all new PC equipment ensuring that all new PCs will set up exactly the same including all files needs to run the Crossroads application.
Computer Equipment Purchases
All computer equipment purchases will be handled through the WV WIC program state office. Any purchase of automated data processing equipment and software must have prior SA approval. See WV Policy & Procedure 6.11. State Requirements
a. Any purchase exceeding $500.00 and being less than $5000.00 requires that three verbal bids be obtained. Documentation verifying the bids must be provided.
b. Any purchase exceeding $5000.00 and being less than $10,000.00 requires the use of state approved vendors and a minimum of three written bid quotes.
c. Any purchase exceeding $10,000.00 must be placed on the State’s Purchasing Bulletin Board and requires a signed bid summary from WV Office of Technology and WV DHHR MIS.
d. Any invoices not meeting the above criteria will be rejected by the WV State Auditors Office.
Federal Requirements
a. The SA will provide a five-year plan which lists ADP equipment at both the SA and LA level which will give purchase date and anticipated replacement date. The five-year plan will also include anticipated costs associated with the replacements.
b. Purchases not listed on the five-year plan and greater than $100,000
will need prior USDA approval. See FNS Handbook 901.
C. Communication Controls
1. Physical Security
a. Clinic Sites: All sensitive networking equipment, to include servers, routers, and switches, will be located in the most secure area of the clinic. If it is necessary that the equipment be located in a room used to serve clients, the
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5 of 12 equipment will be placed in a manner that prohibits access. This will be accomplished by storing the equipment in a protective cabinet or restricting client access to the area. The LAN file server is never to be used as a workstation. Policies are placed on file servers to allow access only by the Network LAN Specialist.
b. State Office: Networking equipment and servers for state personnel is located in the computer room at Bldg6 of the WV State Office Complex.
c. In addition, both the WIC state office and LA clinics will follow the West Virginia State IT Policy - Physical and Environmental Security, Reference I, Policy 12.0.
D. Information Security Controls
1. Data/File Protection – The following guidelines will be followed by both the SA and LA staff to ensure proper data/file protection:
Backup and Recovery
State Office
a. All servers holding information pertinent to WIC will perform full backups nightly via the network to an external storage device.
b. In case of a data loss, or hardware failure in a file server, a full backup will be restored by WV Office of Technology staff.
c. All servers will be connected to a power conditioning UPS in order to prevent data loss and hardware damage.
Clinic Sites
a. All file servers located at WIC clinics will be backed up nightly with a 30-day retention.
b. In case of a data loss, or hardware failure in a file server, a full backup will be restored by WV Office of Technology Staff
c. All servers will be connected to a power conditioning UPS in order to prevent data loss and hardware damage.
d. Files should not be saved to the Clinic PC’s as they are not backed up.
2. Data/Software Backup
Application backups are also being completed for the Crossroads servers by WV Office of Technology back up procedures.
3. Security Training
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All Local Agency staff is required to have mandatory online information security awareness training performed annually. This training is provided by WV Office of Technology annually and is provided online.
E. Personnel Security Controls
1. Organization
Responsibilities in this area include that of the SA and MIS Department to hire and train personnel in proper security procedures. WIC/MIS shall hire and maintain certain levels of personnel with differing roles and responsibilities. Staff shall always have someone who can back them up if the need arises. Personnel shall be assigned certain roles and responsibilities according to their skills.
The SA will establish the roles and responsibilities of MIS Personnel. The WIC SA and LA Users will adhere to all current state procedures and outlined roles and responsibilities as outlined in Reference I, Policy 3.0 - Management and Staff Responsibilities.
The SA will maintain and update as needed a set of roles and responsibilities for all MIS staff. This will be done on a periodic basis, probably during Employee Evaluations and reviews. Once established, these responsibilities should not be modified unless job duties change. WIC/MIS Project Leader and WIC Equipment Coordinator report to DHHR/MIS supervisory staff and receive direction from WIC State Agency Administrative staff. The Helpdesk Analyst and Crossroads Project Manager will report directly to WIC State Agency Staff.
2. The Current WIC/MIS positions and responsibilities are as follows:
a. WIC Security Officer
• Approve and Maintain Local Agency User Sign-on’s to the LAN. • Developing the ADP Security Policies/Plan along with the WIC/MIS Project Leader and the Crossroads Project Manager. • Investigate security breaches of any type recommending emergency procedures when deemed necessary. Informing MIS and WIC administration of problems as necessary. • Monitor adherence to WVOT and WVDHHR Security Policies. • Assist in contingency planning for emergencies at the local level. • Review biennial security review of 20% of WIC Sites completed by the WIC Equipment Coordinator according to the review policy. • Maintain a list of all Logon ID’s issued and what locals they are assigned to and their duties. • Coordinate with the Field PC Technician, the inventory of WIC computer equipment.
b. Crossroads Project Manager
• Supervise Helpdesk Analysts and EBT coordinator positions
West Virginia WIC Policy & Procedure 1.26 Effective Date: 3/20/2018 1.26 Security Policy
7 of 12 • Coordinate all equipment and Crossroads related functions with local and site staff. • Coordinate with MIS Supervisory staff the duties of the WIC Equipment Coordinator and give directions to the staff member. • Assist the trainer in developing Crossroads Training. • Developing the ADP Security Policies / Plan along with the WIC/MIS Project Leader and the WIC Equipment Coordinator. • Assist in contingency planning for emergencies at the local level. • Gather Site Surveys and WV WIC Program Site Description form every year from local sites according to policy. • Contact person for local site offices that are moving. • Oversee Equipment Inventory practice of field equipment. • Gather work requests from sites for equipment repairs
c. MIS/WIC Project Leader
• Develop the Security Policies/Plan with the Crossroads Project Manager • Act as WIC Security Officer • Determine system needs and modifications to the Crossroads System and present them to the Crossroads User Group along with the Crossroads Project Manager • Coordinate System Distribution • Solve Complex processing problem with nightly batch processing, as needed. • Work with WIC Admin Staff and Field Users to determine needs. • Determine needs associated with new federal regulations. • Provide needed reports to the Regional Office along with the Crossroads project Manager. • Give direction to WIC Equipment Coordinator and Helpdesk Analysts • Oversee the overall function of all MIS Processes • Ensure that sites are able to serve clients • Coordinate all EBT processing and daily redemptions reconciliation • Coordinate and process ACH payments to the Cap Formula Warehouse. • Develop Crossroads reports as needed • Run reports for the 798, rebates and caseload monthly
d. WIC Equipment Coordinator
• Ensure all servers are successfully backing up on an appropriate level. • Create Telecommunication Change Requests for phone and WAN line changes. • Coordinate equipment purchases along with MIS to post requested computer purchases for approval by WV Office of Technology. • Coordinate moving of computer equipment and network lines at WIC local offices that are moving. • Coordinate the replacement of computer equipment in field offices and state office with the Office of Technology. • Coordinate repairs for equipment that is under warranty with vendors providing the equipment with OT field staff.
West Virginia WIC Policy & Procedure 1.26 Effective Date: 3/20/2018 1.26 Security Policy
8 of 12 • Add and update software to PCs as necessary. • Ensure that inventory records are kept up-to-date. • Coordinate maintenance with all sites. • Match inventory records with on-site inventory on a biennial basis. • Assist in problem resolution with Autodialer • Revise the Five Year Equipment Replacement Plan and see that goals are met accordingly. • Request OAF(Operational Adjustment Funding) funding for equipment to meet the Five Year Plan. • Coordinate with eRecycle and surplus on how to dispose of computer hardware following department guidelines ensuring proper data encryption and/or destruction.
e. Help Desk Analyst
• Answer Help Desk calls from local sites and resolve problems over the phone. • Resolve and monitor Autodialer activities. • Train users on solving Crossroads Problems over the phone. • Test new version of Crossroads according to the release management notes. • Assist Crossroads Project Manager in determining errors and entering JIRA tickets for Crossroads UAT and Production Problems. • Be available to assist on Crossroads Design calls, as requested • Assist WIC Crossroads Manager and MIS Project lead as needed • Maintain user rights and roles within the Crossroads System and E-WIC system.
3. Separation of Duties
Within the SA, separation of duties is accomplished in the following manner: WIC IT Staff are separated into different levels of responsibilities depending on their civil service classification. WIC Project Manager and WIC MIS Project lead with have will have separate responsibilities from The WIC Equipment Coordinator and Help Desk Personnel. Both units may backup the other unit, when necessary due to illness, vacations or vacancies.
The WIC Security Officer will approve network logon requests received from the LA Directors. These will then be completed by WV Office of Technology staff. The WIC Crossroads manager will oversee the roles that are available within Crossroads. The WIC Help Desk Staff will add/maintain users within Crossroads and give them the roles and site access as needed in Crossroads.
Software Development
All modification request are presented to the Crossroads User Group for approval. Once approved, the Crossroads Maintenance and Enhancement contractors will create the system design for approval and implementation.
4. Personnel
West Virginia WIC Policy & Procedure 1.26 Effective Date: 3/20/2018 1.26 Security Policy
9 of 12 Each SA/LA employee must sign a Confidentiality Statement upon their hiring. This statement extends to participant records, databases, and the release of information. Reference II draft IT policy 0504 also addresses the issue of Background Investigations and Employee Confidentiality Statement.
It is also the responsibility of the SA and LA Director to brief all new employees on the Security Policies in effect. Upon termination of employment, personnel must turn in to the Security Manager/LA Director all identification cards, keys, programs, data files etc. in their possession. SA and LA Director must interview and emphasize to each terminated employee their continuing responsibility to maintain the privacy and confidentiality of State data.
SA staff will be briefed on Emergency Preparedness annually, which will include fire evacuations and procedures to follow in the event of a bomb threat. The SA staff will follow regulations as set forth in Reference V.1 & Reference V.2 Bomb Threat Checklist.
SA and LA personnel will abide by the following System Usage guidelines E-Mail Usage
a. Every WIC staff member will have their own personal email account. In addition, there is a clinic email for each clinic site. This email may be accessed by multiple people within the clinic. Clinic personnel will check for new messages a minimum of once a day for the clinic email.
b. Microsoft Outlook provided by the Office of Technology desk will be the only e-mail programs installed on WIC PCs. Use of Internet E-mail services such as Hotmail is prohibited.
c. If a message is received that is designated as “Critical”, clinic personnel will open the message in a minimum of two working days.
d. All WIC state office and clinic staff will abide by the Email Use Standards Policy mentioned previously.
Internet Usage
a. All WIC personnel will adhere to the Internet Usage Policy and Information Security Policy mentioned earlier.
Other Software
a. Microsoft Office is installed on all clinic PC’s. b. Security Policies will be placed on all PCs preventing the installation of software by unauthorized users. c. All software installed on WIC PCs will be purchased according to the Computer Equipment Purchases Policy. See West Virginia Policy & Procedure 6.11. d. The SA will maintain licensing information for all software. e. Any additional software must be installed by WV OT staff and approved by the
West Virginia WIC Policy & Procedure 1.26 Effective Date: 3/20/2018 1.26 Security Policy
10 of 12 WIC Office.
F. Physical Security Controls
1. Access Control
a. Physical access to WIC sites will be maintained. b. Facility will be locked at all times when authorized personnel are not present. c. SA/LA personnel shall wear name badges at all times. d. Unauthorized individuals shall be escorted at all times by LA/SA staff. e. If access is via an electrically controlled system, a determination must be made if it can be operated by standby battery power or overridden by an accessible key.
2. Equipment Security
a. WIC Equipment Coordinator will maintain an inventory of all ADP equipment with serial numbers, locations and maintain records. This information is also to be kept by the LA which is updated and submitted to the SA biennially per State WIC Policy & Procedure 6.15.
b. File servers will be placed in limited access area if possible. If this is not feasible, servers may be stored in a protective cabinet or by restricting client access to the area.
c. Proper equipment maintenance/warranty coverage will be maintained for all PC equipment.
d. All computer equipment with memory stored inside hardware must be picked up by WV eRecycle team. WV eRecycle will ensure that all data has been wiped from the device prior to surplus/retirement.
G. Environmental Security Controls
A West Virginia WIC Program Site Description Chart (Reference VI) will be completed/updated for each site administered by each Local WIC Agency by July 1 of each year. This survey will be used for any potential site when relocating clinics. All site surveys will contain emergency contact numbers with a primary number and a secondary phone number for each site.
The Local Agency will complete the Local Agency/SA Security Survey (Reference VII) by July 1 of each year.
Environmental Security - (See Reference I - State of WV Information Security Policy 4.4 Physical & Environmental Policy)
1. Water Damage
a. Local Agencies will consider environmental issues that may affect clinic and equipment operations when choosing a new clinic site. Potential sites should
West Virginia WIC Policy & Procedure 1.26 Effective Date: 3/20/2018 1.26 Security Policy
11 of 12 be examined to determine the probable effect from damage or destruction of contents, interruption of electric power and communications, lack of access to the building due to water/flood related issues.
b. In addition to the overall effect of natural flooding, examine the flood damage potential from all causes. Evaluate the location/future location of computer equipment within the building. (A basement location is potentially the least desirable location). Inspect the ceiling above ADP hardware areas for previous water leakage stains
2. Fire Exposure
a. Review fire emergency procedures with staff, assigning individual responsibilities in the event of fire and ensure staff knows the location of all fire extinguishers. Local fire department may be able to provide training in these emergency procedures.
b. Place portable fire extinguishers strategically in clinics with location clearly marked.
c. If building is equipped with automatic fire extinguishing systems, determine its adequacy and readiness.
d. Determine the location of smoke detectors.
3. Natural Disaster/Housekeeping Program
a. Determine if the building and equipment are properly grounded for lightning protection.
b. Keep computer area free of accumulated papers/trash. This would include refraining from stacking papers, books, handouts on and around the CPUs. These items prohibit the free flow of air that the CPU needs to keep the equipment from overheating.
c. Food and drink must be kept away from computers and their peripherals.
d. Install surge protectors to prevent electrical fluctuations.
e. To prevent destruction of data, the LA staff will notify SA should the UPS malfunction and become inoperable.
f. The SA will secure LA equipment that is covered by a three-year warranty to provide equipment maintenance as well as provide a field tech to do routine PC maintenance.
g. Ensure that backup tapes are stored in fire resistant box.
4. Contingency Plan
West Virginia WIC Policy & Procedure 1.26 Effective Date: 3/20/2018 1.26 Security Policy
12 of 12 a. Contingency plans are to protect PC equipment and its users against unacceptable loss. Proper procedures must be in place in the event of weather-related emergencies and sudden power losses. The SA will identify those applications that must be run immediately, those that can be delayed, and those which can be postponed indefinitely or performed in another manner.
b. Daily backups are performed on the file servers and on the communication stations of each site.
c. Disaster Recovery Exercises will be conducted yearly for the IS&C mainframe to ensure continued operation in the event of an emergency. See Reference VIII.
H. Procedures for WIC Biennial Security Review
The objective of the biennial security review is to perform a network security assessment of the West Virginia WIC Program. The project will involve work being performed on-site at county WIC clinics as well as remotely gathering information on computer systems prior to the on-site visit for corrective action and discussion with the appropriate Local Agency WIC directors. Additionally, a physical safeguards assessment will take place during the on-site visit.
Security reviews consisting of WIC networks will be audited using remote security software in order to detect, interrogate, test for weak passwords, and report on well-known services of identified WIC computers that are network-connected. Scans will occur one week prior to the scheduled on-site security review, and any findings that cannot be corrected remotely will be addressed during the on-site visit. WIC computer users will not be aware of scans, nor will the security scans affect WIC computer operations.
Also, prior to the on-site visit, information will be gathered about WIC user accounts. Reports of user account inconsistencies, disabled, inactive, never used accounts, will be run one week prior to the scheduled on-site security review. Findings will be discussed with the appropriate Local Agency Director and corrected.
REFERENCES:
1. State of West Virginia Information Security Policies 2. WV DHHR Information Technology Policies and Procedures 3. Chapter 61, Article 3C. West Virginia Computer Crime and Abuse Act 4. Diamond Emergency Preparedness Guide 5. FNS Handbook 901
ATTACHMENTS:
1. West Virginia WIC Program Site Description Chart 2. Local Agency Security Survey
Attachment #2, 1.26 LOCAL AGENCY SECURITY SURVEY Page 1 of 3
(Due before July 1 each fiscal year) Local Agency:
Site:
A. Physical Security of ADP Equipment: 1. Describe the physical setting:
2. Is WIC in its own building?
3. If not in its own building, is WIC in a larger building with others?
4. If in a larger building with others, what other entities share the facility?
5. Are WIC offices separated by lockable doors?
6. Who is responsible for locking WIC offices?
7. How many staff have keys?
8. Is there any record of keys issued?
9. How are keys accounted for when someone leaves the agency?
10. Does anyone outside WIC, such as other county staff, cleaning crews, etc. have access to WIC facilities? If yes, please specify:
11. Have any security concerns surfaced in the past 2 years?
12. If yes, how were the security concerns handled?
13. Who handled the security concerns?
14. How is documentation of security concerns kept?
Attachment #2, 1.26 LOCAL AGENCY SECURITY SURVEY Page 2 of 3
B. Equipment Security 1. If laptops are used at your sites, where are they stored when not in use?
2. Who is responsible for the laptops?
3. Is there a system for checkout and return of laptop?
4. Are laptops connected to the network at least every 30 days for updates?
5. What are the allowable reasons for laptops to leave the office?
6. Is there a detailed inventory of all equipment maintained?
7. If yes, where is the detailed inventory of all equipment maintained kept?
8. Who is responsible for updating the detailed inventory of all equipment maintained?
9. What agency or entity is responsible for insurance and other valuables at the WIC local agency clinics?
10. How are computers protected against the busy hands of toddlers in the WIC offices?
11. Are desktops, laptops, and the server inaccessible to unauthorized users (i.e., located away from public areas)?
12. Are participants escorted into and out of computing areas?
13. Are computers locked when the employee steps away from their desk?
C. Personnel Security
1. Is a list maintained of all persons who have access to WIC facilities and equipment?
2. If yes, who is responsible for maintaining the list?
Attachment #2, 1.26 LOCAL AGENCY SECURITY SURVEY Page 3 of 3
3. What procedures are in place to change passwords, change locks, remove access, retrieve keys, etc. when a person leaves the job?
D. Contingency Plans and Emergency Preparedness
1. Does the local agency have a plan in place to get the clinic back up and running in the event of a crisis?
2. Is the plan familiar to everyone in the office?
3. Where are backups stored?
4. Who should you call?
5. Where is the nearest neighboring agency or other computer or laptop you could share, or borrow?
6. Where would WIC operate if the site was damaged by fire, flood, etc.?
7. Are there fire extinguishers readily accessible?
8. Does staff know how to use them?
9. Who is responsible for verifying their operability?
Appendix BBB 2024 Site Security and Site Description Summary
All local agencies submitted their site security and site description reports on or before the July 1 deadline.
Site Security Reports
TSN July 10 , 2024 Central Jul 8, 2024 Monongalia March 15, 2024
Randolph-Elkins July 11, 2024 Shenandoah July 9, 2024 Wheeling-Ohio Jul 9, 2024 Mid-Ohio Valley July 11,2024 Valley Health June 28, 2024 Site Description Reports
TSN Jul 10, 2024 Central Jul 8, 2024 Monongalia March 15, 2024 Randolph-Elkins July 11, 2024 Shenandoah Jul 9, 2024 Wheeling-Ohio July 9, 2024 Mid-Ohio Valley July 11, 2024 Valley Health June 28, 2024
West Virginia Computer Equipment Replacement Plan FFY 2020 FFY 2021 FFY 2022 FFY 2023 FFY 2024 FFY 2025 10/1/2019 - 9/30/2020 10/1/2020 - 9/30/2021 10/1/2021 - 9/30/2022 10/1/2022 - 9/30/2023 10/1/2023 - 9/30/2024 10/1/2024 - 9/30/2025 Item / Make Units Unit Monthly Total Cost Purchase Warranty Years Planned Status Status Status Status Status Status Servers Virtual Web Servers x5 Production - x3 3 n/a 169
6,084
Oct-19 n/a n/a n/a Completed Uat/Test Bed - x2 2 n/a 149
3,576
Oct-19 n/a n/a n/a Completed Virtual Servers x2 Batch Process - Prod x1 1 n/a 134
1,608
Oct-19 n/a n/a n/a Completed Batch Process - UAT x1 1 n/a 134
1,608
Oct-19 n/a n/a n/a Completed Virtual Web Servers x5 (SQL Database/Production/UAT 2 SQL/DB Servers - Prod x1 UAT x1 2 n/a 1,293.25
15,519
Jan-20 Dec-24 5 Jun-24 Completed ***** ***** 2 Reporting DB Servers - Prod x1 UAT x1 2 n/a 1,204.00
14,448
Jan-20 Dec-24 5 Jun-24 Completed ***** ***** 1 State Office 1 n/a 372.00
4,464
Jan-20 Dec-24 5 Jun-24 Completed ***** ***** Physical Clinic Servers * 51 2,752
140,335
May-13 n/a n/a n/a completed Total Servers 63 Networking Equipment APC BR1350MS Back-UPS Pro 10-Outlet UPS, 1,350VA/810 Watts 60 200
11,999
Feb-22 Feb-22 3 Feb-27 warranty expired warranty expired Completed Wireless Access Points - Aerohive ExtremeCloud IQ 10 356
3,560
Apr-23 Apr-23 5 Apr-28 warranty expired warranty expired completed Routers: Cisco 1101 55 643
35,391
Apr-23 Apr-23 5 Apr-28 warranty expired completed Network Switches: Extreme Network 24 port 49 1,078
52,822
Apr-23 Apr-23 5 Apr-28 warranty expired warranty expired completed Network Switches: Extreme Network 4 port 6 3,277
19,662
Apr-23 Apr-23 5 Apr-28 warranty expired warranty expired completed Wireless Access Points - Aerohive ExtremeCloud IQ 27 400
10,800
n/a ** Local Agency Equipment Standard Laptops: HP ProBook 450 G9 200 724
144,800
Jun-21 Jun-25 4 Jun-25 Completed Monitors: HP 20" Monitor- 64X86AA 200 108
21,600
Jun-21 Jun-25 4 Jun-25 Completed Docking Stations: HP Docking station - 72C71AA#ABA 200 158
31,600
Jun-21 Jun-25 4 Jun-25 Completed Printers: Brother HLL6400DW B&W 60 525
31,499
Dec-21 Dec-22 5 May-26 Completed State Agency Equipment Power Laptops: HP Elitebook 650 G9 45 1,010
45,450
Oct-23 Oct-27 4 Oct-28 completed Docking Stations: HP Compatible 45 158
7,110
Oct-23 Oct-27 4 Oct-28 completed Tablet: Dell Latitude 5300 2-in-1 5 1,350
6,750
Sep-19 Sep-23 4 n/a Monitors: Dell 24" P2419HC need model 80 139
11,120
Sep-19 Sep-23 4 n/a Monitors: Dell 27" E2722H 30 199
5,970
Nov-22 Sep-23 4 Mar-27 completed DVD/RW Drives 5 39
195
Sep-19 Sep-23 4 n/a Printers: Brother HLL6400DW B&W 25 525
13,125
Jan-22 Mar-25 3 Jan-27 Completed completed Printers: Canon MF743CDW, Color 11 600
6,600
May-22 May-25 3 May-27 completed Topaz SigLite LCD Signature pads 250 266
66,500
Mar-24 Mar-26 2 Mar-29 completed Telecommunication Equipment Wireless Access Point/Hot Spot model number: MR1100 2 ****** ****** Mar-21 n/a n/a n/a Completed Ipads (via Cell Phone Contract) 10 880
8,800
Jun-24 n/a 5 Jun-29 Completed completed LCD Projectors Projectors (2 for SA and 8 for LAs) 10 672
6,720
Mar-24 Mar-24 2 Mar-29 completed Software / Licenses OnSolve Services 12 *** 1294.58 15534.96 Oct-21 n/a n/a n/a Completed Completed Google (purchased monthly) 240 24
5,760 69,120
n/a n/a n/a n/a Completed Completed Completed Completed Microsoft Office Suite - Contingent on OT approval ***** 50 6
720
n/a n/a n/a n/a **** **** Adobe Professional DC 10 14 1680 n/a n/a n/a n/a **** **** Notes: ** Equipment in process of being ordered. **** The Microsoft Office Suite will be replaced by Google Workspace during FFY2021; costs are unknown at this time. **** Microsoft Office Suite and Adobe Professional - Contingent on OT approval; costs are unknown at this time. ***** Gathering information for diaster recovery options and cost ****** Wireless Access Point/Hot Spot and data plan were purchased via cell phone contract Revised 07/2024
Nutritionist III H&HR Specialist Senior Kathleen Legg MIS Project Lead Programmer Analyst IV Amy Atkins Deputy Commissioner Health Improvement
H&HR Specialist Special Projects-Outreach H&HR Specialist Lisa Donohew Crossroads Project Coordinator Brent Warden
H&HR Specialist Sara Smith Help Desk Lead Rebecca Neely Equipment Lead Info System Specialist II Administrative Services Asst I Specialist H&HR Specialist Matthew Parker Help Desk Alanna Foster Research Coordinator Research Specialist 2 Matthew Christiansen Bureau for Public Health Commissioner and State Health Officer Program Manager II Kimberly Dawson EBT Benefit Specialist ASA III H&HR Specialist Vacant Nutrition Services Trainer Nutritionist III Nutrition Security Partnership Liaison CDC PHA Vacant Nutrition Services Coordinator Program Manager I Vacant Accountant BPH CFU Program Manager I Vacant Operations Unit Coordinator Program Manager I Secretary I 0506P02841 Dietetic Interns (up to 2 per year) Natasha Jones, MS, RD Deputy Director Vacant Outreach Coordinator Kara Blount FMNP Special Projects
Food Delivery Coordinator H&HR Specialist Senior Sherri Easter Monitoring Specialist H&HR Specialist Heather King FMNP Coordinator Tiffany Plear Authorization & Compliance Denise Ferris Nutrition Consultant Program Manager II 0506T00025 Cindy Pillo, MA Admin Special Projects Program Manager I 0506T00225
Payten Brown Heidi Staats, MSW Office Director Office Director III Julia Washington Operations Support Specialist Admin Services Asst I 0506T01309 Carrie Brooks Administrative Lead Specialist Vacant MIS Training Coordinator H&HR Specialist Senior Robin Anderson Help DeskH&HR Kara Napier Breastfeeding Coordinator Nutritionist III Bitna Turay Catherine Desruisseau Program Integrity Coordinator Dan Pickens Quality Improvement Coordinator Program Manager I Destiny White Vacant Policy & Procedures Coordinator H&HR Specialist Senior West Virginia Department of Health and Human Resources BUREAU FOR PUBLIC HEALTH OFFICE OF NUTRITION SERVICES June 2024 Vacant Vendor Unit Coordinator Program Manager I Laura Stewart Nutrition Services Onboarding Specialist H&HR Associate 0506P03093 0506P03086 0506P03107 0506P02477 0506P06736 0506P02865 0506P05902 Help Desk Analyst II 0506P01344 0506P02837 0506T00067 0506P03082 0506P04495 0506P03087 0506P03081 0506P03085 0506P02740 0506P03098 0506T01353 0506P03057 0506P03094 0506P02625 0506P00050 0506P02753 0506T00052
Community Services Directory Food Sources - West Virginia American Red Cross - West Virginia Mountaineer Food Bank American Red Cross Gassaway, WV 26624 113 Lakeview Drive Carla Nardella, Director Charleston, WV 25303 (800) HUNGRY-8 Phone: 304-340-3650 Huntington Area Food Bank American Red Cross 1327 7th Avenue 718 W. Pike Street Huntington, WV 25701 Clarksburg, WV 26301 Leigh Ann Zappin, Executive Director Phone: 304-624-7689 (304) 523-6029 WV Dept. of Agriculture American Red Cross 1900 Kanawha Blvd. E 1299 Pineveiw Drive Suite 300 Charleston, WV 25305 Morgantown, WV 26505 Jean Smith, Director Phone: 304-598-9500 (304) 558-2210 Brian Pauley, Director of Operational Administration American Red Cross Office of Shared Administration Rt 2 Box 153A One Davis Square Lewisburg, WV 24901 Suite 100, Room 120 Phone: 304-645-1070 Charleston, WV 25301 (304) 957-0211 American Red Cross USDA SNAP Contact 1948 Wiltshire Road Pat Barker Kearneysville, WV 25430 304-347-5944 Phone: 304-725-5015 (c) 304-904-2272 West Virginia Retailers Association OMEGA
Bridgett Lambert, President WV Oil Marketers & Grocers Assn 2110 Kanawha Blvd. East, Suite 102 Janet Vinyard, President Charleston, WV 25311 2506 Kanawha Blvd. East Office (304) 342-1183 Charleston, WV 25311 Fax (304) 342-1471 Office (304) 343-5500 wvra@teays.net Cell (304) 415-2497 Fax (304) 343-5810 jan@omegawv.com Revised 6/2024
MARO SUPPLEMENTAL NUTRITION PROGRAMS DIVISION
Director: Monique Feeny x 5159 Management Analyst: Jennifer Nagy x 5108
SUPPLEMENTAL FOOD PROGRAMS BRANCH WIC/FMINP/SFIMNP Branch Chief: Christine Berberich: x. 5113
FOOD DISTRIBUTION PROGRAMS BRANCH TEFAP/CSFP/ USDA Foods in Schools/Disaster Response Coordinator Branch Chief: Joni Garcia: x. 5160
Unit 1 Vendor Management, Food Delivery Information Systerns/EBT Nutrition Education (NE), Breast Feeding (BF) Services, Food Packages Infant Formula Rebates Organization/ Management
Unit 2 Funds Management Certification/Eligibility FMNP & SFMNP Caseload Management/Participation Civil Rights, OIG Hotline Complaints Monitoring & Audits
Food Distribution/Disasters TEFAP, CSFP USDA Foods Disasters
Food Distribution/Disasters TEFAP, CSFP USDA Foods Disasters
Amy Holtan, x. 5164 Team Lead
FOIA
State Plan
Connie Kramer-Walker, x. 5173 Team Lead
Disaster Assistance
State Plan
Kim Peretik-Jabat, x. 5098 Team Lead USDA Foods, TEFAP, CSFP, Disasters
Paulette Buszko, x. 5046 Team Lead USDA Foods, TEFAP, CSFP, Disasters
JoAnna Hazard, x. 5002
Vira“ Nutritionist (NE, BF) Food Packages Organization/Management Infant Formula Rebates Studies
Liaison
Justin Wohlsifer, x. 5045
WIC Vendor Management - Lead Food Delivery
PartnerWeb
Data Analytics
Vacant x.
WIC MIS/EBT
ARPA Grants
WIC Modernization Projects
Kellie Boyle, x. 5032
WIC Certification/Eligibility - Lead WIC FMNP/SFMNP - Lead Breastfeeding - Support
Civil Rights
OIG Hotline Complaints
Disaster Response
Vacant x.
WIC/FMNP/SFMNP Funds Management Caseload Management
Monitoring & Audits
WIC Certification/Eligibility - Support
Caribbean Area Office
Eduardo Segarra 787-766-5619
PR DOH, DOA/ADEA - POC
WIC FMNP/SFMNP - Support
WIC Vendor Management - Support
Donald Farrell, x. 5103 Vacant, Program Specialist x. Caribbean Area Office
Alberto Morales 787-766-5684 USDA Foods, TEFAP, CSFP, Disasters
Vacant Program Specialist x.
Vacant Program Specialist x.
Updated March 2024
**Phone Number = 609-259-xxxx
Email = firstname.lastname@usda.gov
West Virginia DOCUMENTATION OF DISASTER PROBLEMS AND RESOLUTIONS Date:____________ To:_________________________ Fax #:__________________________ # Pages:__________ From:_______________________ Phone #:________________________ State Agency Director:____________________________________________________ Local Agency Director:__________________________________________________________ WIC Clinic(s) Affected:_________________________________________________________ Date and Description of Disaster:__________________________________________________ Location where Water is provided: _________________________________________________ Location where Food is provided: __________________________________________________ List all disaster problems including WIC clinic, WIC staff, vendor, and participant. Write “Resolved” and the date of resolution on the line of the problem when it is resolved. Once a problem is marked as “Resolved”, omit the problem from the following lists. 1.____________________________________________________________________________ 2.____________________________________________________________________________ 3.____________________________________________________________________________ 4.____________________________________________________________________________ 5.____________________________________________________________________________ 6.____________________________________________________________________________ 7.____________________________________________________________________________ 8.____________________________________________________________________________ 9.____________________________________________________________________________ 10.___________________________________________________________________________ 11.___________________________________________________________________________ 12.___________________________________________________________________________ Signed:_________________________________Date:__________________________________ Email/Fax0 daily to the State Agency Disaster Coordinator to report ongoing problems and resolutions until all problems are resolved or addressed
West Virginia Department of Health Office of Nutrition Services Alternate Operating Procedures 1
Table of Contents Page I. Background 3 II. Coordination & Communication 3 III. Continuation of Benefits 5 IV. Benefit Issuance and Redemption 6 V. Vendor Management 7 VI. Nutrition Services 8 2
I. Background This Alternative Operating Procedure (AOP) document outlines the Continuity of Operations (COOP) priority for the Office of Nutrition Services (ONS), within the West Virginia Department of Health, which is to provide continued Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) services and a healthy and safe environment for participants and staff in the clinics, distribution sites, authorized grocery stores, and local, regional, and state offices. The AOP/COOP Plan is used as a guide to help ensure that all essential functions of ONS and its Programs will continue to be performed under all threats and conditions. ONS staff can achieve the latter while also minimizing the impact on its mission, participants, Programs, personnel, and information technology operations. Critical employees have been identified and understand what is expected of them during a public health emergency, natural disaster or supply chain disruption. The ONS, in the event of an emergency or major disaster affecting large numbers of participants, will take those resources necessary to: A. Provide for the safety of personnel and equipment; B. Secure records, equipment, materials and supplies; C. Restore WIC Program operations and delivery of service as soon as possible; D. Support the emergency procedures of the West Virginia Office of Emergency Services. The extent of disaster preparation depends on the type of disaster. E. When there is advance notice that a WIC clinic may be damaged by a flood, WIC personnel will attempt to remove vehicles, computer equipment, participant charts, medical supplies and equipment to a secure location. F. When a WIC clinic is struck by lightning which causes a fire, there is no time to make advance preparation. In this case, it is important that all people inside the building leave immediately and call the fire department. When there is advance notice that a disaster may occur, the Local Agency Director will take immediate action upon receipt of the notice. During a disaster, the mission of the West Virginia WIC Program remains the same: To improve the health of women, infants and children in West Virginia through the provision of nutrition and breastfeeding counseling, health monitoring and the provision of nutritious supplemental foods. This Office of Nutrition Services’ Alternative Operating Procedure document will be reviewed and updated as required. II. Coordination and Communication A. The following designated emergency contacts within the State Agency (SA) for disasters, emergencies, public health emergencies, supplemental food recalls and other supply chain disruptions to ensure that the appropriate entities (e.g., Regional 3
Offices, other State Agencies and Coordinating programs) are aware of the SA’s designated contacts. Area Emergency Contact Office Phone State Agency Disaster Coordination Office Director 304-352-0960 Administration/Nutrition Services Deputy Director 304-352-0967 Vendor Management Division Director 304-352-0964 Nutrition Services Nutrition Services Coordinator 304-352-0967 Crossroads/MIS Services Division Director 304-352-0958 B. The above named individuals will be tasked with providing contact information for key SA staff on the SA’s public website and to ensure that this information is kept up to date. They will also ensure that the appropriate entities (e.g., Regional Offices, or other State agencies, coordinating Programs) are aware of the SA’s designated contact and to ensure that this information is kept up to date. The Nutrition Services (NS) area will address the needs of participants with documented qualifying conditions receiving Food Package III. They will provide participants with a point of contact at their Local Clinic as well as the SA’s public website for additional information. ONS will ensure this information is kept up to date. C. ONS will develop a plan that establishes a relationship with relief agencies responsible for disaster and public health emergency planning which includes the West Virginia Bureau for Public Health Continuity of Operations Plan (COOP) elements. The Office will coordinate with FEMA, relief organizations, State and local emergency operation centers and maintain a list of these agencies’ contacts that is kept up to date. The State Agency Disaster Coordinator will identify WIC SA staff positions for full or partial deployment if needed through the duration of the disaster. D. ONS will develop a communication plan to keep FNS, State and Local Agency (LA) staff, authorized WIC vendors, WIC participants and the public informed during an emergency, food recalls or other supply chain disruption. ONS will maintain the Community Service Directory (ATT 1), utilize active vendor listing in Crossroads and FNS contact sheet (ATT 2), to keep those entities informed during the disasters. LAs through the SA will utilize Documentation of Disaster Problems and Resolutions (ATT 3), to keep FNS apprised of disaster related issues. Through the LA and SA websites participants and the general public will be advised of program changes that affect their area. E. The Local Agency Director will use the list of responsibilities and designated personnel on the Emergency Preparedness Meetings, Drills and Test Exercises form that was completed during a staff meeting to discuss the emergency plan as a check list for preparation. 4
F. The Local Agency Director will: Maintain contact with SA, media and local sources of food assistance for information and maintain contact with WIC personnel for notification of preparedness and problems. G. The Local Agency Director will be responsible for the following: 1. Assuring that annual pre-disaster preparation is completed; 2. Maintaining communication with SA, WIC personnel, the media and local sources of food assistance during the initial disaster alert/activation phase, during the disaster and during the restoration/recovery phase; and 3. Assuring that pre-disaster procedures and restoration/recovery procedures following a disaster are followed and documented according to the AOP III. Continuation of Benefits To meet requirement or implement waivers the SA must first determine if the disaster meets one of the following criteria: A. A presidentially declared major disaster as defined under Section 102 of the Robert T. Stafford Disaster Relief and Emergency Assistance Act (Stafford Act, 42 U.S.C. 5121 et seq.) B. A presidentially declared emergency as defined under the Stafford Act C. A public health emergency declared by the Secretary of Health and Human Services under Section 319 of the Public Health Service Act (42 U.S.C. 247d) D. A renewal of such a public health emergency E. A supply chain disruption as declared by the Secretary of Agriculture. In conjunction with the State’s Emergency Operation Center, if SA determines one these events exist, the SA will request a waiver to continue WIC services. Waivers may be requested to address: A. Physical presence for participants such a remote/virtual certification appointment B. Separation of duties C. Vendor and local agency monitoring Alternate operating procedures are already available: A. Certification/serving applicants and participants from an alternate WIC clinic and providing nutrition assessment and referral to other organizations B. Set up mobile or satellite clinic to certify/serve applicants and participants and providing nutrition assessment and referral to other organizations C. Allowing temporary certifications for applicants who are missing only one proof D. Collection of anthropometric and bloodwork data for participants through alternate means such as the West Virginia Health Information Network E. The collection of eligibility documentation (secure website upload, mobile device screen share, mail, secure email and video conference) F. The collection of signatures on required documents 5
G. Replacement of EBT cards and destroyed supplemental foods, See WV Policy & Procedures 1.10.F & 3.07.A H. Mailing of EBT Cards If an EBT card is mailed, clinic should use first class mail with one of the following phrases included on the envelope: “Do Not Forward, Return to Sender” or “Do Not Forward, Address Correction Requested.” The exterior of the envelope will not mention WIC or “Women, Infants, and Children” including on the return address and will not use envelopes with windows. I. Verification of Certification (VOC) Issuance – See WV Policy and Procedure 1.10.E The SA and LA will update their public web pages/social media accounts with instructions for obtaining an up-to-date VOC and to notify neighboring State agencies of where a VOC may be obtained by displaced participants. This policy should help to expedite the certification process and ease transition to another SA. IV. Benefit Issuance and Redemption The Crossroads WV databases are backed up nightly and the servers have failover if one server goes down. WV is looking at Cloud and hosted solutions. WV has only had one day that the system was down in the past 10 years and clients could not be certified. Clients with benefits could still redeem their benefits at the store during that time. If a clinic has infrastructure issues, other clinics can sign into the affected clinic and serve clients remotely. The EBT system ensures robust telecommunications redundancy by utilizing commercial networks and available commercial POS terminals, or FIS-installed WIC-only stand-beside hardware, for benefit redemption. To enhance system reliability, the system includes backup host processing capabilities that conform to federal regulations, national standards, and specified WIC State Office performance standards. These measures ensure continuous service availability and data integrity, even in the event of network or system failures. Remote benefit issuance will be available for all appointments excluding an appointment to determine eligibility for a second or subsequent certification period. A. WIC participants may require a change in food package during a disaster. 1. Ready-to-feed infant formula may be issued when water sources are not safe. 2. Formula in supply at the WIC clinic may be distributed to WIC participants, as necessary. 3. There are no exemptions or exceptions allowed when medical documentation is required for the issuance of certain supplemental foods, including exempt infant formulas during disasters. 4. A homeless food package may be issued to WIC participants with no storage and/or electricity. 5. WIC personnel will provide nutrition counseling and handouts about safety when cooking, eating and drinking following a disaster, as necessary. 6
B. EBT Card Replacement 1. EBT card replacement and benefit transfer will be completed on a daily basis as ONS is made aware. If needed, these replacements can be completed from an alternate location. 2. In areas where mail could be unreliable in a disaster or emergency, they could be picked up at the clinic. 3. If an emergency clinic is in place, an EBT card could be allocated to the client and later linked to the EBT account once the staff is connected to Crossroads. 4. The WIC Program will not replace food lost in a mass disaster where community emergency feeding services are provided. WIC personnel will be aware of locations of emergency feeding services and sources of clean water to be able to refer those who contact WIC for this type of assistance. 5. In the case of a natural disaster affecting large numbers of people in a regional or State nature where emergency declarations initiate action by Federal and State public and private disaster assistance providers, participants are not required to provide proof of disaster for food benefit replacement. 6. The State Agency will provide guidance on the replacement of benefits based on the situation. The state agency will ensure they have enough funds before replacing lost EBT purchased supplemental foods. If the state agency does not have the funds, they will contact FNS for assistance. V. Vendor Management A. Alternative Procedures for Vendor Monitoring and Compliance Investigations During a declared disaster affecting food supply chains or distribution networks, the State Agency activates its disaster recovery plan, which includes provisions for adjusting authorization requirements for new vendor applicants and authorized vendors. This adjustment allows expedited processing of new vendor applications and streamlines the renewal process for existing vendors to ensure continued access to supplemental foods by Women, Infants, and Children (WIC) program participants. In this scenario, the State Agency may temporarily waive certain documentation or procedural requirements, prioritize essential inspections, or utilize electronic submission methods to facilitate swift authorization adjustments. These measures aim to maintain a robust vendor network capable of meeting increased demand during the disaster while adhering to program integrity and participant access standards. B. Vendor Minimum Stocking Requirements (MSR) for Continuous WIC Food Distribution To ensure uninterrupted distribution of supplemental foods to Women, Infants, and Children (WIC) program participants during disasters, this policy outlines procedures for 7
adjusting vendor Minimum Stocking Requirements (MSR). The State Agency will assess and communicate MSR adjustments promptly to vendors, ensuring adequate food supply in times of crisis. The plan also involves modifying state-specific minimum requirements for the variety and quantity of supplemental foods that vendors must stock to be authorized. For instance, this could involve lowering minimum stocking requirements to match federal standards when state-specific requirements are excessive or implementing a federal waiver. State agencies should consider variety and quantity when developing a plan to meet minimum stocking requirements.The State Agency will assess and communicate MSR adjustments promptly to vendors, ensuring adequate food supply in times of crisis. 1. Responsibilities: a. The State Agency monitors and assesses food supply disruptions. b. Establishes and communicates adjusted MSR procedures to vendors. 2. Procedure: a. Activate the disaster recovery plan upon disaster declaration. b. Assess disaster impact on food availability and adjust MSR accordingly. c. Communicate adjusted MSR requirements promptly to vendors. d. Vendors implement adjustments and provide inventory updates. 3. Monitoring and Evaluation: a. Monitor effectiveness of adjusted MSR during disaster recovery. b. Conduct regular evaluations for continuous improvement. 4. Review and Revision: Annually review and update policy as necessary. . C. Adjusting Vendor Authorization Requirements During Emergencies 1. The State Agency will implement alternative procedures to meet annual vendor routine monitoring and compliance investigation requirements under 7 CFR 246.4(a)(14)(iv). These measures aim to maintain program integrity and ensure continued access to supplemental foods for WIC program participants. a. Remote Monitoring: Use electronic methods for vendor compliance monitoring. b. Prioritized Investigations: Focus on critical vendors for food distribution. c. Flexible Documentation: Adjust documentation requirements temporarily for quicker compliance assessments. d. Communication and Coordination: Maintain regular communication with local agencies and vendors about adjusted procedures. e. Monitoring and Evaluation: Assess effectiveness of alternative procedures during disaster recovery and conduct post-disaster evaluations. f. Review and Revision: Annual review and update of policies to align with regulatory changes and best practices. 8
VI. Nutrition Services A. Food Delivery Procedures 1. Establish a Disaster Response Team 2. Designate a Disaster Coordinator within the WIC State agency to lead the response efforts. 3. Establish a working relationship with the State's emergency management agency and other relevant organizations (e.g., FEMA, American Red Cross). The WIC Program will not replace food lost in a mass disaster where community emergency feeding services are provided. WIC personnel will be aware of locations of emergency feeding services and sources of clean water to be able to refer those who contact WIC for this type of assistance. In the case of a natural disaster affecting large numbers of people in a regional or State nature where emergency declarations initiate action by Federal and State public and private disaster assistance providers, participants are not required to provide proof of disaster for food benefit replacement. a. The State Agency will provide guidance on the replacement of benefits based on the situation. b. WIC participants may require a change in food package during a disaster. i. Adjust food packages and authorized food lists to accommodate participants with limited access to food storage or preparation facilities. c. Ready-to-feed infant formula may be issued when water sources are not safe. d. Formula in supply at the WIC clinic may be distributed to WIC participants, as necessary. i. Develop a schedule for food distribution to minimize congestion and ensure orderly access. e. There are no exemptions or exceptions allowed when medical documentation is required for the issuance of certain supplemental foods, including exempt infant formulas during disasters. f. A homeless food package may be issued to WIC participants with no storage and/or electricity. g. WIC personnel will provide nutrition counseling and handouts about safety when cooking, eating and drinking following a disaster, as necessary. 4. Maintain up-to-date contact information for key staff members and partners. 5. Develop a communication strategy to keep staff, participants, and partners informed about changes in WIC services during a disaster. a. Use multiple communication channels, including websites, social media, email, and local media, to disseminate information. B. Special Formulas 1. Strengthen partnerships with healthcare providers and hospitals to facilitate rapid collection of medical documentation needed to issue special formulas. 9
2. Special formula will be provided by the State contracted distribution center. The distribution center will ship requested special formulas to either the Local Agency clinic or the participant’s home considering which one is more appropriate. C. Breastfeeding Support for Participants 1. Utilize Pacify services to provide remote/virtual breastfeeding support as able. 2. Ensure trained breastfeeding peer counselors can provide support and assistance during emergencies. Peer counselor staff will educate breastfeeding participants on the importance of safe and adequate water consumption to maintain milk supply. 3. Distribute breastfeeding supplies, such as breast pumps and nursing pads, through WIC clinics and emergency distribution points. 4. Deploy breastfeeding peer counselors to emergency shelters and community centers to provide in-person breastfeeding support. 10
Policy DOP-P02 EFFECTIVE DATE: October 1, 1991 REVISION DATE: December 18, 2020 1 DRUG- AND ALCOHOL-FREE WORKPLACE I. PURPOSE The purpose of this policy is to establish clear and uniform guidelines in accordance with federal and State regulations regarding alcohol, drugs, or controlled substances, including the provisions of the Drug-Free Workplace Act of 1988, as amended. Further, the purpose of this policy is to make every effort to institute and maintain a drug- and alcohol-free workplace by describing to all individuals (e.g., employees, visitors, vendors/independent contractors, and the general public) the prohibitions regarding alcohol and drugs in State and affiliated government workplaces as such use, abuse, and misuse of alcohol, drugs, and/or controlled substances may impact job performance and bring discredit upon the employer. The provisions of this policy apply to all employees of West Virginia Executive agencies or any affiliated political subdivision, including executive, administrative, classified, non-classified, exempt, volunteer, seasonal and temporary employees, and employees of county health departments affiliated with the West Virginia Division of Personnel, as well as vendors/independent contractors. II. DEFINITIONS A. Agency: Any administrative department of state government or an affiliated political subdivision, including, but not limited to, executive, administrative, classified, non-classified, exempt, and county health departments affiliated with the West Virginia Division of Personnel. B. Alcohol: For the purposes of this policy, includes beer, fortified beer, nonintoxicating beer, wine and spirits, ethanol, isopropanol, or methanol alcohol, and any liquid, gel, gas or solid containing more than one half of one percent of alcohol by volume and capable of being used as a beverage or being ingested, inhaled or otherwise taken into the body. C. Assessment: An evaluation used to determine the presence of drug and/or alcohol use. A drug and/or alcohol assessment may include but is not limited to observation of behavioral indicators, self-disclosure, or clinical/laboratory testing. D. Controlled Substance: A federally-regulated substance listed in Schedules I through V or a controlled substance analogue as provided in the Controlled Substance Act (21 U.S.C. 801 et seq.) and/or a substance listed in West Virginia Code § 60A-2-201, et seq., that when taken into the body, may or may not impair one’s mental faculties and/or physical performance. E. Conviction: A finding of guilt, (including a plea of nolo contendere) or the imposition of a sentence, or both, by any judicial body charged with the responsibility to determine violations of the federal or State criminal drug statutes. F. Criminal Drug Statute: A criminal statute involving the manufacture, distribution, dispensing, use, or possession of any controlled substance. G. Drug Paraphernalia: Drug paraphernalia as defined in West Virginia Code § 47-19-3.
Policy DOP-P02 EFFECTIVE DATE: October 1, 1991 REVISION DATE: December 18, 2020 2 H. Drug Test and Alcohol Testing: A procedure using a sample of the human body capable of revealing the presence of alcohol or other drugs or other metabolites to determine if the individual ingested, injected, or was otherwise exposed to drugs or alcohol. I. Employee: Any person who lawfully occupies a permanent or temporary position with an Executive agency of the State, or any affiliated political subdivision, and who is paid a wage or salary including, but not limited to, executive, administrative, classified, non-classified, exempt, seasonal, temporary employees, and employees of county health departments affiliated with the West Virginia Division of Personnel. For the purpose of this policy, “employee” shall also include authorized students, interns and volunteers performing services for an agency under direct supervision irrespective of receipt of wages. J. Federal Agency: Any agency as that term is defined in 5 U.S.C. § 551. K. Grantee: Any department, division, unit, or any person responsible for the performance of work under the provisions of a federal grant. L. Illegal Drug: Any drug which is not legally obtainable or a drug available by prescription that is being used in a manner or for a purpose other than as prescribed. Illegal drugs include those controlled substances under federal or State law which are not authorized for sale, possession, or use, and legal drugs which are used, obtained, or distributed illegally. M. Legal Drug: Legal drugs include medications prescribed by a physician or, medications in West Virginia that have been legally obtained and that are being used solely for the purpose for which they were lawfully prescribed, and in the dosage and quantity for which they were prescribed. Legal drugs also include over-the-counter medications that have been legally obtained and that are being used for the purpose, and in the dosage and quantity, specified by the drug manufacturer. N. Reasonable Suspicion: The belief premised on facts and inferences based primarily upon, but not limited to: (1) Observable phenomena, such as direct observation of use, possession or distribution of alcohol or drugs, or of the physical symptoms of being under the influence of alcohol or drugs, such as, but not limited to, slurred speech, dilated pupils, odor of an alcoholic beverage or drugs, changes in affect or dynamic mood swings; (2) a pattern of abnormal conduct, erratic or aberrant behavior or deteriorating work performance such as frequent absenteeism, excessive tardiness or recurrent accidents, that appears to be related to the use of alcohol or drug abuse and does not appear to be attributable to other factors; (3) the identification of an employee as the focus of a criminal investigation into unauthorized possession, use or trafficking of drugs; (4) a report of use of alcohol or drugs provided by a reliable and credible source; and (5) repeated or flagrant violations of the safety or work rules of the employee's employer, that are determined by the employee's supervisor to pose a substantial risk of physical injury or property damage and that appears to be related to the use of alcohol or drug and that does not appear attributable to other factors. O. Safety Sensitive Position: Any position determined by federal, State, or agency provisions where a lapse of attention or judgment, can lead to an accident that could cause loss of human life, serious bodily injury, or significant property or environmental damage.
Policy DOP-P02 EFFECTIVE DATE: October 1, 1991 REVISION DATE: December 18, 2020 3 P. Vendor/Independent Contractor: Any entity or person responsible for the performance of work under a vendor agreement or contract. Q. Volunteer: Any authorized individual directly engaged in the performance of services for a State or affiliated agency without promise, expectation, or receipt of compensation. R. Workplace: A site where service or work is performed in connection with the employment or service of an employee or vendor/independent contractor, including sites of social functions and conferences. The workplace shall include, but is not limited to, facilities, property, buildings, offices, structures, automobiles, trucks, trailers, or other means of conveyance (either private or public, while engaged in the performance of duties), and parking areas provided by the agency, even if not owned, leased, or operated by the agency. III. POLICY It is the policy of West Virginia State government and its affiliated agencies to ensure that its workplaces are free of alcohol, and illegal drugs by prohibiting the use, possession, purchase, manufacture, distribution, dispensing, sale of, or having such substances in the body system. Attempting to obtain, possess, purchase, manufacture, distribute, dispense, or sell alcohol or illegal drugs in the workplace is also prohibited. Although the sale and use of alcohol by an adult may be legal, the use, possession, purchase, manufacture, distribution, dispensing, or sale of alcohol in the workplace is strictly prohibited. Employees violating this policy are subject to disciplinary action up to and including dismissal and may be required to participate in a drug rehabilitation program as a condition of continued employment or reemployment. A. This policy is applicable while employees or vendors/independent contractors, are engaged in any work-/service-related activities which include performance of agency business. Work/service- related activity includes, but is not limited to, conducting work/service, representing the State or the agency, participation in conferences or off-site meetings, receiving awards, speaking as a State or agency representative, and participation in receptions when invited as a result of employment/service with the State or the agency. B. The use, possession, purchase, manufacture, distribution, dispensing, or sale of alcohol; the reporting to work under the influence of alcohol, or having alcohol in the body system at work, whether the alcohol was consumed at work or away from work, attempting to obtain, possess, purchase, manufacture, distribute, dispense, or sell alcohol, are all prohibited in the workplace. Industrial, cleaning, or medical products containing alcohol are not prohibited by this policy when used in the manner in which intended. C. The unlawful use, possession, purchase, manufacture, distribution, dispensing or sale of a controlled substance, legal drug, or illegal drug in the workplace; the reporting to work under the influence of an illegal drug; having an illegal drug in the body system; or possession of drug paraphernalia (other than drug paraphernalia lawfully prescribed by a physician or other person licensed to prescribe and used for the lawful purposes for which it was prescribed) are all prohibited in the workplace. Attempting to obtain, possess, purchase, manufacture, distribute, dispense, or sell illegal drugs in the workplace is also prohibited.
Policy DOP-P02 EFFECTIVE DATE: October 1, 1991 REVISION DATE: December 18, 2020 4 D. When reasonable suspicion exists that an employee or vendor/independent contractor has reported to work under the influence of alcohol or an illegal drug, or is impaired due to abuse or misuse of controlled substances or a legal drug, the individual may be subject to assessment, which may include a drug or alcohol test. Refusal of an employee to submit to an assessment or an assessment resulting in a positive result may result in disciplinary action up to and including dismissal. E. Exceptions to the provisions of this policy may be necessary in limited situations where employees or vendors/independent contractors are engaged in a lawful work-/service-related activity which may otherwise result in violation of this policy (e.g., law enforcement, regulatory enforcement, confiscation, collection and disposal of refuse, etc.). Appointing authorities may be required to conduct random testing in compliance with applicable state and federal law and/or for safety- sensitive positions. Exceptions to this policy approved by appointing authorities must be communicated in writing to the Director of Personnel. F. An appointing authority, or his or her designee, may issue specific safety reporting standards requiring reporting or notification of use of a controlled substance or legal drug, whether prescribed or over-the-counter, that may substantially affect the performance of job responsibilities and give rise to a safety issue (e.g., driving, operating machinery, etc.). G. Though legal intoxicants (e.g., glue, paint, etc.) are not specifically prohibited in this policy, unacceptable performance or conduct resulting from the misuse of such intoxicants may result in disciplinary action up to and including dismissal. H. As a condition of employment/service with the State of West Virginia or its affiliated agencies, employees and vendors/independent contractors shall: 1. Abide by the terms of this policy; 2. Notify their supervisor or appointing authority in writing of any criminal drug statute conviction for a violation occurring in the workplace, no later than five (5) calendar days after such conviction; 3. Comply with agency-issued safety reporting standards if using a controlled substance or legal drug, whether prescribed or over-the-counter, that may substantially affect the performance of job responsibilities and give rise to a safety issue (e.g., driving, operating machinery, etc.); and, 4. Acknowledge understanding of and compliance with this policy by signing the Drug- and Alcohol-Free Workplace Employee Acknowledgment Form (Appendix A) or appropriate volunteer/service agreement, as applicable. IV. RESPONSIBILITIES A. It shall be the responsibility of the West Virginia Division of Personnel to establish a drug awareness program and to provide training to employees of Executive and affiliated agencies on the following:
Policy DOP-P02 EFFECTIVE DATE: October 1, 1991 REVISION DATE: December 18, 2020 5 1. The establishment and maintenance of a drug- and alcohol-free workplace in compliance with this policy; 2. The dangers of alcohol use or drug abuse in the workplace; 3. Availability of the State’s Employee Referral Program; 4. The consequences of violation of this policy; and, 5. The utilization of resources concerning the abuse and misuse of alcohol and/or drugs. B. It shall be the responsibility of each agency to: 1. Maintain a copy of the Drug- and Alcohol-Free Workplace policy in an accessible location and display the poster in a central location. 2. Ensure that each new employee receives a copy of the policy during orientation. 3. Maintain the signed Drug- and Alcohol-Free Workplace Employee Acknowledgment Form (Appendix A) in each employee’s agency personnel file. 4. Enforce the policy and take appropriate action against individuals who are convicted or violate the policy within 30 calendar days from the date of the conviction or violation. 5. In accordance with applicable legal and administrative disciplinary procedures, promptly address any attempted or unlawful use, possession, purchase, manufacture, consumption, distribution, dispensing or sale of alcohol, a legal drug, or an illegal drug; an employee found to be, or suspected of being, under the influence of alcohol or an illegal drug in the workplace; an employee having alcohol or an illegal drug in the body system; or an employee being impaired due to use, abuse or misuse of a legal drug, intoxicant, or controlled substance in the workplace. Supervisors should contact their respective agency personnel office or individual designated by the appointing authority for guidance. However, in emergency situations supervisors should first ensure the safety of the employee and others and then immediately contact 911, appropriate law enforcement officials, or agency security. Agencies in Kanawha County may also contact the Division of Protective Services at (304) 558-9911 for assistance. Prior to an incident occurring, agencies in outlying areas should ascertain if assistance is available with emergency response and drug and/or alcohol testing through other related services and in compliance with existing agency policy. 6. Pursuant to the Drug-Free Workplace Act, State agencies that are independent contractors or grantees of federal contracts or recipients of federal grants amounting to at least $100,000 shall notify, in writing, the federal agency administering the grant, within ten (10) calendar days after receiving notice from an employee of his or her conviction for a violation of a criminal drug statute occurring in the workplace or otherwise receiving actual notice of such conviction. Such notice, including position title, must be submitted to every grant officer or other designee on whose grant activity the convicted employee was working, unless the federal agency has designated a central point for the receipt of such notices. The notice shall include the identification number(s) of each affected grant. State agencies covered by the
Policy DOP-P02 EFFECTIVE DATE: October 1, 1991 REVISION DATE: December 18, 2020 6 Act are subject to suspension of payments and termination of the contract or grant for violations of any of the requirements of a drug-free workplace. 7. Make a good faith effort to continue to maintain a drug- and alcohol-free workplace by communicating this policy to all employees annually. 8. Ensure that vendors/independent contractors have executed agreements to ensure compliance with drug- and alcohol-free workplace requirements. V. REFERENCES A. Administrative Procedures Act, 5 U.S.C. § 551 B. Drug-Free Workplace Act, 41 U.S.C. Sections 701-707. C. West Virginia Code § 47-19-3. D. West Virginia Code § 60A-2-201 et seq. and applicable federal statutes. VI. EFFECTIVE DATE: October 1, 1991. VII. REVISIONS A. Previous Revisions: January 16, 2003 and October 1, 2004. B. Latest Revision: December 18, 2020 VIII. POLICY NUMBER: DOP-P2. Approved and Issued By: _________________________________________ Sheryl R. Webb, Director of Personnel Date Signed: December 18, 2020.
Policy DOP-P02 EFFECTIVE DATE: October 1, 1991 REVISION DATE: December 18, 2020 7 APPENDIX A DRUG- AND ALCOHOL-FREE WORKPLACE EMPLOYEE ACKNOWLEDGMENT FORM I certify that I have received a copy of the West Virginia Division of Personnel Drug- and Alcohol-Free Workplace policy. I agree to abide by the terms of the policy and I am aware that with any violation of this policy, I will be subject to disciplinary action, up to and including dismissal. I may also be required to participate in a drug or alcohol abuse assistance or rehabilitation program as a condition of continued employment or reemployment. I understand that I must also comply with any agency-issued safety standards. In addition, I understand that if I am a federal contractor or federal grant recipient or an employee of a federal contractor or federal grant recipient, under federal law and as a condition of employment, if I am convicted of any violation of a criminal drug offense in the workplace, I must report this conviction to my supervisor and the appointing authority in writing within five (5) calendar days of the conviction. My signature acknowledges my receipt of the policy and my understanding of its contents and requirements. My signature does not indicate that I agree or disagree with the content of the policy. ____________________________________________ Name (Print) ____________________________________________ Signature ____________________________________________ Date TO BE COMPLETED BY SUPERVISOR I certify that I have discussed with and provided the above-named employee a copy of the West Virginia Division of Personnel Drug- and Alcohol-Free Workplace policy. ____________________________________________ Name (Print) ____________________________________________ Signature ____________________________________________ Date FORM DOP-P2-AF Distribution: Original – Human Resources Copy – Employee
STATE AND LOCAL GOVERNMENT RATE AGREEMENT
EIN: 55-6000810 Date: 06/29/2023 ORGANIZATION: FILING REF.: The preceding West Virginia Department of Health & Human agreement was dated Resources 07/14/2021
One Davis Square
Suite 300
Charleston, WV 25301
The rates approved in this agreement are for use on grants, contracts and other agreements with the Federal Government, subject to the conditions in Section III.
SECTION I: INDIRECT COST RATES
RATE TYPES: FIXED FINAL PROV. (PROVISIONAL) PRED. (PREDETERMINED) EFFECTIVE PERIOD
TYPE FROM aie) RATE(%) LOCATION APP’ BLE T'
FINAL 07/01/2021 06/30/2022 113.10 On-site Bureau of Behavioral Health
FINAL 07/01/2021 06/30/2022 41.50 On-site Office of Threat Preparedness
FINAL 07/01/2021 06/30/2022 14.30 On-site Office of Health Facilities; Licensure
FINAL 07/01/2021 06/30/2022 31.50 On-site Office of Chief Medical Examiner
FINAL 07/01/2021 06/30/2022 27.60 On-site State Trauma & Emergency Care
FINAL 07/01/2021 06/30/2022 32.70 On-site Office of Epidemiology and Prevention Services
FINAL 07/01/2021 06/30/2022 33.20 On-site Health Statistics Center
FINAL 07/01/2021 06/30/2022 75.80 On-site Office of Laboratory Services
FINAL 07/01/2021 06/30/2022 63.70 On-site Office of Community Health & Health Promotion
FINAL 07/01/2021 06/30/2022 38.30 On-site Office of Maternal, Child & Family Health
FINAL 07/01/2021 06/30/2022 33.70 On-site Office of Nutrition Services
FINAL 07/01/2021 06/30/2022 47.30 On-site Office of Environmental Health Services
FINAL 07/01/2021 06/30/2022 32.80 On-site Nursing Home Administrators Licensing Board
FINAL 07/01/2021 06/30/2022 13.80 On-site Developmental Disabilities Planning Council
PROV. 07/01/2022 06/30/2025 18.60 On-site Human Rights Commission
Page 1 of 4 G37449
ORGANIZATION: West Virginia Department of Health & Human Resources AGREEMENT DATE: 06/29/2023
PROV. 07/01/2022 06/30/2025 Use same rates and conditions as
those cited for fiscal year ending June 30, 2022
*BASE
Direct salaries and wages excluding all fringe benefits.
Page 2 of 4 G37449
ORGANIZATION: West Virginia Department of Health & Human Resources AGREEMENT DATE: 06/29/2023
SECTION II: SPECIAL REMARKS
TREATMENT OF FRINGE BENEFITS: The fringe benefits are specifically identified to each employee and are charged individually as direct costs. The directly claimed fringe benefits are listed below.
TREATMENT OF PAID ABSENCES:
Vacation, holiday, sick leave pay and other paid absences are included in salaries and wages and are claimed on grants, contracts and other agreements as part of the normal cost for salaries and wages. Separate claims are not made for the cost of these paid absences.
Equipment Definition —
Equipment means an article of nonexpendable, tangible personal property having a useful life of more than one year and an acquisition cost of $5,000 or more per unit.
Fringe Benefits -
FICA
Retirement
Worker's Compensation Unemployment Insurance Health Insurance
Life Insurance
Your next proposal based on FYE June 30, 2023 is due in our office by December 31, 2023.
Page 3 of 4 G37449
ORGANIZATION: West Virginia Department of Health & Human Resources AGREEMENT DATE: 06/29/2023
SECTION III: GENERAL
A LIMITATIONS:
The rates in this Agreement are subject to any statutory or administrative limitations and apply to a given grant, contract or other agreement only to the extent that funds are available. Acceptance of the rates is subject to the following conditions: (1) Only costs incurred by the organization were included in its indirect cost pool as finally accepted: such costs are legal obligations of the organization and are allowable under the governing cost principles; (2) The same costs that have been treated as indirect costs are not claimed as direct costs; (3) Similar types of costs have been accorded consistent accounting treatment; and (4) The information provided by the organization which was used to establish the rates is not later found to be materially incomplete or inaccurate by the Federal Government. In such situations the rate(s} would be subject to renegotiation at the discretion of the Federal Government.
B. | ACCOUNTING CHANGES:
This Agreement is based on the accounting system purported by the organization to be in effect during the Agreement period. Changes to the method of accounting for costs which affect the amount of reimbursement resulting from the use of this Agreement require prior approval of the authorized representative of the cognizant agency. Such changes include, but are not limited to, changes in the charging of a particular type of cost from indirect to direct. Failure to obtain approval may result in cost disallowances.
C. FIXED RATES:
If a fixed rate is in this Agreement, it is based on an estimate of the costs for the period covered by the rate. When the actual costs for this period are determined, an adjustment will be made to a rate of a future year(s) to compensate for the difference between the costs used to establish the fixed rate and actual costs.
D. USE BY OTHER FEDERAL AGENCIES:
The rates in this Agreement were approved in accordance with the authority in Title 2 of the Code of Federal Regulations, Part 200 (2 CFR 200), and should be applied to grants, contracts and other agreements covered by 2 CFR 200, subject to any limitations in A above. The organization may provide copies of the Agreement to other Federal Agencies to give them early notification of the
Agreement.
E. OTHER:
If any Federal contract, grant or other agreement is reimbursing indirect costs by a means other than the approved rate(s) in this Agreement, the organization should (1) credit such costs to the affected programs, and (2) apply the approved rate(s) to the appropriate base to identify the proper amount of indirect costs allocable to these programs.
BY THE INSTITUTION: ON BEHALF OF THE GOVERNMENT:
West Virginia Department of Health & Human Resources DEPARTMENT OF HEALTH AND HUMAN SERVICES INSTITUTION) (AGENCY) Diels s-Us GonunmentoucHHS, ou=FSC
: Darryl W. Mayes -S corteowl 182342192020 1001 R203,
\ j 1 Date: 2023 07.03 9:41:50 -0¢0 (SIGNATURE (SIGNATURE)
“Tov, L Ruck ner Darryl W, Mayes
(NAME) (NAME)
Chick Gndnyal OE: Cor Deputy Director, Cost Allocation Services
(TITLE) (TITLE)
W171 20%3 06/29/2023
(DATED i} (DATE)
HHS REPRESENTATIVE: Pamela Page TELEPHONE: (212) 264-2069
Page 4 of 4 G37449
MILK-BASED INFANT FORMULA PRODUCT NAME SIZE/FORM SKU BY UNIT WHOLESALE PRICE PER UNIT REBATE PER UNIT NET COST PER UNIT PERCENT DISCOUNT WHOLESALE PRICE PER UNIT REBATE PER UNIT NET COST PER UNIT PERCENT DISCOUNT WHOLESAL E PRICE PER UNIT REBATE PER UNIT NET COST PER UNIT % Change in NET COST Similac Advance 13 oz. Liquid Concentrate 56974 $4.69 5.670
(0.980)
120.90% $4.69 5.670
(0.980)
120.90% $0.00 -
-
0.00% Similac Advance 12.4 oz. Powder 55958 $16.34 19.150
(2.810)
117.20% $17.16 19.970
(2.810)
116.38% $0.82 0.820
-
0.00% Similac Advance 32 oz. Ready to Feed 53364 $8.31 6.230
2.080
74.97% $8.80 6.720
2.080
76.36% $0.49 0.490
-
0.00% Similac 360TC 32 oz. Ready to Feed 68146 $10.04 7.663
2.377
76.32% $10.04 7.663
2.377
76.32% $0.00 -
-
0.00% Similac 360TC 8 oz. Ready to Feed* 68140 $17.38 13.359
4.021
76.86% $17.38 13.359
4.021
76.86% $0.00 -
-
0.00% Similac Sensitive 12.5 oz. Powder 57541 $16.82 19.630
(2.810)
116.71% $18.27 21.080
(2.810)
115.38% $1.45 1.450
-
0.00% Similac Sensitive 32 oz. Ready To Feed 57534 $8.31 6.230
2.080
74.97% $8.80 6.720
2.080
76.36% $0.49 0.490
-
0.00% Similac 360TC Sensitive 32 oz. Ready to Feed 68161 $10.04 7.663
2.377
76.32% $10.04 7.663
2.377
76.32% $0.00 -
-
0.00% Similac 360TC Sensitive 8 oz. Ready to Feed* 68159 $17.38 13.359
4.021
76.86% $17.38 13.359
4.021
76.86% $0.00 -
-
0.00% Similac Total Comfort 12.6 oz.Powder 62600 $16.82 19.740
(2.920)
117.36% $18.27 21.190
(2.920)
115.98% $1.45 1.450
-
0.00% SOY-BASED INFANT FORMULA PRODUCT NAME SIZE/FORM SKU BY UNIT WHOLESALE PRICE PER UNIT REBATE PER UNIT NET COST PER UNIT PERCENT DISCOUNT WHOLESALE PRICE PER UNIT REBATE PER UNIT NET COST PER UNIT PERCENT DISCOUNT WHOLESAL E PRICE PER UNIT REBATE PER UNIT NET COST PER UNIT % Change in NET COST Similac Soy Isomil 13 oz. Liquid Concentrate 56976 $5.03 4.970
0.060
98.81% $5.03 4.970
0.060
98.81% $0.00 -
-
0.00% Similac Soy Isomil 12.4 oz. Powder 55964 $17.67 16.170
1.500
91.51% $19.06 17.560
1.500
92.13% $1.39 1.390
-
0.00% Similac Soy Isomil 32 oz. Ready To Feed 55968 $9.13 5.970
3.160
65.39% $9.61 6.450
3.160
67.12% $0.48 0.480
-
0.00% Primary Contract Infant Formulas are shown in BOLD Abbott will continue to pay rebates on this item until further notice * SKU by pack: 6 units per pack CURRENT CONTRACT PRICING CURRENT CONTRACT PRICING CONTRACT PRICING Effective July 1st, 2024 CONTRACT PRICING Effective July 1st, 2024 NASPO WIC CONTRACT PRICING ABBOTT NUTRITION Price Increase in Market effective on June 1st, 2024; Rebate increase effective on July 1st, 2024 (Per Contract) CONTRACT PRICING Change CONTRACT PRICING Change
Appendix VII (A) VII. Caseload Management Caseload Allocation Methodology For the 2025 caseload allocation, the State will look at the last three years’ average caseload of each Local Agency and weight the averages at .5 for FY 2024, .3 for FY 2023 and .2 for FY 2022. This figure will then be assigned to the Local Agency for the FY 2025.
Clinic Name and Site Number Address Fayette #01101 1822 East Main Street Logan #01231 20 Forutne Street Mcdowell # 01242 17 Mcdowell Street Mercer #01281 (Main Office) 286 Blue Price Road Mingo #01301 114 Grace Street Monroe #01321 108 Black Valley Road Raleigh #01411 1600 Harper Road Summers #01451 312 3rd Avenue Wyoming #01551 Route 10, Main Street *Parent site in bold
TSN WIC PROGRAM DIRECTORY City, State, Zip Phone Fax Oak HIll, WV, 25901 304-465-5314 304-465-5316 Logan, WV, 25601 304-752-5400 304-752-9102 Welch, WV, 24801 304-436-6122 304-436-6125 Bluefield, WV, 24701 304-325-3922 304-325-3935 Delbarton, WV, 25670 3044752295 3044752853 Lindside, WV, 24951 304-753-5582 304-753-5584 Beckley, Wv, 25801 304-255-9034 304-255-9034 Hinton, WV 25951 304-446-5900 304-455-6470 Oceana, WV, 24870 304-682-0475 304-682-0477 STAFF:
Email Hours fayettewic@wv.gov M-Th 8:00am-6:00pm loganwic@wv.gov Thu 7:30am-5:30pm F 8:00am-4:00pm mcdowellwic@wv.gov M-Thu 7:30a-5:30pm mercerwic@wv.gov M-Thu 8:00am-6:00Pm mingowic@wv.gov M-Thu 7:30am-3:30pm monroewic@wv.gov Tues and Thur7:30am-5:30pm raleighwic@wv.gov M-Thu 7:30a-5:30pm summerswic@wv.gov Mon and Wed 7:30am-5:30pm wyomingwic@wv.gov M-Thu 7:30a-5:30pm
2018 2019 2020 2021 WV County Children Women Both Children Women Both Children Women Both Children Women Both Children Barbour 320 74 394 314 99 413 293 77 370 303 76 379 291 Berkeley 1774 601 2375 1806 579 2385 1820 558 2378 1842 597 2439 1957 Boone 383 115 498 356 118 474 367 163 530 355 124 479 359 Braxton 309 63 372 284 58 342 235 61 296 223 54 277 215 Brooke 285 96 381 293 97 390 296 83 379 281 70 351 260 Cabell 1946 505 2451 1915 534 2449 1930 492 2422 1908 461 2369 1866 Calhoun 164 39 203 153 33 186 134 33 167 129 42 171 131 Clay 239 65 304 228 68 296 203 71 274 194 62 256 190 Doddridge 99 30 129 93 31 124 87 31 118 80 37 117 81 Fayette 944 133 1077 889 193 1082 819 185 1004 788 165 953 784 Gilmer 88 28 116 89 33 122 84 36 120 86 27 113 94 Grant 210 66 276 200 73 273 185 67 252 190 50 240 174 Greenbrier 681 139 820 655 178 833 610 147 757 609 148 757 585 Hampshire 363 109 472 345 117 462 343 119 462 347 115 462 371 Hancock 387 115 502 373 115 488 370 108 478 358 115 473 328 Hardy 304 91 395 312 70 382 316 79 395 305 68 373 308 Harrison 1142 306 1448 1126 329 1455 1068 292 1360 1054 307 1361 1054 Jackson 507 143 650 503 138 641 482 146 628 483 139 622 539 Jefferson 601 186 787 576 191 767 566 205 771 554 177 731 549 Kanawha 3110 991 4101 3012 923 3935 2962 965 3927 2845 939 3784 2756 Lewis 310 99 409 310 102 412 315 103 418 307 102 409 308 Lincoln 482 124 606 473 126 599 475 131 606 464 127 591 431 Logan 858 193 1051 814 228 1042 818 209 1027 807 204 1011 747 Marion 949 226 1175 941 240 1181 920 234 1154 906 232 1138 519 Marshall 503 128 631 484 124 608 465 110 575 447 110 557 869 Mason 501 153 654 482 119 601 450 140 590 418 116 534 426 McDowell 579 120 699 533 136 669 549 121 670 507 125 632 396 Mercer 1395 413 1808 1350 402 1752 1335 394 1729 1288 397 1685 1260 Mineral 354 102 456 346 99 445 336 109 445 332 119 451 348 Mingo 723 174 897 702 197 899 673 207 880 664 168 832 660
Monongalia 1663 296 1959 1625 308 1933 1578 282 1860 1561 315 1876 1523 Monroe 237 53 290 250 41 291 226 68 294 217 58 275 234 Morgan 189 63 252 179 82 261 171 69 240 173 65 238 167 Nicholas 495 68 563 462 80 542 437 105 542 410 88 498 381 Ohio 672 160 832 664 143 807 652 142 794 634 163 797 622 Pendleton 115 18 133 109 30 139 102 29 131 109 31 140 89 Pleasants 108 28 136 107 24 131 113 26 139 109 24 133 112 Pocahontas 167 30 197 160 32 192 151 37 188 146 32 178 150 Preston 493 157 650 482 157 639 482 118 600 485 129 614 436 Putnam 700 193 893 657 231 888 635 218 853 631 198 829 623 Raleigh 1561 160 1721 1517 235 1752 1528 302 1830 1503 194 1697 1403 Randolph 491 143 634 479 147 626 456 162 618 456 130 586 454 Ritchie 179 50 229 183 48 231 159 43 202 159 40 199 165 Roane 314 81 395 296 91 387 306 89 395 304 82 386 301 Summers 197 45 242 186 47 233 177 58 235 175 41 216 178 Taylor 290 71 361 268 81 349 259 70 329 231 76 307 259 Tucker 80 30 110 74 28 102 70 23 93 65 25 90 61 Tyler 125 44 169 116 32 148 106 46 152 101 37 138 112 Upshur 517 124 641 500 136 636 484 121 605 465 128 593 440 Wayne 736 215 951 691 221 912 672 207 879 650 203 853 680 Webster 202 45 247 192 44 236 188 40 228 186 36 222 154 Wetzel 318 79 397 309 91 400 298 77 375 297 81 378 271 Wirt 110 37 147 102 41 143 95 28 123 95 31 126 98 Wood 1545 455 2000 1491 393 1884 1452 362 1814 1410 350 1760 1393 Wyoming 460 67 527 435 96 531 452 83 535 457 99 556 442 Total 32471 8339 40810 31490 8609 40099 30752 8481 39233 30104 8129 38233 29602 See file named WV WIC Eligible Population Methodology 2024 for more details about data sources
2022 2018-2022 Women Both Children Women Both 94 385 1520 420 1941 608 2565 9199 2943 12142 137 496 1821 657 2477 61 277 1266 297 1563 63 323 1415 409 1824 478 2344 9565 2470 12035 34 165 711 181 892 49 240 1054 315 1369 27 108 439 156 595 152 937 4225 828 5053 22 116 441 146 587 57 231 959 313 1272 146 731 3139 758 3897 102 473 1770 562 2332 82 410 1816 535 2351 74 382 1545 382 1927 273 1327 5444 1507 6951 146 685 2514 712 3226 166 715 2847 925 3772 875 3631 14684 4693 19377 103 411 1549 509 2058 124 555 2325 632 2957 222 969 4044 1056 5100 116 634 4234 1048 5281 224 1093 2769 696 3465 145 571 2276 673 2949 108 504 2565 610 3175 377 1637 6627 1983 8610 95 444 1715 524 2239 182 842 3422 928 4350
293 1816 7951 1494 9445 64 298 1164 284 1448 56 223 879 335 1214 72 453 2185 413 2598 160 783 3244 768 4012 21 110 523 129 652 25 137 549 127 676 43 193 774 174 948 135 571 2378 696 3073 174 797 3245 1014 4259 199 1602 7511 1090 8601 139 593 2335 721 3057 38 203 845 219 1064 64 365 1522 407 1929 38 216 913 229 1142 77 336 1306 375 1681 29 90 351 135 486 38 150 560 197 757 115 555 2406 624 3030 211 891 3429 1057 4486 31 185 921 196 1117 78 349 1492 406 1898 31 129 500 168 668 327 1720 7291 1887 9178 86 528 2246 431 2677 7886 37488 154419 41444 195864
WV WIC Eligible Population Methodology, 2024 Estimate of Eligible Mothers 1. Determine the percentage of each WV county population that is below 185% of the Federal Poverty Level. Current percentages were taken from the 2018-2022 American Community Survey estimates provided online by the Census Bureau (Table S1701: Poverty Status in the Past 12 Months). 2. Determine the number of births among WV residents in each county that were paid for by Medicaid. Yearly numbers are extracted from the birth certificate data collected by the WV Health Statistics Center. 3. Determine the number of births among WV residents in each county that have an unknown payer. Yearly numbers are extracted from the birth certificate data collected by the WV Health Statistics Center. 4. Multiply #1 and #3 for each county to get the remaining eligible births with an unknown payer. 5. Add the results of #2 and #4 for each county. This is the number of mothers that are WIC eligible. Estimate of Eligible Infants and Children Ages 0-4 1. Determine the percentage of each WV county population that is below 185% of the Federal Poverty Level. Current percentages were taken from the 2018-2022 American Community Survey estimates provided online by the Census Bureau (Table S1701: Poverty Status in the Past 12 Months). 2. Determine the estimated population of WV infants and children less than 5 years of age in each county. Current population estimates of WV residents by county and age groups are available yearly from the Census Bureau (cc-est2022-agesex-54). Please note that this methodology changed in 2023 due to NCHS no longer providing single year of age bridged-race population estimates by county.) 3. Multiply #1 and #2 for the age group in each county. This is the number of infants and children aged less than 5 in each county that are WIC eligible.
Recommendations Since percentages shouldn’t be averaged together, the standard deviation isn’t used here. It should also be noted that the outliers are rather far out from the top and bottom of the group. In the above chart, each box represents a county. The graph starts at 42% and goes to 275%, giving us the minimum and maximum for our group. Each column can be viewed as a “bin” or a group of “like numbers.” Meaning anything within 5% of the minimum and maximum percentage. The lowest 3 counties and the highest 3 counties were grouped together. It should be noted, however, that we have two counties that are outliers (the boxes to the far right and the left). By doing this, we can create a more normal looking curve, but it is important to note that this is still not a normal curve. When examining the above chart and by looking at the median for state potentially eligible served (94.29%) it would be recommended that the line of 70% of potentially eligible served. That leaves 6 counties who need to meet that goal, however, two counties are very close to this goal (less than 10%). Below is a list of the 6 counties and an estimate of how many new participants they would need in order to meet the 70% mark. Given that the majority of the counties are above 55% and the counties that are not are relatively close with the exception of a couple, this is a reachable goal. It is important to note that most counties are within the 86% to 100% range of the PEP served, this is only representing those that receive Medicaid. Please refer to the WV WIC Eligible Population Methodology for more information. These potentially eligible numbers are Medicaid PEP, not whole population PEP.
Barbour PEP Served-54.78% # of participants needed-60 Calhoun PEP Served-67.43% # of participants needed-5 Mingo PEP Served-59.76% # of participants needed- 90 Monroe PEP Served-46.34% # of participants needed- 71 Pendleton PEP Served-62.41% # of participants needed-10 Pocahontas PEP Served-42.48% # of participants needed- 55
Unduplicated Count for FY2023 Pregnant BF Postpart Site Total Women Women Women Child Infants Families 01101 1331 192 44 100 638 357 801 01231 1383 209 32 153 531 458 773 01242 756 121 19 64 333 219 434 01281 2351 417 47 220 914 753 1308 01301 823 134 15 79 341 254 450 01321 246 37 14 20 103 72 143 01411 2209 345 104 194 865 701 1207 01451 306 52 9 13 150 82 175 01551 607 90 14 66 234 203 346 Tot 01 10012 1597 298 909 4109 3099 5637 02040 504 70 24 35 236 139 291 02080 428 64 15 25 220 104 259 02130 1483 230 110 94 602 447 801 02340 1035 150 49 51 497 288 594 02380 128 17 8 8 53 42 69 02510 249 39 11 11 118 70 156 Tot 02 3827 570 217 224 1726 1090 2170 03091 145 23 7 7 76 32 85 03172 2300 343 116 132 1060 649 1323 03251 1834 255 105 103 897 474 1079 03311 2089 314 146 130 881 618 1216 03391 745 125 26 54 312 228 428 03461 373 58 14 26 167 108 218 Tot 03 7486 1118 414 452 3393 2109 4349 05012 303 54 10 15 148 76 186 05121 939 125 46 48 475 245 522 05161 401 74 20 20 178 109 236 05211 608 82 39 48 256 183 358 05361 79 17 6 4 29 23 44 05421 1351 195 59 97 620 380 769 05471 145 21 11 8 69 36 83 05491 876 158 38 49 379 252 491
Tot 05 4702 726 229 289 2154 1304 2689 06021 3669 478 220 254 1665 1052 2057 06141 846 124 45 44 408 225 482 06191 1158 146 48 88 554 322 658 06291 864 126 36 50 405 247 497 06331 421 55 25 19 207 115 250 Tot 06 6958 929 374 455 3239 1961 3944 08051 441 72 17 29 198 125 263 08151 858 122 38 64 374 260 481 08261 900 155 31 69 367 278 523 08351 1041 162 53 88 411 327 604 08521 791 128 21 62 333 247 439 Tot 08 4031 639 160 312 1683 1237 2310 09070 173 32 8 16 66 51 101 09110 148 33 3 10 62 40 87 09181 979 145 35 71 439 289 557 09271 879 129 20 83 371 276 509 09371 210 33 9 12 98 58 122 09431 265 30 9 13 140 73 139 09441 563 92 24 28 268 151 325 09531 199 17 6 14 109 53 119 09541 2768 425 135 200 1192 816 1601 Tot 09 6184 936 249 447 2745 1807 3560 11031 740 112 30 60 321 217 436 11061 3497 531 152 251 1548 1015 2053 11201 5739 804 313 389 2562 1671 3364 11202 687 86 30 48 316 207 390 11221 633 75 19 42 317 180 369 11401 1091 131 76 73 487 324 643 11501 892 143 28 65 395 261 506 11502 337 64 7 18 155 93 191 Tot 11 13616 1946 655 946 6101 3968 7952 State 56816 8461 2596 4034 25150 16575 32611
Code Condition Criteria Assigned 101 Pregnant BF NBF Underweight P: Pre-pregnancy Body Mass Index (BMI) < 18.5 N and B < 6 months postpartum: Pre-pregnancy or current BMI < 18.5 B > or = to 6 months postpartum: Current BMI < 18.5 System Assigned 103 Infant Child Underweight I and C (< 24 months): < or = to 2.3rd percentile weight-for-length C (2-5 years): < or = to 5th percentile BMI-for-age At Risk of Underweight I and C (< 24 months): >2.3rd percentile weight-for-length and < or = to 5th percentile weight-for-length C (2-5 years): >5th percentile and < or = to 10th percentile Body Mass Index (BMI)-for-age System Assigned High-risk I: < 2.3rd percentile weight-for-length C: < 2.3rd percentile weight-for-length (< 24 months of age) C: < 5th percentile BMI for age (2-5 years) 111 Pregnant BF NBF Overweight P: Pre-pregnancy Body Mass Index (BMI) > or = to 25 N and B < 6 months postpartum: Pre-pregnancy BMI > or = to 25 B > or = to 6 months postpartum: Current BMI > or = to 25 System Assigned 113 Child (2-5 yr.) Obese (Children 2 to 5 years of age) C: > or = to 95th percentile BMI or > or = to 95th percentile or weight-for- stature System Assigned 114 Infant Child Overweight C (2 to 5 years): > or = to 85th percentile and < 95th percentile BMI or weight-for-stature At Risk of Overweight I (<12 mo. of age): born to a woman who was obese (BMI > or = to 30) at the time of conception or at any time in the 1st trimester of pregnancy I (<12 mo. of age): biological mother/father is obese (BMI > or = to 30) at time of certification (BMI is based on self-reported weight/height) C (> or = to 12 months of age): biological mother/father who is obese (BMI > or = to 30) at time of certification (BMI is based on self-reported weight/height). System or CPA Assigned 115 Infant Child (<24 m) High Weight-for-Length I: > or = to 97.7th percentile weight-for-length C (< 24 months): > or = to 97.7th percentile weight-for-length System Assigned 121 Infant Child Short Stature I: < or = to 2.3rd percentile length-for-age System Assigned Effective 8/2020
Code Condition Criteria Assigned 121 (cont.) Infant Child (cont.) C (< 24 months): < or = to 2.3rd percentile length-for-age C: < or = to 5th percentile stature-for-age (2-5 years) At Risk of Short Stature I: > 2.3rd percentile and < or = to 5th percentile length-for-age C (< 24 months): 2.3rd percentile and < or = to 5th percentile length-for-age C: > 5th percentile and < or = to 10th percentile stature-for-age (2-5 years) 131 Pregnant Low Maternal Weight Gain Low rate of weight gain in the 2nd and 3rd trimesters, singleton pregnancy: ● underweight < 1 lb. per week ● normal weight < 0.8 lb. per week ● overweight < 0.5 lb. per week ● obese < 0.4 lb. per week Or low weight gain at any point in the pregnancy (weight gain charts) System or CPA Assigned High-risk 133 Pregnant BF NBF High Maternal Weight Gain High rate of weight gain in the 2nd and 3rd trimesters, singleton pregnancy: ● underweight > 1.3 lbs. per week ● normal weight > 1 lb. per week ● overweight > 0.7 lb. per week ● obese > 0.6 lb. per week Or high weight gain at any point in pregnancy (weight gain charts) System or CPA Assigned 134 Infant Child Failure to Thrive* (*Presence of disease or disorder diagnosed by physician as self-reported by applicant/participant/caregiver; or as reported by a physician, or someone working under a physician’s orders.) CPA Assigned High-risk 135 Infant (<6 m) Slowed/Faltering Growth Pattern I: Birth to 2 weeks: excessive weight loss after birth; defined as > or = 7% birth weight. I: 2 weeks to 6 months of Age: Any weight loss. Use two separate weight measurements taken at least eight weeks apart. System Assigned High-risk 141 Infant Child (<24 m) Low Birth Weight I: < or = to 5 lbs. 8 oz. (< or = to 2,500 g) C (< 24 months): < or = to 5 lbs. 8 oz. (< or = to 2,500 g) Very Low Birth Weight I: < or = to 3 lbs. 5 oz. (< or = to 1,500 g) C (< 24 months): < or = to 3 lbs. 5 oz. (< or = to 1,500 g) System Assigned High-risk if <24 months-old and birth weight <5 pounds 8 ounces 142 Infant Child (<24 m) Preterm Delivery System Assigned Effective 8/2020
Code Condition Criteria Assigned Delivery of an infant born < or = 36 6/7 weeks gestation Early Term Delivery Delivery of an infant born > or = 37 0/7 and < or = 38 6/7 weeks gestation. 151 Infant Child (<24 m) Small for Gestational Age* (*Presence of disease or disorder diagnosed by physician as self-reported by applicant/participant/caregiver; or as reported by a physician, or someone working under a physician’s orders.) System or CPA Assigned 153 Infant Large for Gestational Age* Birth weight > or = to 9 lbs. (> or = to 4,000 g) (*Presence of disease or disorder diagnosed by physician as self-reported by applicant/participant/ caregiver; or as reported by a physician, or someone working under a physician’s orders.) CPA Assigned 201 Pregnant BF NBF Infant Child Low Hematocrit/Low Hemoglobin Pregnant: Non-Smoking Smoking 1 up to 2 packs per day < 11.0 hgb (0-13 w) < 11.5 hgb (0-13 w) < 10.5 hgb (14-26 w) < 11.0 hgb (14-26 w) < 11.0 hgb (27-40 w) < 11.5 hgb (27-40 w) Smoking up to <1 pack per day Smoking 2 packs plus per day < 11.3 hgb (0-13 w) < 11.7 hgb (0-13 w) < 10.8 hgb (14-26 w) < 11.2 hgb (14-26 w) < 11.3 hgb (27-40 w) < 11.7 hgb (27-40 w) BF, NBF: Non-Smoking Smoking 1 up to 2 packs per day < 11.8 hgb 8 to < 12 y < 12.3 hgb 8 to < 12 y < 11.8 hgb 12 to < 15 y < 12.3 hgb 12 to < 15 y < 12.0 hgb 15 to < 18 y < 12.5 hgb 15 to < 18 y < 12.0 hgb ≥18 y < 12.5 hgb ≥18 y Smoking up to <1 pack per day Smoking 2 packs plus per day < 12.1 hgb/hct 8 to < 12 y < 12.5 hgb 8 to < 12 y < 12.1 hgb 12 to < 15 y < 12.5 hgb 12 to < 15 y < 12.3 hgb 15 to < 18 y < 12.7 hgb 15 to < 18 y < 12.3 hgb ≥18 y < 12.7 hgb/hct ≥18 y Infant/Child: System Assigned High-risk Pregnant: Non-smoking; smoking up to < 1 pack/day; smoking 1 up to 2 packs/day; smoking 2 packs/day + HR ≤10.0 hgb (0-40 w) 201 + 371 High risk Pregnant BF, NBF: Non-smoking; smoking up to < 1 pack/day; smoking 1 up to 2 packs/day; smoking 2 packs/day + HR ≤10.0 hgb Infant (6 to 12 months of age): HR: Hgb (g): < or = to 9.5 Effective 8/2020
Code Condition Criteria Assigned 6-12 months of age- Hgb (g): <11.0 12-23 months of age- Hgb (g): <11.0 24 months-5 years of age- Hgb (g): < 11.1 Child (12 months-5 years of age): HR: Hgb (g): < or = to 10.0 211 Pregnant BF, NBF Infant Child Elevated Blood Lead Levels > or = to 5 ug/dl within the past 12 months (documentation required) System Assigned 301 Pregnant Hyperemesis Gravidarum* (*Presence of disease or disorder diagnosed by physician as self-reported by applicant/participant/caregiver; or as reported by a physician, or someone working under a physician’s orders.) System or CPA Assigned 302 Pregnant Gestational Diabetes* (*Presence of disease or disorder diagnosed by physician as self-reported by applicant/participant/caregiver; or as reported by a physician, or someone working under a physician’s orders.) System or CPA Assigned High-risk 303 Pregnant BF NBF History of Gestational Diabetes* (*Presence of disease or disorder diagnosed by physician as self-reported by applicant/participant/caregiver; or as reported by a physician, or someone working under a physician’s orders.) P: any pregnancy; B, N; most recent pregnancy System or CPA Assigned High-risk 304 Pregnant BF NBF History of Preeclampsia* (*Presence of disease or disorder diagnosed by physician as self-reported by applicant/participant/caregiver; or as reported by a physician, or someone working under a physician’s orders.) System or CPA Assigned 311 Pregnant BF NBF History of Preterm Delivery*: < or = to 36 6/7 weeks gestation P: any pregnancy; B, N: most recent pregnancy History of Early Term Delivery*: > or = to 37 and < or = 38 6/7 weeks gestation P: any pregnancy; B, N: most recent pregnancy (*Presence of disease or disorder diagnosed by physician as self-reported by applicant/participant/caregiver; or as reported by a physician, or someone working under a physician’s orders.) System or CPA Assigned 312 Pregnant BF NBF History of Low Birth Weight*: < or = to 5 lbs. 8 oz. (< or = to 2,500 g) P: any pregnancy; B, N: most recent pregnancy (*Presence of disease or disorder diagnosed by physician as self-reported by applicant/participant/caregiver; or as reported by a physician, or someone working under a physician’s orders.) System or CPA Assigned 321 Pregnant BF History of Spontaneous Abortion, Fetal or Neonatal Loss*: System or CPA Assigned Effective 8/2020
Code Condition Criteria Assigned 321 (cont.) NBF Pregnant BF NBF Spontaneous abortion = spontaneous termination of a pregnancy at <20 weeks Fetal death = spontaneous termination of gestation at > or = 20 weeks Neonatal death = death of an infant within first 28 days of life P: any pregnancy fetal or neonatal death; 2 or more spontaneous abortions B: most recent pregnancy with multifetal gestation with one or more fetal or neonatal deaths but with one or more living infants N; most recent pregnancy with spontaneous abortion, fetal or neonatal death (*Presence of disease or disorder diagnosed by physician as self-reported by applicant/participant/caregiver; or as reported by a physician, or someone working under a physician’s orders.) 331 Pregnant BF NBF Pregnancy at a Young Age: Conception < or = to 17 years of age P: current pregnancy; B, N: most recent pregnancy System Assigned High-risk if < or = 15 years of age 332 Pregnant BF NBF Short Interpregnancy Interval Conception < 18 months postpartum P: current pregnancy; B, N: most recent pregnancy System or CPA Assigned 333 Pregnant BF NBF High Parity and Young Age Woman < 20 years of age and > or = to 3 previous pregnancies > or = to 20 weeks, regardless of birth outcome P: current pregnancy; B, N: most recent pregnancy System or CPA Assigned 334 Pregnant Lack of or Inadequate Prenatal Care Prenatal care begins after the 1st trimester (after 13th week) or first prenatal visit in 3rd trimester (27-40 weeks) or: 14-21 weeks: 0 or unknown visits 32-33 weeks: < or = 3 visits 22-29 weeks: < or = 1 visit 34+ weeks: < or = 4 visits 30-31 weeks: < or = 2 visits System Assigned 335 Pregnant BF, NBF Multi-fetal Gestation P: current pregnancy; B, N: most recent pregnancy System Assigned 336 Pregnant Fetal Growth Restriction* (*Presence of disease or disorder diagnosed by physician as self-reported by applicant/participant/caregiver; or as reported by a physician, or someone working under a physician’s orders.) CPA Assigned 337 Pregnant BF NBF History of Birth of a Large for Gestational Age Infant* birth of an infant > or = to 9 lbs. (4,000 g) P: any pregnancy; B, N: most recent pregnancy or history System or CPA Assigned Effective 8/2020
Code Condition Criteria Assigned (*Presence of disease or disorder diagnosed by physician as self-reported by applicant/participant/caregiver; or as reported by a physician, or someone working under a physician’s orders.) 338 Pregnant Pregnant Woman Currently Breastfeeding System Assigned I (< 12 months): mother gets fully BF package; I(> or = 12 months): mother gets pregnancy package 339 Pregnant BF NBF History of Birth with Nutrition Related Congenital or Birth Defect* (SPECIFY) P: any pregnancy; B, N: most recent pregnancy (*Presence of disease or disorder diagnosed by physician as self-reported by applicant/participant/caregiver; or as reported by a physician, or someone working under a physician’s orders.) System or CPA Assigned 341 Pregnant BF, NBF Infant Child Nutrient Deficiency Diseases* (SPECIFY) Including but not limited to: Protein Energy Malnutrition, Scurvy, Rickets, Beriberi, Hypocalcemia, Osteomalacia, Vitamin K Deficiency, Pellagra, Xerophthalmia, and Iron Deficiency. (*Presence of disease or disorder diagnosed by physician as self-reported by applicant/participant/caregiver; or as reported by a physician, or someone working under a physician’s orders.) System or CPA Assigned 342 Pregnant BF NBF Infant Child Gastrointestinal Disorders* Including but not limited to: Gastroesophageal reflux disease (GERD), post-bariatric surgery, inflammatory bowel disease, ulcerative colitis, Crohn’s disease, pancreatitis, peptic ulcer, short bowel syndrome, liver disease, biliary tract disease. (*Presence of disease or disorder diagnosed by physician as self-reported by applicant/participant/caregiver; or as reported by a physician, or someone working under a physician’s orders.) System or CPA Assigned 343 Pregnant BF, NBF Infant Child Diabetes Mellitus* (*Presence of disease or disorder diagnosed by physician as self-reported by applicant/participant/caregiver; or as reported by a physician, or someone working under a physician’s orders.) System or CPA Assigned 344 Pregnant BF NBF Infant Child Thyroid Disorders* Including but not limited to: Hyperthyroidism, congenital hyperthyroidism, hypothyroidism, congenital hypothyroidism, postpartum thyroiditis. System or CPA Assigned Effective 8/2020
Code Condition Criteria Assigned (*Presence of disease or disorder diagnosed by physician as self-reported by applicant/participant/caregiver; or as reported by a physician, or someone working under a physician’s orders.) 345 Pregnant BF, NBF Infant, Child Hypertension and Prehypertension* (*Presence of disease or disorder diagnosed by physician as self-reported by applicant/participant/caregiver; or as reported by a physician, or someone working under a physician’s orders.) System or CPA Assigned 346 346 (cont.) Pregnant BF, NBF Infant, Child Renal Disease* Does not include urinary tract infections involving the bladder. (*Presence of disease or disorder diagnosed by physician as self-reported by applicant/participant/caregiver; or as reported by a physician, or someone working under a physician’s orders.) System or CPA Assigned 347 Pregnant BF, NBF Infant, Child Cancer* (*Presence of disease or disorder diagnosed by physician as self-reported by applicant/participant/caregiver; or as reported by a physician, or someone working under a physician’s orders.) System or CPA Assigned 348 Pregnant BF NBF Infant Child Central Nervous System Disorders* Including but not limited to: Epilepsy, Cerebral Palsy, Neural Tube Defects, Parkinson’s Disease, Multiple Sclerosis. (*Presence of disease or disorder diagnosed by physician as self-reported by applicant/participant/caregiver; or as reported by a physician, or someone working under a physician’s orders.) System or CPA Assigned 349 Pregnant BF NBF Infant Child Genetic and Congenital Disorders* Including but not limited to: cleft lip or palate, Down’s Syndrome, Thalessemia Major, Sickle Cell Anemia, Muscular Dystrophy. (*Presence of disease or disorder diagnosed by physician as self-reported by applicant/participant/caregiver; or as reported by a physician, or someone working under a physician’s orders.) System or CPA Assigned 351 Pregnant BF NBF Infant Child Inborn Errors of Metabolism* Including but not limited to: Amino Acid Disorders, Carbohydrate Disorders, Fatty Acid Oxidation Disorders, Lysosomal Storage Diseases, Mitochondrial Disorders, Organic Acid Metabolism Disorders, Peroxisomal Disorders, Urea Cycle Disorders. (*Presence of disease or disorder diagnosed by physician as self-reported by applicant/participant/caregiver; or as reported by a physician, or someone working under a physician’s orders.) System or CPA Assigned 352a Pregnant Infectious Diseases – Acute* (present within the last 6 months) System or CPA Assigned Effective 8/2020
Code Condition Criteria Assigned BF NBF Infant Child Including but not limited to: Bronchitis (3 episodes in last 6 months), Hepatitis A, Hepatitis E, Listeriosis, Meningitis (Bacterial/Viral), Parasitic Infections, Pneumonia. (*Presence of disease or disorder diagnosed by physician as self-reported by applicant/participant/caregiver; or as reported by a physician, or someone working under a physician’s orders.) 352b 352b (cont.) Pregnant BF, NBF Infant, Child Infectious Diseases – Chronic* (likely lasting a lifetime) Including but not limited to: Acquired Immunodeficiency Syndrome (AIDS), Hepatitis B, Hepatitis C, Hepatitis D, Human Immunodeficiency Virus (HIV). (*Presence of disease or disorder diagnosed by physician as self-reported by applicant/participant/caregiver; or as reported by a physician, or someone working under a physician’s orders.) System or CPA Assigned 353 Pregnant BF, NBF Infant, Child Food Allergies* (SPECIFY) (*Presence of disease or disorder diagnosed by physician as self-reported by applicant/participant/caregiver; or as reported by a physician, or someone working under a physician’s orders.) System or CPA Assigned 354 Pregnant BF, NBF Infant, Child Celiac Disease* Including but not limited to: Celiac Sprue, Gluten Enteropathy, Non-tropical Sprue. (*Presence of disease or disorder diagnosed by physician as self-reported by applicant/participant/caregiver; or as reported by a physician, or someone working under a physician’s orders.) System or CPA Assigned 355 Pregnant BF, NBF Infant, Child Lactose Intolerance* (*Presence of disease or disorder diagnosed by physician as self-reported by applicant/participant/caregiver; or as reported by a physician, or someone working under a physician’s orders.) System or CPA Assigned 356 Pregnant BF, NBF Infant, Child Hypoglycemia* (*Presence of disease or disorder diagnosed by physician as self-reported by applicant/participant/caregiver; or as reported by a physician, or someone working under a physician’s orders.) System or CPA Assigned 357 Pregnant BF, NBF Infant, Child Drug Nutrient Interactions (SPECIFY) (*Presence of disease or disorder diagnosed by physician as self-reported by applicant/participant/caregiver; or as reported by a physician, or someone working under a physician’s orders.) System or CPA Assigned 358 Pregnant BF, NBF Eating Disorders (Anorexia Nervosa and Bulimia) * System or CPA Assigned Effective 8/2020
Code Condition Criteria Assigned (*Presence of disease or disorder diagnosed by physician as self-reported by applicant/participant/caregiver; or as reported by a physician, or someone working under a physician’s orders.) 359 Pregnant BF NBF Infant Child Recent Major Surgery, Trauma, Burns Major surgery (including C-sections), physical trauma or burns severe enough to compromise nutritional status. Within past 2 months: self-reported > 2 months – diagnosed by physician or health care provider under the orders of a physician System or CPA Assigned 360 Pregnant BF NBF Infant Child Other Medical Conditions* Including but not limited to: Cardiorespiratory Diseases, Cystic Fibrosis, Heart Disease, Juvenile Rheumatoid Arthritis (JRA), Lupus Erythematosus, Persistent Asthma (moderate or severe, requiring daily medication). (*Presence of disease or disorder diagnosed by physician as self-reported by applicant/participant/caregiver; or as reported by a physician, or someone working under a physician’s orders.) System or CPA Assigned 361 Pregnant BF NBF Child Depression* (*Presence of disease or disorder diagnosed by physician as self-reported by applicant/participant/caregiver; or as reported by a physician, or someone working under a physician’s orders.) System or CPA Assigned 362 Pregnant BF NBF Infant Child Developmental, Sensory or Motor Disabilities Interfering with the Ability to Eat Including but not limited to: Birth injury, Brain damage, Feeding problems due to pervasive developmental disorder (including autism), Head trauma, Minimal brain function, Other disabilities. System or CPA Assigned 363 BF, NBF Pre-Diabetes* (*Presence of disease or disorder diagnosed by physician as self-reported by applicant/participant/caregiver; or as reported by a physician, or someone working under a physician’s orders.) System or CPA Assigned 371 Pregnant BF, NBF Maternal Smoking Any smoking of tobacco products, pipes or cigars System Assigned Risk 201 + 371 = High-Risk 372 Pregnant BF, NBF Alcohol and Illegal Drug Use P: Any alcohol use Any illegal substance use and/or abuse of prescription medications System or CPA Assigned Effective 8/2020
Code Condition Criteria Assigned Any marijuana use in any form B, N: Alcohol use High risk drinking: consumption of > or = 8 drinks/week OR > or = 4 drinks on any day drinks/day; Binge drinking: routine consumption of > or = 4 drinks within 2 hours B, N: Any illegal substance use and/or abuse of prescription medications; B, N: Any marijuana use in any form 381 381 (cont.) Pregnant BF, NBF Infant Child Dental Problems* (SPECIFY) (*Presence of disease or disorder diagnosed by physician as self-reported by applicant/participant/caregiver; or as reported by a physician, or someone working under a physician’s orders.) System or CPA Assigned 382 Infant Child Fetal Alcohol Syndrome* (*Presence of disease or disorder diagnosed by physician as self-reported by applicant/participant/caregiver; or as reported by a physician, or someone working under a physician’s orders.) System or CPA Assigned 383 Infant Neonatal Abstinence Syndrome This condition must be present within the first 6 months of birth and diagnosed, documented, or reported by a physician or someone working under a physician’s orders, or as self-reported by the infant’s caregiver. CPA Assigned 401 Pregnant BF NBF Child (2 – 5 years) Failure to Meet Dietary Guidelines for Americans (This risk may be assigned only to individuals whom a complete nutrition assessment has been performed to include an assessment for all risks under Inappropriate Nutrition Practices for Women and for whom no other risk(s) are identified.) System or CPA Assigned 411 Infant Inappropriate Nutrition Practices for Infants (SPECIFY BY THE FOLLOWING): 411.1 Infant Routinely using a substitute(s) for breast milk or FDA approved iron fortified formula as the primary nutrient source during the 1st year of life System or CPA Assigned 411.2 Infant Routinely using nursing bottles or cups improperly System or CPA Assigned 411.3 Infant Routinely offering complementary foods or other substances that are inappropriate in type or timing System or CPA Assigned 411.4 Infant Routinely using feeding practices that disregard the developmental needs or stage of the infant System or CPA Assigned 411.5 Infant Feeding foods to an infant that could be contaminated with harmful microorganisms or toxins System or CPA Assigned Effective 8/2020
Code Condition Criteria Assigned 411.6 Infant Routinely feeding inappropriately diluted formula System or CPA Assigned 411.7 Infant Routinely limiting the frequency of nursing of the exclusively breastfed infant when breast milk is the sole source of nutrients. Examples of inappropriate frequency of nursing: ● Scheduled feedings instead of demand feedings. ● Less than 8 feedings in 24 hours if less than 2 months of age, System or CPA Assigned 411.8 Infant Routinely feeding a diet very low in calories and/or essential nutrients System or CPA Assigned 411.9 Infant Routinely using inappropriate sanitation in preparation, handling, and storage of expressed breast milk or formula System or CPA Assigned 411.10 Infant Feeding dietary supplements with potentially harmful consequences System or CPA Assigned 411.11 Infant Routinely not providing dietary supplements as essential by National Public Health Policy when an infant’s diet alone cannot meet nutrient requirements System or CPA Assigned 425 Child Inappropriate Nutrition Practices for Children (SPECIFY BY THE FOLLOWING): 425.1 Child Routinely feeding inappropriate beverages as the primary milk source System or CPA Assigned 425.2 Child Routinely feeding a child any sugar containing fluids System or CPA Assigned 425.3 Child Routinely using nursing bottles, cups, or pacifiers improperly System or CPA Assigned 425.4 Child Routinely using feeding practices that disregard the developmental needs or stages of the child System or CPA Assigned 425.5 Child Feeding foods to a child that could be contaminated with harmful microorganisms System or CPA Assigned 425.6 Child Routinely feeding a diet very low in calories and/or essential nutrients System or CPA Assigned 425.7 Child Feeding dietary supplements with potentially harmful consequences System or CPA Assigned 425.8 Child Routinely not providing dietary supplements recognized as essential by the National Public Health Policy when a child’s diet alone cannot meet nutrient requirements System or CPA Assigned 425.9 Child Routine ingestion of non-food items (Pica) System or CPA Assigned 427 Pregnant, BF, NBF Inappropriate Nutrition Practices for Women (SPECIFY BY THE FOLLOWING) 427.1 Pregnant BF, NBF Consuming dietary supplements with potentially harmful consequences System or CPA Assigned 427.2 Pregnant BF, NBF Consuming a diet very low in calories and/ or essential nutrients; or impaired caloric intake or absorption of essential nutrients following bariatric surgery System or CPA Assigned 427.3 Pregnant BF, NBF Compulsively ingesting non-food items (Pica) System or CPA Assigned 427.4 Pregnant BF, NBF Inadequate vitamin/mineral supplementation recognized as essential by National Public Health Policy System or CPA Assigned Effective 8/2020
Code Condition Criteria Assigned 427.5 Pregnant Pregnant women ingesting foods that could be contaminated with pathogenic microorganisms System or CPA Assigned 428 Infant (4-12 m) Child (<24 m) Dietary Risk Associated with Complimentary Feeding Practices I: > or = to 4 months (A complete nutrition assessment for inappropriate nutrition practices for infants must be completed prior to assigning this risk). C: <24 months (A complete nutrition assessment for inappropriate nutrition practices for children must be completed prior to assigning this risk). System or CPA Assigned 501 BF NBF Children Possibility of Regression B: Priority I and Priority IV N: Priority III and Priority IV Use only once for sub-certification, (document reason in care plan note) C: Priority III and Priority V Use only once for sub-certification (document reason in individual care plan note) CPA Assigned 502 502 (cont.) Pregnant BF, NBF Infant Child Transfer of Certification System Assigned 601 BF Breastfeeding Mother of an Infant at Nutritional Risk Priority I (at-risk infant must be priority I) Priority II (at-risk infant must be priority II) Priority IV (at-risk infant must be priority IV) System or CPA Assigned 602 BF Breastfeeding Complications or Potential Complications (Women): Severe breast engorgement; Cracked, bleeding or severely sore nipples; Recurrent plugged ducts; Age > or = 40; mastitis; Failure of milk to come in by 4 days postpartum; Flat or inverted nipples; Tandem nursing System or CPA Assigned 603 Infant Breastfeeding Complications or Potential Complications (Infants): Jaundice; Difficulty latching onto mother’s breast; Weak or ineffective suck; Inadequate stooling for age and/or less than 6 wet diapers/day System or CPA Assigned 701 Infant Infant Up to 6 Months Old of WIC Mother or Would Have Been Eligible During Pregnancy System or CPA Assigned 702 Infant Breastfeeding Infant of Woman at Nutritional Risk Priority I (At-risk mother must be Priority I) System Assigned Effective 8/2020
Code Condition Criteria Assigned Priority II (At-risk mother must be Priority II) Priority IV (At-risk mother must be Priority IV) 801 Pregnant BF, NBF Infant Child Homelessness Includes: a supervised publicly or privately-operated shelter (including a welfare hotel or congregate shelter or domestic violence shelter); institutional residence that is temporary; temporary residence with another individual (not > 365 days); public or private place not designed for sleeping accommodation. System Assigned 802 Pregnant BF, NBF Infant Child Migrancy Includes: families that have one individual whose principal employment is in agriculture on a seasonal basis and has been so employed within the last 24 months and has a temporary abode. System Assigned 901 Pregnant BF, NBF Infant Child Recipient of Abuse Battering; child abuse/neglect within past 6 months (state law requires the reporting of known or suspected child abuse or neglect) System or CPA Assigned 902 Pregnant BF, NBF Infant Child Woman or Infant/Child of Primary Caregiver with Limited Ability to Make Feeding Decisions and/or Prepare Food Woman/primary caregiver < or = to 17 years of age; mentally disabled/delayed and/or a mental illness; physical disability which restricts or limits food preparation abilities or current abuse of alcohol or other drugs System or CPA Assigned 903 Pregnant BF, NBF Infant Child Foster Care System or CPA Assigned 904 Pregnant BF, NBF Infant Child Environmental Tobacco Smoke Exposure Exposure to smoke from tobacco products inside the home (also known as passive, secondhand or involuntary smoke.) System Assigned *Presence of disease or disorder diagnosed by physician as self-reported by applicant/participant/caregiver; or as reported by a physician, or someone working under a physician’s orders. Effective 8/2020
1 Crossroads – CTad- Woman New Family/Family Demographics Screen (fill-out once for entire family) Parent/Guardian1 Participant Last Name: __________________________________________First Name: __________________________________M.I._________ Proof of Identification: ___________________________________SSN: ______________________ DOB: ______________________ Marital Status: _____________________________________ Education Level: ____________________________________________ Parent/Guardian2 Last Name: __________________________________________First Name: __________________________________M.I._________ Proof of Identification: ___________________________________SSN: ______________________ DOB: ______________________ Marital Status: _____________________________________ Education Level: ____________________________________________ Caretaker Last Name: __________________________________________First Name: __________________________________M.I._________ Proof of Identification: ___________________________________ SSN: _____________________ DOB: _______________________ Marital Status: ____________________________________ Education Level: ____________________________________________ Physical Address: Street: _____________________________________________________________________________________________________ Street 2: ____________________________________________________________________________________________________ ZIP: ________________________ City: _________________________________ State: _______ County: ______________________ Proof of Residence: ___________________________________________________________________________________________ Homeless/Incarcerated Status: _____________________________________Migrant Status: ________________________________ Mailing Address: Street: ______________________________________________________________________________________________________ Street 2: ____________________________________________________________________________________________________ ZIP: ______________________ City: __________________________________ State: _______ County: _______________________ Telephones: Voter Registration: Telephone Number: __________________ Type: H, C, W, F, M Primary: _______Carrier: _______________________ Telephone Number: __________________ Type: H, C, W, F, M Primary: _______Carrier: _______________________ Military Status – Non-military, National Guard, Active Confidentiality: Communication Options: Language Read: ______________ Language Spoken: __________________ Interpreter Sign Language Interpreter Email Address: _____________________________________ Preferred Method of Contact: ________________________________ Family Assessment Screen (fill-out once for entire family) 1. Does anyone smoke inside your house? Yes
No 2. Has adequate household food storage and preparation? Yes No 3. Has household food insecurity? Yes No 4. Source of drinking water? City Not Sure Well Cistern Spring Other Where did you hear about WIC? ________________________________________ 37433_WIC_Ctad_FIN2.indd 1 37433_WIC_Ctad_FIN2.indd 1 7/31/20 3:00 PM 7/31/20 3:00 PM
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Participant Demographics Screen (fill out one page for each participant) Identity Information Last Name: _____________________________________ First Name: ______________________________________ M.I. ________ Proof of ID: _____________________________________ SSN: __________________ DOB: ____________ WIC Category: ________
Male Female Foster Child: Yes No
Race/Ethnicity Declared Observed
Ethnicity: Non-Hispanic Hispanic (Circle one)
Race: (Circle all that apply) American Indian or Alaskan Native
Asian
Black or African American
White
Native Hawaiian or Pacific Islander Physical Presence:
Yes
No Physical Presence exception reason: ______________________________________________________________________________ Incarcerated Status:
Yes
No Immunization Consent:
Yes
No Special Needs: (Circle all that apply) Forms assistance Hearing impaired Mentally Challanged
Physically Disabled
Visually Impaired Speech impaired Wheelchair access
Reading assistance
Other: __________________________________________________________________ Education – Highest level completed: _____________________________________________________________________________ Marital Status: Single
Married Separated Divorced Widowed Employment Status:
Full-time Plans to work full-time Part-time Plans to work part-time No plans to work
Income Screen Family Size ________________________ No. of Expected Infants ______________ Total Family Size ___________________
Family – Adjunct Participation _________________________________________________________ SNAP Medicaid
TANF Participant _________________________________________________________ SNAP
Medicaid
TANF Participant _________________________________________________________ SNAP
Medicaid
TANF Participant _________________________________________________________ SNAP
Medicaid
TANF Participant
Self-Declared Income _________________________ or Self-Declared Income Range ________________________
Income Details __________________ __________________ ______________________ ____________________ _________________________ Source Proof
Frequency
Amount
Duration __________________ __________________ ______________________ ____________________ _________________________ Source Proof
Frequency
Amount
Duration __________________ __________________ ______________________ ____________________ _________________________ Source Proof
Frequency
Amount
Duration
Zero Income Declaration Reason _________________________________ Comparison Frequency ___________________________
Total Income: ______________________________________* Remember: Foster children have their own income documentation
Issue EBT Card Screen Select Cardholder _____________________________________________________________________________________________
Card Number __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ (Card should be 16 digits long. Double check number.)
Certification Signature Parent/Guardian will sign a hard copy of the Rights and Responsibilities. This document will be scanned in later. 37433_WIC_Ctad_FIN2.indd 2 37433_WIC_Ctad_FIN2.indd 2 7/31/20 3:00 PM 7/31/20 3:00 PM
3 Anthro/Lab Screen Height/Weight Measurement date: ___________ Height: ____________________ Weight: ______________ lb. ___________oz. Collected by: _________________ Gestational Age: _____________ Blood Work Blood work Date: ______________ Hgb: _____________________ or Hct _________________ Collected by: _________________ Exempt Reason: _____________________________ Deferred Reason: _______________________________ Health Information Screen Pre-Pregnancy Cigarettes Per Day Pre-pregnancy Weight ________lbs. _________ozs. ________ Three Months Prior to Pregnancy _____ Today Drinks Per Week ____________ Three Months Prior to Pregnancy _________ Last Trimester Pregnancy __________ Last Menstrual Period _________ Expected Delivery Date ____ 1st Prenatal Healthcare Visit __________ Number of Prenatal Healthcare Visits _________Date last seen by Physician Proof of Pregnancy ____________________________________ Number of Fetuses this Pregnancy __________ Gravida __________ Para __________ Medical Home: (e.g. ob/gyn, clinic) _______________________________________________________________________________ Dietary Supplement Taken Before Pregnancy: _______________________________________________________________________ Pregnancy Induced Health Conditions: _____________________________________________________________________________________________________ Health Conditions: _____________________________________________________________________________________________________ Currently Breastfeeding: Postpartum Labor Medications: ____________________________________________________________________________________________ Health Conditions: ____________________________________________________________________________________________ Pregnancy Induced Health Conditions: ____________________________________________________________________________ Delivery Date: __________________ Weight at Delivery ___________lbs. __________ ozs. Number of Fetuses this Pregnancy: __________ Gravida __________ Para __________ Medical Home (e.g. ob/gyn, clinic) ________________________________________________________________________________ Participant (infant’s name) ______________________________________________________________________________________ Outcome: Live Term Birth Fetal Death Miscarriage Neonatal Death Delivery Type: Vaginal Cesarean Weeks Gestation: __________ Birth Length: __________ Birth Weight: __________ Breastfeeding Information Data Collection Date: ______________ Are you breastfeeding? Yes No Ever Breastfed? Yes No Breastfeeding Frequency: _______________________________________________________________________________________ Age Infant Stopped Breastfeeding: ________________________________________________________________________________ Reason Infant Stopped Breastfeeding: _____________________________________________________________________________ Age supplement was Given: ___________ No. of Wet Diapers/ 24 hr. Period: __________No. of Stools / 24 hr. Period: ___________ Do you give your baby any formula? Yes No How much formula do you give your infant in a 24-hour period? __________ ozs. Complications (breastfeeding): __________________________________________________________________________________ Eco-Social Assessment Screen Participant: Recipient of Abuse: Yes No Limited Abilities to Feed-Self: Yes No Maternal Intellectual Disability: Yes No Dietary Supplement During Pregnancy Yes No Dietary & Health Screen Participant’s inappropriate Nutrition Practices _____ Consuming dietary supplements with potentially harmful consequences. _____ Consuming a diet very low in calories and/or essential nutrients or impaired caloric intake or absorption of essential nutrients following bariatric surgery. 37433_WIC_Ctad_FIN2.indd 3 37433_WIC_Ctad_FIN2.indd 3 7/31/20 3:00 PM 7/31/20 3:00 PM
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_____ Compulsively ingesting non-food items (pica). _____ Inadequate vitamin/mineral supplementation recognized as essential by national public health policy. _____ Pregnant woman ingesting foods that could be contaminated with pathogenic micro-organisms.
1. How is your appetite?
Good
Fair
Poor 2. Are you taking vitamins? Yes
No 3. If so, what vitamins are you taking? ________________________________________________________________________ 4. How many servings of vegetables do you eat per day? 1-2 3-4
5 or more None 5. How many servings of fruit do you eat per day? 1-2 3-4
5 or more None 6. How many servings of dairy do you eat per day? 1-2 3-4
5 or more I do not eat dairy 7. Are you having any issues feeding your baby? Yes
No 8. Do you have any questions regarding infant formula? 9. How do you plan on feeding your infant? Breastfeeding Infant Formula Combination of Breastfeeding & Infant Formula Undecided at this time
Family Alerts Screen Add Family Alert Participant Alert: ______________________________________________________ Start Date: _____________ End Date: _____________________
Care Plan Screens Maintain Care Plan Goals
Family Goals (circle all that apply) Dairy Intake
Family Mealtimes Increase Fruits and Vegetables Healthy Snacks Physical Activity Iron Foods
Weaning
Smoke Exposure
Whole Grains Free Form Goals: _____________________________________________________________________________________________
Individual Goals Participant 1: _________________________________________ Dairy Intake
Family Mealtimes Increase Fruits and Vegetables Healthy Snacks Physical Activity Iron Foods
Weaning
Smoke Exposure
Whole Grains Free Form Goals: _____________________________________________________________________________________________ Family Class: __________________________________________ Method: ______________________________________________ Individual Class: _____________________________________ Method: _________________________________________________
Nutrition Education Family Individual Class Topic: ________________________________________ Nutrition Education Refusal Refusal Type: Family Individual
Date: _____________ Reason: ______________________________________________
Referral Program Program Name: ___________________________________________ Family Individual __________________________ Program Name: ___________________________________________ Family Individual __________________________ Program Name: ___________________________________________ Family Individual __________________________
Care Plan Summary Nutrition Assessment
_____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________
Entered by: ____________________________________________________________________
Issue Benefits Prescribe Food: Default Package Any Exceptions: _________________________________________________________________________ WIC 53 Category: ___________________________________ Subcategory: _______________________________________ Quantity: _______________________
WIC – 8 XR 6/2020 WIC-08 (7/2020) 37433_WIC_Ctad_FIN2.indd 4 37433_WIC_Ctad_FIN2.indd 4 7/31/20 3:00 PM 7/31/20 3:00 PM
1 Crossroads – CTad-Child New Family/Family Demographics Screen (fill-out once for entire family) Parent/Guardian1 Participant Last Name: __________________________________________First Name: __________________________________M.I._________ Proof of Identification: ___________________________________SSN: _______________________ DOB: _____________________ Marital Status: _______________________________________Education Level: ___________________________________________ Parent/Guardian2 Last Name: __________________________________________First Name: __________________________________M.I._________ Proof of Identification: ___________________________________SSN: _______________________ DOB: _____________________ Marital Status: ______________________________________Education Level: ___________________________________________ Caretaker Last Name: __________________________________________First Name: __________________________________M.I._________ Proof of Identification: __________________________________SSN: ________________________ DOB: _____________________ Marital Status: _______________________________________Education Level: ___________________________________________ Physical Address: Address:_____________________________________________________________________________________________________ _____________________________________________________________________________________________________ ZIP: _______________________ City: __________________________________ State: _______ County: ______________________ Proof of Residence: ___________________________________________________________________________________________ Homeless/Incarcerated Status: _____________________________________Migrant Status: ________________________________ Mailing Address: Street: ______________________________________________________________________________________________________ Street 2: ____________________________________________________________________________________________________ ZIP: ______________________ City: _________________________________ State: _______ County: ________________________ Telephones: Voter Registration: Telephone Number: __________________ Type: H, C, W, F, M Primary: _______Carrier: _______________________ Telephone Number: __________________ Type: H, C, W, F, M Primary: _______Carrier: _______________________ Confidentiality: Communication Options: Language Read: _______________ Language Spoken: ___________________ Interpreter Sign Language Interpreter Email Address: _____________________________________ Preferred Method of Contact: _______________________________ Family Assessment Screen (fill-out once for entire family) 1. Does anyone smoke inside your house? Yes
No 2. Has adequate household food storage and preparation? Yes No 3. Has household food insecurity? Yes No 4. Source of drinking water? City Not Sure Well Cistern Spring Other 5. Where did you hear about WIC? ________________________________________ 37433_WIC_Ctad_FIN2.indd 5 37433_WIC_Ctad_FIN2.indd 5 7/31/20 3:00 PM 7/31/20 3:00 PM
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Participant Demographics Screen (fill out one page for each participant) Identity Information Last Name: _____________________________________ First Name: ______________________________________ M.I. ________ Proof of ID: _____________________________________ SSN: ____________ DOB: _________________ WIC Category: ________
Gender: Male Female
Foster Child Yes No
Foster Care Entry Date: ___________________ or Date unknown
Proof of Foster Care: ________________________
Race/Ethnicity Declared Observed
Ethnicity: Non-Hispanic Hispanic (Circle one)
Race: (Circle all that apply) American Indian or Alaskan Native
Asian
Black or African American
White
Native Hawaiian or Pacific Islander Physical Presence Yes
No Physical Presence exception reason: ______________________________________________________________________________ Immunization Consent
Yes
No Special Needs (Circle all that apply) Forms assistance Hearing impaired Mentally Challanged
Physically Disabled Visually Impaired Speech impaired Wheelchair access
Reading assistance
Other: __________________________________________________________________
Income Screen Family Size ________________________ No. of Expected Infants ______________ Total Family Size ___________________
Family – Adjunct Participation _________________________________________________________ SNAP Medicaid
TANF Participant _________________________________________________________ SNAP
Medicaid
TANF Participant _________________________________________________________ SNAP
Medicaid
TANF Participant _________________________________________________________ SNAP
Medicaid
TANF Participant
Self-Declared Income _________________________ or Self-Declared Income Range ________________________
Income Details __________________ __________________ ______________________ ____________________ _________________________ Source Proof
Frequency
Amount
Duration __________________ __________________ ______________________ ____________________ _________________________ Source Proof
Frequency
Amount
Duration __________________ __________________ ______________________ ____________________ _________________________ Source Proof
Frequency
Amount
Duration
Zero Income Declaration Reason _________________________________ Comparison Frequency ___________________________
Total Income: ______________________________________ * Remember: Foster children have their own income documentation
Issue EBT Card Screen Select Cardholder _____________________________________________________________________________________________
Card Number __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ (Card should be 16 digits long. Double check number.)
Certification Signature Parent/Guardian will sign a hard copy of the Rights and Responsibilities. This document will be scanned in later. 37433_WIC_Ctad_FIN2.indd 6 37433_WIC_Ctad_FIN2.indd 6 7/31/20 3:00 PM 7/31/20 3:00 PM
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Anthro/Lab Screen Height/Weight Measurement date: __ Height: ___________________ Weight: ______________ lb. ___________oz. Collected by: _________________ Source of Measures: _______________ Measurement Type: ________________ Gestational Age: _____________ Blood Work Blood work Date: _______________ Hgb: ______________ or Hct _________________ Collected by: _____________ Source of Measures: ________________ Exempt Reason: ________________ Deferred Reason: ____________________
Health Information Screen Infant/Child Health Information Birth Length: ________________in.
Hospital Discharge Date: ______________________________ Birth Weight: _______________lb. ______________oz.
Hospital Discharge Weight: ______________lb. ________ oz. Medical Home: _________________________ Last seen by Physician: _________________ Weeks Gestation: ____________ Multiple Gestation: Yes No Unknown Immunization Status: unknown up-to-date not up-to-date Medical Health Conditions: _____________________________________________________________________________________
Eco-Social Assessment Screen Participant: Recipient of Abuse: Yes No Parent/Guardian/Caretaker limited abilities to feed: Yes No Maternal Intellectual Disability: Yes No Day Care Status: Yes No Physical Activity: ________ hrs. per day TV/Video Viewing: ____________ hrs. per day Mother participated in WIC during pregnancy: Yes No Unknown Mother was WIC eligible but did not participate: Yes No Mother abused alcohol or drugs during her most recent pregnancy: Yes No Unknown
Dietary & Health Screen Participant’s Inappropriate Nutrition Practices _____ Routinely feeding inappropriate beverages as the primary milk source. _____ Routinely feeding a child any sugar-containing fluids. _____ Routinely using nursing bottles, cups, or pacifiers improperly. _____ Routinely using feeding practices that disregard the developmental needs or stages of the child. _____ Feeding foods to a child that could be contaminated with harmful microorganisms. _____ Routinely feeding a diet very low in calories and/or essential nutrients. _____ Feeding dietary supplements with potentially harmful consequences. _____ Routinely not providing dietary supplements recognized as essential by national public health policy when a child’s diet
alone cannot meet nutrient requirements. _____ Routine ingestion of nonfood items (pica). 1. How many meals does your child eat per day? __________________ 2. How many snacks does your child eat per day? __________________ 3. How many servings of vegetables does your child eat per day? ____________ 4. How many servings of fruits does your child eat per day (includes 100% juice)? ________________ 5. What types of beverages does your child usually drink (list all that apply) _________________________________________
Family Alerts Screen Add Family Alert Participant Alert: ______________________________________________________ Start Date: _________________ End Date: __________________________
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Care Plan Screens Maintain Care Plan Goals
Family Goals (circle all that apply) Dairy Intake
Family Mealtimes Increase Fruits and Vegetables Healthy Snacks Physical Activity Iron Foods
Weaning
Smoke Exposure
Whole Grains Free Form Goals: _____________________________________________________________________________________________
Individual Goals Participant 1: _________________________________________ Dairy Intake
Family Mealtimes Increase Fruits and Vegetables Healthy Snacks Physical Activity Iron Foods
Weaning
Smoke Exposure
Whole Grains Free Form Goals: _____________________________________________________________________________________________ Family Class: __________________________________________ Method: ______________________________________________ Individual Class: _____________________________________ Method: _________________________________________________
Nutrition Education Family Individual Class Topic: ________________________________________
Nutrition Education Refusal Refusal Type: Family Individual
Date: _____________ Reason: ______________________________________________
Referral Program Program Name: ___________________________________________ Family Individual __________________________ Program Name: ___________________________________________ Family Individual __________________________ Program Name: ___________________________________________ Family Individual __________________________
Care Plan Summary Nutrition Assessment
_____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________
Entered by: ____________________________________________________________________
Issue Benefits Prescribe Food: Default Package Any Exceptions: _________________________________________________________________________ WIC 53 Category: ___________________________________ Subcategory: _______________________________________ Quantity: _______________________
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Crossroads – CTad – Infant New Family/Family Demographics Screen (fill-out once for entire family) Parent/Guardian1 Participant Last Name: __________________________________________First Name: __________________________________M.I. ________
Proof of Identification: ___________________________________SSN: _____________________________DOB: ________________
Marital Status: ____________________________________Education Level: _____________________________________________ Parent/Guardian2 Last Name: __________________________________________First Name: __________________________________M.I. ________
Proof of Identification: ___________________________________SSN: _____________________________DOB: ________________
Marital Status: _____________________________________Education Level: ____________________________________________ Caretaker Last Name: __________________________________________First Name: __________________________________M.I. ________
Proof of Identification: ___________________________________SSN: ______________________________DOB: _______________
Marital Status: _______________________________________Education Level: ___________________________________________ Physical Address: Street: ______________________________________________________________________________________________________
Street 2: ____________________________________________________________________________________________________
ZIP: _______________________City: __________________________________State: _______County: ________________________
Proof of Residence: ___________________________________________________________________________________________
Homeless/Incarcerated Status: _____________________________________Migrant Status: ________________________________ Mailing Address: Street: ______________________________________________________________________________________________________
Street 2: ____________________________________________________________________________________________________
ZIP: _______________________City: __________________________________State: _______County: ________________________
Telephones:
Voter Registration: Telephone Number: __________________ Type: H, C, W, F, M Primary: _______ Carrier: _______________________ Telephone Number: __________________ Type: H, C, W, F, M Primary: _______ Carrier: _______________________ Military Status – Non-military, National Guard, Active
Confidentiality:
Communication Options: Language Read: ________________Language Spoken: __________________ Interpreter Sign Language Interpreter
Email Address: _____________________________________Preferred Method of Contact: ________________________________
Family Assessment Screen (fill-out once for entire family) 1. Does anyone smoke inside your house?
Yes
No 2. Has adequate household food storage and preparation? Yes
No 3. Has household food insecurity?
Yes
No 4. Source of drinking water? City Not Sure Well Cistern Spring Other 5. Where did you hear about WIC? ________________________________________
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Participant Demographics Screen (fill out one page for each participant) Identity Information Last Name: _____________________________________ First Name: ______________________________________ M.I. ________ Proof of ID: _____________________________________ SSN: ___________________ DOB: ___________ WIC Category: ________
Gender: Male Female
Foster Child Yes No
Foster Care Entry Date: ___________________ or Date unknown
Proof of Foster Care: ________________________
Race/Ethnicity Declared Observed Ethnicity: Non-Hispanic Hispanic (Circle one)
Race (Circle all that apply): American Indian or Alaskan Native / Asian / Black or African American / White / Native Hawaiian or Pacific Islander
Physical Presence:
Yes
No Physical Presence exception reason: ______________________________________________________________________________ Immunization Consent:
Yes
No Special Needs: (Circle all that apply) Forms assistance Hearing impaired Mentally Challanged
Physically Disabled
Visually Impaired Speech impaired Wheelchair access
Reading assistance
Other: __________________________________________________________________
Income Screen Family Size ________________________ No. of Expected Infants ______________ Total Family Size ___________________
Family – Adjunct Participation _________________________________________________________ SNAP Medicaid
TANF Participant _________________________________________________________ SNAP
Medicaid
TANF Participant _________________________________________________________ SNAP
Medicaid
TANF Participant _________________________________________________________ SNAP
Medicaid
TANF Participant
Self-Declared Income _________________________ or Self-Declared Income Range ________________________
Income Details __________________ __________________ ______________________ ____________________ _________________________ Source Proof
Frequency
Amount
Duration __________________ __________________ ______________________ ____________________ _________________________ Source Proof
Frequency
Amount
Duration __________________ __________________ ______________________ ____________________ _________________________ Source Proof
Frequency
Amount
Duration
Zero Income Declaration Reason _________________________________ Comparison Frequency ___________________________
Total Income: ______________________________________* Remember: Foster children have their own income documentation
Issue EBT Card Screen Select Cardholder _____________________________________________________________________________________________
Card Number __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ (Card should be 16 digits long. Double check number.)
Certification Signature Parent/Guardian will sign a hard copy of the Rights and Responsibilities. This document must be scanned in later. 37433_WIC_Ctad_FIN2.indd 10 37433_WIC_Ctad_FIN2.indd 10 7/31/20 3:00 PM 7/31/20 3:00 PM
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Anthro/Lab Screen Height/Weight Measurement date: _ Height: ___________________ Weight: ______________ lb. ___________oz. Collected by: _________________ Gestational Age: _____________ Blood Work Blood work Date: _____________ Hgb: ______________ or Hct _________________ Collected by: _____________ Exempt reason: __________________ Deferred reason_________________________
Health Information Screen Infant/child Health Information Birth Length: ________________in. ______________1/8’s
Hospital Discharge Date: ______________________________ Birth Weight: _______________lb. ______________oz.
Hospital Discharge Weight: ______________lb. ________ oz. Medical Home: _________________________ Last seen by Physician: __________________ Weeks Gestation: ____________ Multiple Gestation: Yes No Unknown Immunization Status: unknown up-to-date not up-to-date Medical Health Conditions_____________________________________
Breastfeeding Information Data Collection Date: _ __ Are you breastfeeding? Yes No Ever Breastfed? Yes No Breastfeeding Frequency: ______________________________ Age Infant Stopped Breastfeeding: _______________________ Reason Infant Stopped Breastfeeding: ___________________________________________________________ Age Supplement Was Given: ___________ No. of Wet Diapers/24 hr. Period: __________ No. of Stools/24 hr. Period: ____________ Do you give your baby any formula? Yes No How much formula do you give your infant in a 24-hour period? ozs. ________
Complications (breastfeeding): ________________________________________________________________
Eco-Social Assessment Screen Participant: Recipient of Abuse: Yes No Parent/Guardian/Caretaker limited abilities to feed: Yes No Maternal Intellectual Disability: Yes No Day Care Status: Yes No Physical Activity: ________ hrs. per day TV/Video Viewing: ____________ hrs. per day Mother participated in WIC during pregnancy: Yes No Unknown Mother was WIC eligible but did not participate: Yes No Mother abused alcohol or drugs during her most recent pregnancy: Yes No Unknown
Dietary & Health Screen Participant’s Inappropriate Nutrition Practices _____ Routinely using a substitute(s) for breast milk or for FDA approved iron-fortified formulas as the primary nutrient source
during the first year of life. _____ Routinely using nursing bottles or cups improperly. _____ Routinely offering complementary foods* or other substances that are inappropriate in type or timing. *Complementary
foods are any foods or beverages other than breast milk or infant formula. _____ Routinely using feeding practices that disregard the developmental needs or stage of the infant. _____ Feeding foods to an infant that could be contaminated with harmful microorganisms or toxins. _____ Routinely feeding inappropriately diluted formula. _____ Routinely limiting the frequency of nursing of the exclusively breastfed infant when breast milk is the sole source of
nutrients. _____ Routinely feeding a diet very low in calories and/or essential nutrients. _____ Routinely using inappropriate sanitation in preparation, handling, and storage of expressed breast milk or formula. _____ Feeding dietary supplements with potentially harmful consequences. 37433_WIC_Ctad_FIN2.indd 11 37433_WIC_Ctad_FIN2.indd 11 7/31/20 3:00 PM 7/31/20 3:00 PM
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_____ Routinely not providing dietary supplements recognized as essential by national public health policy when an infant’s diet
alone cannot meet nutrient requirements. 1. Do you have any concerns with your baby? Yes No 2. How are you feeding your baby? Breastfed Formula Fed Combination 3. If using formula, which appliances do you use to heat up formula? ______________________________________________
Family Alerts Screen Add: Family Alert
Participant Alert: _______________________________________________________ Start Date: __________________ End Date: ______________________________________________________________
Care Plan Screens Maintain Care Plan Goals
Family Goals (circle all that apply) Dairy Intake
Family Mealtimes Increase Fruits and Vegetables Healthy Snacks Physical Activity Iron Foods
Weaning
Smoke Exposure
Whole Grains Free Form Goals: _____________________________________________________________________________________________
Individual Goals Participant 1: _________________________________________ Dairy Intake
Family Mealtimes Increase Fruits and Vegetables Healthy Snacks Physical Activity Iron Foods
Weaning
Smoke Exposure
Whole Grains Free Form Goals: _____________________________________________________________________________________________ Family Class: __________________________________________ Method: ______________________________________________ Individual Class: _______________________________________ Method: _______________________________________________
Nutrition Education Family Individual Class Topic: ________________________________________
Nutrition Education Refusal Refusal Type: Family Individual
Date: _______________ Reason: ____________________________________________
Referral Program Program Name: ___________________________________________ Family Individual __________________________ Program Name: ___________________________________________ Family Individual __________________________ Program Name: ___________________________________________ Family Individual __________________________
Care Plan Summary Nutrition Assessment
_____________________________________________________________________________________________________ _____________________________________________________________________________________________________ _____________________________________________________________________________________________________
Entered by: ____________________________________________________________________
Issue Benefits Prescribe Food: Default Package Any Exceptions: _________________________________________________________________________ WIC 53 Category: ___________________________________ Subcategory: ______________________________________ Quantity: _______________________
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NUTRITION RISK REVISIONS WIC State agencies are required to implement the Nutrition Risk revisions below by Octob **Attach a complete, updated listing of your State’s nutrition Implementation Date Requesting Extension? Requesting to Not Adopt? (Month/Year) If yes, include justification and timeline for implementation. If yes, include an evidence-based justification as to why this risk is not applicable in your State. Nutrition Risk Revisions: Example 5/1/2016 No No 211 Elevated Blood Lead Levels: The Definition is revised to reflect the current reference value published in guidance from the Centers for Disease Control and Prevention. The Justification, Implications for WIC Nutrition Services and Reference sections have been expanded and updated. 10/1/2016 no no 332 Short Interpregnancy Interval (Previously titled Closely Spaced Pregnancy): The Definition is revised to reflect a more recent review of data indicating increased risks for adverse perinatal and maternal outcomes with an interpregnancy interval of less than 18 months. In addition, the revised cut-off is consistent with the Healthy people 2020 goal of reducing the proportion of pregnancies conceived within 18 months of a previous birth. The Justification, Implications for WIC Nutrition Services and Reference sections have been expanded and updated. 10/1/2016 no no
425 Inappropriate Nutrition Practices for Children: Only section 425.1.9 (routinely feeding inappropriate beverages as the primary milk source) is revised to be consistent with March 2014 Final Rule: Revisions in the WIC Food Packages [7 CFR Part 246.10€(10)] that allows the option for WIC State agencies to issue reduced-fat milk and/or reduced-fat yogurt to children (1 to 2 years of age) for whom overweight or obesity is a concern. The Justification and reference sections have been expanded and updated. Implemented with Final Food Rule; Risk code revisions sent to CPAs no no Corrected Criteria and Guidance: 201 Low Hematocrit/Low Hemoglobin: The priority level for Non-Breastfeeding women was corrected to reflect the appropriate priority levels of III, IV, V, and VI. Table 201-C was created and included, having been previously omitted. No other revisions were made to this criterion. 10/1/2016 no no 601 Breastfeeding Mother of Infant at Nutritional Risk: Pregnant women were added as an allowable category for assignment of this risk. 10/1/2016 no no 602 Breastfeeding Complications or Potential Complications: Pregnant women were added as an allowable category for assignment of this risk. 10/1/2016 no no Guidance for Screening and Referring Women with or At Risk for Depression: The link to the website: The Perinatal Depression Information Network was removed from this guidance. The website had been hacked and no longer provided information about mental health resources. 10/1/2016 no no **Attach a complete, updated listing of your State’s nutritio
er 1st, 2016. n risk criteria.** New/ Revised Policy Number (s) MIS Changes Required? Please explain. When/ How will staff be trained? Please submit these P&Ps with your State Plan. P&P 3.04 Reference values updated 5/26/16 Nutrition Coordinators Meeting P&P 8.007 cut-off values updated 7/18/16 webinar with CPAs P&P 8.007 name change; cut-off values updated 7/18/16 webinar with CPAs
n/a n/a 8/22/16 revisions sent to CPAs P&P 8.007; no revision necessary; Priority III remains n/a n/a P&P 8.007 Pregnant Women added as allowable category; Priority III assigned 7/18/16 webinar with CPAs P&P 8.007 Pregnant Women added as allowable category; Priority I assigned 7/18/16 webinar with CPAs n/a n/a 8/22/16 revisions sent to CPAs on risk criteria.**
DATA SHARING AGREEMENT Between the West Virginia Bureau for Public Health WIC Program And Ohio Department of Health WIC Program
This Data Sharing Agreement (hereafter referred to as Agreement) is entered into by and between the West Virginia Bureau for Public Health WIC Program (hereafter referred to as WVBPh), and the Ohio Department of Health WIC Program (hereafter referred to as ODH). In consideration of the mutual understandings and covenants set forth herein, the parties agree as follows:
1. PURPOSE
VWVBPH and ODH enter into this Agreement for the purpose of detecting and preventing dual participation between participants of the WIC program as required by 7 CFR 246.7(1)(1)-(4).
i. TERM
This Agreement shall become effective October 1, 2022, and shall remain in effect through September 30, 2027.
Ill. CONDITIONS
A. Ona semi-annual basis, the WVBPH will compare its list of program participants in a mutually agreed upon electronic format. The data exchanged will be for the contiguous service areas located across borders. If dual participation is suspected, the state or local agency will take appropriate follow-up action within 120 days of detecting instances of suspected dual participation.
B. Miscellaneous
Notwithstanding the foregoing agreed upon uses of data, the parties may not disclose or further distribute such data unless permitted by law.
IV. DATA FLOW VWVEPH and ODH agree to:
A. ODH posting its electronic file for WWBPH comparison on a semi-annual basis for the months of June and December by the tenth (10) working day of the next month; i.e., July 10th and January 10th. The ODH data will be provided on the ODH secure website for download by WVBPH, and will be in an XML schema format.
B. Provide that the file contains, for active participants only, participant ID, the first name, middle initial (if available), last name, sex, date of birth, ethnicity, race, street address, city, state, zip code, certification date, date of last issuance, and agency clinic number.
C. Provide that the data is only for those counties in West Virginia contiguous to the following ODH counties: Jefferson, Belmont, Monroe, Washington, Athens, Meigs, Gallia, and Lawrence.
Vi.
Vil.
Vill.
IX.
D. Use the data participation reports, upon receipt, to match and contact local WIC agencies if dual participation is suspected.
E. Take the following actions, per the WIC program regulations, if dual participation has occurred:
a. Termination from one (1) program immediately. The continuing WIC program shall be chosen based upon the participant's state of residence.
b. In cases of intentional misrepresentation resulting in dual participation, 7 CFR 246.12(u)(2) and 246.23(c)(1) will be followed.
CONFIDENTIALITY
The parties agree that data shared pursuant to this Agreement is confidential pursuant to 7 CFR 246.26(d). The parties further agree to restrict the use and disclosure of confidential applicant and participant information to persons directly connected with the administration of enforcement of the WIC program whom the parties determine have a need to know the information for WIC program purposes as provided in 7 CFR 246.26(d)(1)(ii).
The parties shall not disclose, release, or otherwise grant access to the data covered by this Agreement to any third party for any purpose unless permitted by law.
COMPLIANCE WITH LAWS
Both parties agree to comply with all applicable Federal, State, and local laws, regulations or ordinances, and all provisions required thereby to be included herein are incorporated by reference.
AMENDMENTS No alteration or variation of the terms of this Agreement shall be valid unless made in
writing and signed by the parties hereto. No oral understanding or agreement not incorporated herein shall be binding on any of the parties hereto.
TERMINATION
WVBPH or ODH may terminate this Agreement at any time for any reason, including failure to comply with any condition of this Agreement, upon thirty (30) days advance written notice. The written notice will state the reason for termination.
RENEWAL OPTION
This Agreement may be renewed under the same terms and conditions, subject to the approval of the WVBPH Director Office of Nutrition Services/WIC Program and Ohio WIC.
Program Administrator. The term of the renewed contract may not be longer than the term of the original contract.
NOTICE TO PARTIES
Whenever any notice, statement, or other requirement is required under this Agreement, it shall be sent to the following addresses, unless otherwise specifically advised:
Notices to WVBPH shall be sent to:
Heidi E. Staats, Director West Virginia WIC Program Bureau for Public Health Office of Nutrition Services 350 Capitol Street, Room 515 Charleston, WV 25301-3717
Notices to ODH shall be sent to:
Corey J. Shepherd, Director Ohio WIC Program
Ohio Department of Health 246 N. High Street — 4th Floor Columbus, Ohio 43215
Xl. SIGNATURES
Upon execution by both parties, this Agreement supersedes any and all agreements between the parties with respect to the use of data files and preempts and overrides any instructions, directions, agreements, or other understandings between the parties with respect to the data files specified herein.
The parties having read and understanding the foregoing terms of this Agreement do by their respective signatures dated below hereby agree to the terms thereof:
Ohio WIC Program: West Virginia WIC Program:
Bruce Vanduloeld, WD,WEA by AWD Mes (=>
Bruce Vanderhoff’ MD, MBA 7 Matthew Q. Christiansen, MD, MPH Director of Health State Health Officer and Commissioner, Ohio Department of Health Bureau for Public Health
DATE: 09/20/2023 DATE: lis [ets
Steven L. Beshear Governor CABINET FOR HEALTH AND FAMILY SERVICES DEPARTMENT FOR PUBLIC HEALTH 275 East Main Street-HS2W-D Frankfort, KY 40621 502-564-3827 FAX 502-696-38 1 1 OCT 3 1 2011 Janie Miller Secretary October 26, 201 1 Denise V. Ferris, RD, LD, Dr PH Director WIC Program 350 Capitol Street, Room 519 Charleston, WV 25301 -371 7 Dear Ms. Ferris: According to federal regulations, Kentucky must enter into agreements with its bordering states for the purpose of detecting and preventing dual participation. In order to be in compliance with 7 CFR Part 246.7 (I), attached is a proposed dual participation Memorandum of Understanding (MOU) between the West Virginia and Kentucky WIC Programs. Please review the attached MOU and, if satisfactory, please sign and date, keeping on copy for your records and returning the other copy. If you have questions about this agreement, please contact me at 502-564-3827 x.3831, or by email at Fran.Hawkins@kv.nov. Sincerely, dl- W L
Fran Hawkins MS, RD, LD Manager Nutrition Services Branch Attachment cc: Jeff Hinton Rhonda Goff Dennis Hill 4n Equal Opportunity Employer MlFlD
Agreement for WIC Dual Participation Detection and Prevention between Kentucky and West Virginia WIC Programs Consistent with the intent of $246.7(1) of the USDA-FNS WIC Regulations, the Kentucky WIC Program and the West Virginia WIC Program are entering into this Memorandum of Understanding (MOU) for the purpose of detecting and preventing dual participation between the participants of both WIC Programs. Responsibilities of the programs include: 1. Local WIC staff operating clinics in contiguous local service.areas located across state agency borders agrees to contact the neighboring state WIC office or the bordering WIC clinic when a participant is suspected to be participating in the WIC Programs of both states. 2. If dual participation is found to occur, $246.7(1) specifies the following action be taken: a. The participant(s) found committing dual participation shall be terminated from one of the Programs immediately. §246.7(1)(3) b. Where intentional misrepresentation is involved, the state WIC office or the bordering WIC clinic will: Establish a claim against the participant for the full value of benefits received. ($ 246.7 (1) (4) and $246.23(c) (1)) Disqualify participant(s) from participation in both programs for one year unless exceptions stated in $246.12(~)(2) apply. ($246.7(1)(4) and $246.1 2(u)(2)) $246.12(~)(2) states that disqualification may be waived for infants, children and those participants under age eighteen, if the StatelLocaI Agency approves the designation of a proxy and the competent professional authority determines that a serious health risk may result from Program disqualification. Warning may be given prior to the imposition of state sanctions. Participant(s) shall be advised of the procedures to follow to obtain a fair hearing pursuant to S246.9. This agreement shall remain valid from the effective date of the agreement until canceled or terminated by mutual consent, for cause or default, or for convenience by either party. The party desiring to terminate or cancel must give written notice of their intention thirty (30) days prior to the date of the cancellation or termination, setting forth the reasons and conditions of said termination. Kentucky WIC Program West Virginia WIC Program Fran Hawkins, MS, RD, LD Branch Manager, Nutrition Services a== a&-.- ,&A&/// Signature Date
DATA SHARING AGREEMENT Between the Commonwealth of Pennsylvania Department of Health Bureau of Women, Infants and Children and This Data Sharing Agreement (“Agreement”) is entered into by and between the Commonwealth of Pennsylvania, acting through the Department of Health, Bureau of Women, Infants and Children (“PA DOH”), and the (the “Foreign WIC Program” or “FWP”). In consideration of the mutual understandings and covenants set forth herein, the parties agree as follows: I. PURPOSE PA DOH and FWP enter into this Agreement for the purpose of detecting and preventing dual participation among participants of the WIC program as required by 7 CFR 246.7(I)(1)-(4). II. TERM This Agreement shall become effective either January 1, 2023 or when it is fully executed by the parties and all approvals required by Commonwealth contracting procedures have been obtained, as indicated by the date of the last Commonwealth signature, whichever is later, and shall remain in effect for five (5) years thereafter. III. CONDITIONS On a semi-annual basis, the parties will compare their lists of participants in their respective WIC programs in a mutually agreed upon electronic format. The data exchanged will be for the contiguous service areas located across borders. If dual participation is suspected, the parties will take appropriate follow-up action within 120 calendar days of detecting instances of suspected dual participation. IV. DATA FLOW A. FWP shall post its electronic file for PA DOH comparison on a semi-annual basis. The electronic file posted by January 15th each year shall contain data for the six previous months of December, November, October, September, August, and July. The electronic file posted by July 15th each year shall contain data for the six previous months of June, May, April, March, February, and January. FWP data will be provided on the secure website for download by PA DOH and will be in an XML schema format. PA DOH will provide the “Interstate Dual Participation State West Virginia Office of Nutritio State ITO/WIC Entity
Guide” with the XML schema details. As needed the PA DOH will update and share the guidance to FWP. B. The provided electronic file shall contain data elements for categorically eligible individuals only, as identified in Attachment A: Data Elements. C. The return electronic file will contain matched categorically eligible individuals. The file shall contain the data of the submitting state and the data of the matched state for each categorically eligible individual matched. This report will be provided in a csv file. D. Use the data participation reports, upon receipt, to match and investigate potential dual participation. E. Take the following actions, per the WIC Federal regulations, if dual participation has occurred: a. Termination from one program immediately. The continuing WIC program shall be chosen based upon the participant’s state of residence. b. In cases of intentional misrepresentation, the collection of improperly issued benefits in accordance with 7 CFR 246.12(u)(2) and 246.23(c)(1). V. DESTRUCTION OF DATA PA DOH will destroy the data provided by the FWP for the purpose of this Agreement in accordance with the retention requirement for records set forth at 2 CFR § 200.334 (effective November 12, 2020) unless a FWP requests in writing that PA DOH retain such data for a listed exception at 2 CFR § 200.334. Any such request by the FWP must be made to PA DOH as soon as the circumstances giving rise to the exception arise and must notify PA DOH by September 1 of every year of a continued need for such data to be retained. PA DOH will destroy data as set forth in this provision absent FWP requesting that such data be retained or FWP notifying PA DOH of a continued need for such data. VI. INCORPORATION BY REFERENCE The following is incorporated by reference into this Agreement, including all authorities and law cited, incorporated by reference, or otherwise made part of therein: A. The Interstate Dual Participation: State Procedures, as it may be updated. FWP may obtain a copy by requesting one by PA DOH; B. 42 USC § 1786; and
C. WIC Federal regulations, specifically those found under Part 246 of Subchapter A of Chapter II of Subtitle B of Title 7 of the Code of Federal Regulations (7 CFR §§ 246.1-246.29).
VII. CONFIDENTIALITY
The parties agree that data shared pursuant to this Agreement is confidential pursuant to 7 CFR 246.26(d). The parties further agree to restrict the use and disclosure of confidential applicant and participant information to persons directly connected with the administration of enforcement of the WIC program whom the parties determine have a need to know the information for WIC program purposes as provided in 7 CFR 246.26(d)(1)(ii).
The parties shall not disclose, release, or otherwise grant access to the data covered by this Agreement to any third party for any purpose unless permitted by law.
VIII. CIVIL RIGHTS ASSURANCE
Both parties agree to comply with Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.), Title IX of the Education Amendments of 1972 (20 U.S.C. 1681 et seq.), Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), Age Discrimination Act of 1975 (42 U.S.C. 6101 et seq.); Title II and Title III of the Americans with Disabilities Act (ADA) of 1990 as amended by the ADA Amendment Act of 2008 (42 U.S.C. 12131-12189) as implemented by Department of Justice regulations at (28 CFR Parts 35 and 36); Executive Order 13166, "Improving Access to Services for Persons with Limited English Proficiency." (August 11, 2000), all provisions required by the implementing regulations of the U.S. Department of Agriculture (7 CFR Part 15 et seq); and FNS directives and guidelines to the effect that no person shall, on the ground of race, color, national origin, age, sex, or disability, be excluded from participation in, be denied the benefits of, or otherwise be subjected to discrimination under any program or activity for which either party receives Federal financial assistance from FNS; and hereby gives assurance that it will immediately take measures necessary to effectuate this agreement. By providing this assurance, both parties agree to compile data, maintain records and submit records and reports as required to permit effective enforcement of the nondiscrimination laws, and to permit U.S. Department of Agriculture personnel during normal working hours to review and copy such records, books and accounts, access such facilities, and interview such personnel as needed to ascertain compliance with the nondiscrimination laws. If there are any violations of this assurance, the U.S. Department of Agriculture shall have the right to seek judicial enforcement of this assurance. Both parties give this assurance in consideration of and for the purpose of obtaining any and all Federal financial assistance, grants, and loans of Federal funds, reimbursable
expenditures, grant, or donation of Federal property and interest in property, the detail of Federal personnel, the sale and lease of, and the permission to use Federal property or interest in such property or the furnishing of services without consideration or at a nominal consideration, or at a consideration that is reduced for the purpose of assisting the recipient, or in recognition of the public interest to be served by such sale, lease, or furnishing of services to the recipient, or any improvements made with Federal financial assistance extended to the Program applicant by USDA. This includes any Federal agreement, arrangement, or other contract that has as one of its purposes the provision of cash assistance for the purchase of food, and cash assistance for purchase or rental of food service equipment or any other financial assistance extended in reliance on the representations and agreements made in this assurance.
IX. INDEMNIFICATION
FWP shall hold the Commonwealth harmless from and indemnify the Commonwealth against any and all third party claims, demands and actions based upon or arising out of any activities performed by the FWP and its employees and agents under this Agreement, provided the Commonwealth gives FWP prompt notice of any such claim of which it learns. Pursuant to the Commonwealth Attorneys Act (71 P.S. Section 732-101, et seq.), the Office of Attorney General (OAG) has the sole authority to represent the Commonwealth in actions brought against the Commonwealth. The OAG may, however, in its sole discretion and under such terms as it deems appropriate, delegate its right of defense. If OAG delegates the defense to FWP, the Commonwealth will cooperate with all reasonable requests of FWP made in the defense of such suits.
Notwithstanding the above, neither party shall enter into any settlement without the other party's written consent, which shall not be unreasonably withheld. The Commonwealth may, in its sole discretion, allow FWP to control the defense and any related settlement negotiations.
X. GOVERNING LAW
This Agreement shall be governed by and interpreted and enforced in accordance with the laws of the Commonwealth of Pennsylvania (without regard to any conflict of laws provisions) and the decisions of the Pennsylvania courts. FWP consents to the jurisdiction of any court of the Commonwealth of Pennsylvania and any federal courts in Pennsylvania, waiving any claim or defense that such forum is not convenient or proper. FWP agrees that any such court shall have in person jurisdiction over it, and consents to service of process in any manner authorized by Pennsylvania law.
XI. SEVERABILITY
The provisions of this Agreement shall be severable. If any phrase, clause, sentence or provision of this Agreement is declared to be contrary to the Constitution of
Pennsylvania or of the United States or of the laws of the Commonwealth, the applicability thereof to any government, agency, person or circumstance is held invalid, the validity of the remainder of this Agreement and the applicability thereof to any government, agency, person or circumstance shall not be affected XII. AMENDMENTS No alteration or variation of the terms of this Agreement shall be valid unless made in writing and signed by the parties hereto with the same formality as the original. XIII. INTEGRATION When fully executed by the parties, this Agreement shall be the final and complete Agreement between the parties containing all the terms and conditions agreed on by the parties. All representations, understandings, promises and agreements pertaining to the subject matter of this Agreement made prior to or at the time this Agreement is executed are superseded by this Agreement, unless specifically accepted by any other term or provision of this Agreement. There are no conditions precedent to the performance of this Agreement, except as expressly set forth in this Agreement. XIV. TERMINATION PA DOH or FWP may terminate this Agreement at any time for any reason, including failure to comply with any condition of this Agreement, upon 30 days’ advance written notice. The written notice shall state the reason for termination. XV. EXECUTION This Agreement may be executed in counterparts, each of which shall be deemed an original and shall have the full force and effect as an original but all of which shall constitute one and the same instrument. XVI. RIGHT-TO-KNOW This Agreement is subject to the Commonwealth of Pennsylvania’s Right-To-Know Law requirements, which are attached hereto and made a part hereof as Attachment B. All references therein to “Contractor” are applicable to FWP. Rest of page intentionally left blank.
XVII. NOTICE TO PARTIES Whenever any notice, statement, or other requirement is required under this Agreement, it shall be sent to the following addresses, unless otherwise specifically advised: Notices to PA DOH shall be sent to: Sally Zubairu-Cofield, MPH Pennsylvania WIC Program Pennsylvania Department of Health 625 Forster Street, 7th Floor West Harrisburg PA 17120-0701 Notices to FWP shall be sent to: XVIII. SIGNATURES The parties having read and understanding the foregoing terms of this Agreement do, by their respective signatures dated below, hereby agree to the terms thereof: WIC Program: BY: _________________________________________ DATE: ________________________ Signature ________________________________________ ________________________ Title Print or Type Name Heidi Staats, MSW WV Office of Nutrition Service WVDHHR/BPH 350 Capitol Street, Room 515 Charleston WV 25301 West Virgini Heidi E. Staats Digitally signed by Heidi E. Staats Date: 2023.02.28 10:22:13 -05'00' 2/28/23 Director, WV Office of Nutrition Services Heidi E. Staats
PA DOH: _
_ DATE: BY: Commonwealth of Pennsylvania Department of Health Approved as to form and legality: DATE: BY: _
Office of Legal Counsel, Department of Health DATE: BY: _
Office of General Counsel, Commonwealth of PA DATE: BY: _
Office of Attorney General, Commonwealth of PA SIGN SIGN SIGN SIGN
ATTACHMENT A: DATA ELEMENTS I. Required Data Elements The electronic file for categorically eligible individuals shall include the following required data elements for each categorically eligible individual: a. Last Name b. Date of Birth c. Sex II. Optional Data Elements The electronic file for categorically eligible individuals may include the following optional data elements for each categorically eligible individual: d. First Name e. Middle Name f. Participant Identification Number g. Family Identification Number h. Endorser First Name i. Endorser Last Name j. Proxy 1 k. Proxy 2 l. Proxy 3 m. Proxy 4 n. Proxy 5 o. Proxy 6 p. Local Agency Name q. Clinic Name r. WIC Clinic Number s. Certification Start Date t. Certification End Date u. Termination Date v. Participant Status Code w. Date of Last Food Benefits to Use x. Date of Last Transaction y. Street Address 1 z. Street Address 2 aa. City bb. County cc. State dd. Zip Code ee. Primary Telephone Number ff. Secondary Telephone Number gg. Email Address
ATTACHMENT B: RIGHT-TO-KNOW LAW a. The Pennsylvania Right-to-Know Law, 65 P.S. §§ 67.101-3104, (“RTKL”) applies to this Contract. For the purpose of these provisions, the term “the Commonwealth” shall refer to the contracting Commonwealth agency. b. If the Commonwealth needs the Contractor’s assistance in any matter arising out of the RTKL related to this Contract, it shall notify the Contractor using the legal contact information provided in this Contract. The Contractor, at any time, may designate a different contact for such purpose upon reasonable prior written notice to the Commonwealth. c. Upon written notification from the Commonwealth that it requires the Contractor’s assistance in responding to a request under the RTKL for information related to this Contract that may be in the Contractor’s possession, constituting, or alleged to constitute, a public record in accordance with the RTKL (“Requested Information”), the Contractor shall: 1) Provide the Commonwealth, within ten (10) calendar days after receipt of written notification, access to, and copies of, any document or information in the Contractor’s possession arising out of this Contract that the Commonwealth reasonably believes is Requested Information and may be a public record under the RTKL; and 2) Provide such other assistance as the Commonwealth may reasonably request, in order to comply with the RTKL with respect to this Contract. d. If the Contractor considers the Requested Information to include a request for a Trade Secret or Confidential Proprietary Information, as those terms are defined by the RTKL, or other information that the Contractor considers exempt from production under the RTKL, the Contractor must notify the Commonwealth and provide, within seven (7) calendar days of receiving the written notification, a written statement signed by a representative of the Contractor explaining why the requested material is exempt from public disclosure under the RTKL. e. The Commonwealth will rely upon the written statement from the Contractor in denying a RTKL request for the Requested Information unless the Commonwealth determines that the Requested Information is clearly not protected from disclosure under the RTKL. Should the Commonwealth determine that the Requested Information is clearly not exempt from disclosure, the Contractor shall provide the Requested Information within five (5) business days of receipt of written notification of the Commonwealth’s determination. f. If the Contractor fails to provide the Requested Information within the time period required by these provisions, the Contractor shall indemnify and hold the Commonwealth harmless for any damages, penalties, costs, detriment or harm that the Commonwealth may incur as a result of the Contractor’s failure, including any statutory damages assessed against the Commonwealth.
g. The Commonwealth will reimburse the Contractor for any costs associated with complying with these provisions only to the extent allowed under the fee schedule established by the Office of Open Records or as otherwise provided by the RTKL if the fee schedule is inapplicable. h. The Contractor may file a legal challenge to any Commonwealth decision to release a record to the public with the Office of Open Records, or in the Pennsylvania Courts, however, the Contractor shall indemnify the Commonwealth for any legal expenses incurred by the Commonwealth as a result of such a challenge and shall hold the Commonwealth harmless for any damages, penalties, costs, detriment or harm that the Commonwealth may incur as a result of the Contractor’s failure, including any statutory damages assessed against the Commonwealth, regardless of the outcome of such legal challenge. As between the parties, the Contractor agrees to waive all rights or remedies that may be available to it as a result of the Commonwealth’s disclosure of Requested Information pursuant to the RTKL. i. The Contractor’s duties relating to the RTKL are continuing duties that survive the expiration of this Contract and shall continue as long as the Contractor has Requested Information in its possession.
Local Agencies Valley Health South - WIC Program 286 Blue Price Road Bluefield, WV, 24701 304-325-3922 Central WV WIC Program 170 Coleman Drive, Suite 7 Lewisburg, WV 24901 304-647-7430 Monongalia WIC Program 1000 Elmer Prince Drive Morgantown, WV 26505 304-598-5181 Randolph-Elkins WIC Program 107 Davis Street Elkins, WV 26241 304-636-8100 Shenandoah WIC Program 35 Veronica Drive Martinsburg, WV 25401 304-267-5477 Wheeling-Ohio WIC Program 45 18th Street Wheeling, WV 26003 304-234-3888 Mid-Ohio Valley WIC Program 211 Sixth Street Parkersburg, WV 26101 304-428-3688 Valley Health - WIC Program 4188 West Washington Street Charleston, WV 25313 304-746-7880 Clinics County Address City, State, Zip Phone Fax Hours Barbour County WIC Nutrition Program Burbick Hall 101 College Hill Road Philippi, WV 26416 304-457-3362 304-636-8101 Wednesday 9:00am - 3:00pm 2nd Thursday 9:00am-3:00pm Berkeley County WIC Program 35 Veronica Drive Martinsburg, WV 25401 304-267-5477 304-263-8394 Monday, Tuesday, &- Thursday 8:30am -6:30pm Wed. 8:30 - 5 Friday 8:30am -12:00pm Boone County WIC Program 213 Kenmore Drive Danville, WV 25053 304-369-7967 304-369-2832 Wednesday & Thursday 8:30am - 3:30pm Braxton County WIC Program 537 Enterprise Drive Gassaway, WV 26624 304-364-8778 304-364-8776 M-F 8:00am - 4:00pm Brooke County WIC Program 192 Industrial Park Lane Beech Bottom, WV 26030 304-394-5090 304-394-5091 Monday & Tuesday 8:00am - 4:30pm Cabell County WIC Program 3246 US Route 60, Suite 12 Huntington, WV 25705 304-302-2013 OR 1- 800-953-1009 304-302-2074 Monday - Friday 8:00am - 4:30pm 2nd & 4th Tuesday 10:00am - 6:30pm Calhoun County WIC 300 Mill Street - P.O.Box 33 Granstville, WV 26147 304-354-6898 304-354-6654 Wednesdays 8:00am - 4:00pm Clay County WIC Program 452 Main Street Clay, WV 25043 304-587-2323 304-587-7415 Monday & Wednesday 8:00am - 4:00pm Doddridge County Nutrition Services 60 Pennsylvania Street West Union, WV 26456 304-873-1173 304-848-9684 2nd & 4th Wednesday 9:30am - 3:15pm Fayette County WIC Program 1822 East Main Street Oak HIll, WV, 25901 304-465-5314 304-465-5316 M-Th 8:00am-6:00pm Gilmer County WIC 1471 West Virginia Highway 5 EasGlenville, WV 26351 304-462-8290 304-462-5750 Thursdays 8-4 Grant County WIC Nutrition Program 23 Hospital Drive Petersburg, WV 26847 304-257-4936 304-257-2034 Monday 8:00am - 8:00pm Tuesday, Wednesday & Friday 8:00am - 4:00pm Thursday 9:00am - 6:00pm Greenbrier County WIC Program 170 Coleman Drive, Suite 7 Lewisburg, WV 24901 304-647-7430 304-647-7431 Monday - Friday 8:00am - 4:00pm Hampshire County WIC Program 24940 Northwestern Pike Romney, WV 26757 304-882-5703 304-882-5656 Monday - Thursday 8:00am - 4:00pm Hancock County WIC Program 192 Industrial Park Lane Beech Bottom, WV 26030 304-394-5090 304-394-5092 Monday - Thursday 8:00am - 5:00pm Hardy County WIC Nutrition Program 712 North Main Street, Ste. 105 Moorfield, WV 26836 304-538-3382 304-538-3382 Tuesday & Friday 9:00am - 3:00pm Harrison County Nutrition Services 103 East Main Street Bridgeport, WV 26330 304-848-9680 304-848-9684 Monday - Friday 8:30am - 4:30pm 4th Thursday 11:00am-7:00pm Jackson County WIC 600 South Church Street, Suite 2 Ripley, WV 25271 304-372-8525 304-372-5767 Monday -Thursday 8:00am - 4:00pm Jefferson County WIC Program 211 East 5th Avenue Ranson, WV 25438 304-725-2028 304-725-9354 Monday and Tuesday 8-6:30 Kanawha (Cedar Grove) County WIC Program 408 Alexander Street Cedar Grove , WV 25039 304-595-3283 304-595-6466 Wednesday 8:00am - 4:30pm Kanawha County WIC Program 4188 West Washington Street Charleston, WV 25313 304-746-7880 1-800-953-4002 Monday - Friday 8:00am - 4:00pm Lewis County WIC Nutrition Program 2 Brown Avenue Weston, WV 26452 304-269-1318 304-472-0630 Tue & Thur 9 am - 3 pm/1st Thur 9 am - 5 pm Lincoln County WIC Program 357 Walnut Street Hamlin, WV 25523 304-824-4008 304-824-4007 Wednesday & 1st Friday 8:30am - 4:00pm Logan County WIC Program 20 Forutne Street Logan, WV, 25601 304-752-5400 304-752-9102 M-Thu 7:30am-5:30pm F 8:00am-4:00pm Marion County Nutrition Services 532 Pennsylvania Avenue Fairmont, WV 26554 304-366-2387 304-366-2393 M-F 8:30-4:30 Evening Clinic 2nd Wednesday of the Month 11-7 Marshall County WIC Program 500 Tele Tech Drive Moundsville, WV 26040 304-845-7426 304-845-1800 Monday - Thursday 8:00am - 5:00pm Friday 8:00am -12:00pm Mason County WIC 701 22nd Street Point Pleasant, WV 25550 304-675-5279 304-675-5337 Tuesday - Friday 8:00am - 4:00pm McDowell County WIC Program 17 Mcdowell Street Welch, WV, 24801 304-436-6122 304-436-6125 M-Thu 7:30a-5:30pm Mercer County WIC Program 286 Blue Price Road Bluefield, WV, 24701 304-325-3922 304-325-3935 M-Thu 8:00am-6:00Pm Mineral County WIC Program 541 Harley O'Staggers Drive, Suit Keyser, WV 26726 304-788-1693 304-788-6476 Monday - Friday 8:00am - 4:00pm Mingo County WIC Program 114 Grace Street Delbarton, WV, 25670 3044752295 3044752853 M-Thu 7:30am-3:30pm Monongalia County Nutrition Services 1000 Elmer Prince Drive Morgantown, WV 26505 304-598-5181 304-598-5585 Monday, Tuesday, Friday 8:30am - 4:30pm, 4th Tuesday of the month 10:00am-6:00pm Monroe County WIC Program 108 Black Valley Road Lindside, WV, 24951 304-753-5582 304-753-5584 Tues and Thur7:30am-5:30pm Morgan County WIC Program 106 Sand Mine Road, Suite 3 Berkeley Springs, WV 25411 304-258-6074 304-258-7565 W - TH 8:30 - 5 Nicholas County WIC Program 852 Northside Drive, Suite 22 Summersville, WV 26651 304-872-0826 304-874-0815 Monday - Friday 8:00am - 4:00pm Ohio County WIC Program 45 18th Street Wheeling, WV 26003 304-234-3888 304-234-3889 Monday - Thursday 8:00am - 5:00pm Friday 8:00am -12:00pm Pendleton County WIC Nutrition Program 299 Confederate Rd Franklin, WV 26807 304-358-3088 304-358-3088 1st, 3rd & 4th Wednesday 9:00am - 3:00pm
Pleasants County WIC 605 Cherry Street St. Mary's, WV 26170 304-684-2217 304-684-2845 Tuesday 8:00am - 4:00pm Pocahontas County WIC Program 819 Third Avenue, Suite 100 Marlinton, WV 24954 304-799-6550 n/a Monday-Tuesday 8:30am - 2:30pm Preston County Nutrition Services 1343 North Preston Highway, Suit Kingwood, WV 26537 304-329-1957 304-329-1958 T-Th 8:30-4:30 / 1st Wed. 11:00-7:00 Putnam County WIC Program 12535 Winfield Road Winfield WV, 25213 304-757-4200 304-757-3429 Monday, Tuesday 8:30am-4:30pm Raleigh County WIC Program 1600 Harper Road Beckley, Wv, 25801 304-255-9034 304-255-9034 M-Thu 7:30a-5:30pm Randolph County WIC Nutrition Program 107 Davis Street Elkins, WV 26241 304-636-8100 304-636-8101 Monday - Friday 8:00am - 4:00pm last Mon in month 8 - 5:30 Ritchie County WIC 125 West Main Street Harrisville, WV 26362 304-643-4082 304-643-4092 Monday 8:30am - 2:45pm Roane County WIC 200 East Main St. Spencer, WV 25276 304-927-4977 304-927-6043 Monday & Friday 8:00am - 4:00pm Summers County WIC Program 312 3rd Avenue Hinton, WV 25951 304-446-5900 304-455-6470 Mon and Wed 7:30am-5:30pm Taylor County Nutrition Services 718 W Main St Grafton, WV 26354 304-265-1288 304-265-2892 Every Monday 8-4, 2nd and 4th Friday of the month, Evening clinic 3rd Monday of the month 11-7 Tucker County WIC Nutrition Program 206 Senior Lane Parsons, WV 26287 304-478-3096 304-636-8101 Tuesday 9:00am - 3:00pm 1st & 3rd Tyler/Wetzel County WIC Program 430 South 2nd Avenue Paden City, WV 26159 304-337-2011 304-337-2012 Monday - Thursday 8:00am - 5:00pm Friday 8:00am -12:00pm Upshur County WIC Nutrition Program 33 Southfork Plaza Drive Buckhannon, WV 26201 304-472-4714 304-472-0630 Mon 8 am - 6 pm/Tue - Fri 8 am - 4 pm Wayne (Ft. Gay) County WIC Program Ft.Gay Family Health Ctr 71 WaynFort Gay, WV 25514 304-548-5300 304-648-5989 Monday 8:30am - 4:00pm Wayne County WIC Program 42 McGinnis Drive Wayne, WV 25570 304-272-3951 or 1800-3 304-272-3963 Tuesday & Thursday 8:00am - 4:30pm Webster County WIC Program 65 Main Street suite 102 Webster Springs, WV 26288 304-847-2601 n/a Wednesday 9am - 3pm Wirt County WIC 88 Senior Circle Elizabeth, WV 26143 304-275-3150 304-275-6590 Wednesday 8:30am - 3:00pm Wood County WIC 211 Sixth Street Parkersburg, WV 26101 304-428-3688 304-485-7434 Monday - Thursday 8:00am - 4:00pm Fridays 8:00am-4:00pm Wyoming County WIC Program Route 10, Main Street Oceana, WV, 24870 304-682-0475 304-682-0477 M-Thu 7:30a-5:30pm
Vendor Peer Groups, State Agency: ____West Virginia______________ Fiscal Year: ______2025______ Comparable Vendors Peer Group No. Peer Group No. Description (e.g., supermarkets, chain stores, pharmacies) Number of Vendors in Peer Group Regular Vendors Above- 50% Vendors Total 1 Mass Merchandisers: Retailer that a) sells a wide variety of merchandise but also carries groceries, b) owns multiple distribution centers and c) operates nationwide. 38 38 2 National Grocery Chains: Retailer that a) primarily sells groceries, b) owns multiple distribution centers, and c) operates in 10 or more states. 53 53 3 Regional Grocery Chains: Retailer that a) primarily sells groceries, b) orders from a corporate or national grocer distribution center, and c) operates in 4-9 states and/or corporate headquarters not in West Virginia 44 44 4 Local Grocery Chains: Retailer that a) primarily sells groceries, b) orders through corporate or national grocer distribution center, and c) operates in 3 or less states and/or in more than one WIC Local Agency service area of West Virginia. 53 53 5 Rural Independent Grocers: Retailer that a) primarily sells groceries, b) uses a third-party distribution center, and 3) operates in only one WIC Local Agency service area of West Virginia. *May include franchisee of national grocer. 46 46 6 Isolated Independent Stores/Farmers Markets: Retailer that a) sells a wide variety of merchandise but has a limited assortment of grocery items, b) uses a third-party distribution center, and c) operates in only one WIC Local Agency service area of West Virginia. 13 13 Attachment 1: Vendor Peer Group Descrip on State Plan Checklist I. Food Delivery
VII (A). CASELOAD MANAGEMENT GOAL: Outreach Coordinators will increase participation in WIC from high-need populations by improving understanding of WIC service delivery structure and benefits as well as increasing referral rates from community partner organizations that serve target populations. Education, relationship building, and new referral processes for partner organizations will be created through group meetings and personal (or 1-on-1) follow-up connections with partner representatives. This is a new goal for FY2025. METHODOLOGY: Outreach Liaisons (ORLs) will improve existing and build new relationships with community partner organizations that serve high-need populations. ORLs will host a minimum of four (4) meetings with representatives from partner organizations that feature a presentation to introduce WIC's service delivery structure and open discussion to understand partners’ needs to successfully make referrals. ORLs will recruit representatives to participate in meetings from partner organizations that provide direct services to high-need populations in the most populous counties in each region. Example high-need service populations include: ● Migrant Families ● Grandfamilies ● Foster Care Families ● Addiction Recovery and Treatment Program Participants ● Domestic Violence Program Participants ● Homeless and Housing Insecure Families
This is a new goal for FY2025. EVALUATION: Before the ORLs meet with partners in their area, baseline data will be gathered from Crossroads, "How did you hear about WIC?" One quarter (three months) following each meeting, data will be pulled again from Crossroads. ORLs will be expected to report the number of referrals received from any partner organization that was targeted in the mid-year and final report. For the narrative portion of the evaluation, following each of the four meetings coordinators will be expected to document answers to the following questions: 1) Who did you meet with? This is the organization name, contact name, and the target population this organization serves. 2)Was this meeting held virtually, at a WIC clinic, or at a different location? 3) What did you determine was your partner's greatest need in making referrals to WIC? 4) At your one week follow up, what educational resources and materials did you share?
5) For your first point of contact, what was done to increase referrals? Please include details such as time of contact and the types of resources discussed or needed. If your partner requested your presence or assistance with a separate event please provide that information here. 6) For your second point of contact, what was done to increase referrals? Please include details such as time of contact and the types of resources discussed or needed. If your partner requested your presence or assistance with a separate event, please provide that information here. 7) For your third point of contact, what was done to increase referrals? Please include details such as time of contact and the types of resources discussed or needed. If your partner requested your presence or assistance with a separate event, please provide that information here. Presentations and Follow-Up Actions ORLs will host group meetings at a mix of virtual and in-person locations, with preference for in-person meetings. Location is dependent on partner needs. Presentations will cover the following topics: ● Education on WIC service delivery structure (with focus on changes made to service delivery in the public health emergency years) ● Accessible options to enroll in WIC Services for participants ● How to make referrals to WIC ● Discussion on unique needs (successful methods to communicate, potential challenge areas for understanding and accessibility of WIC services etc.) of high-need service populations ● Discussion points of contact, materials, and processes needed for partners to successfully complete referrals ORCs will follow-up within 1 week after the meeting to share educational resources and materials requested by partners to successfully complete referrals. Within 2 months following the meeting, ORCs will make, at a minimum, three additional points of contact with partner representatives to ensure organizations understand educational materials, request if additional materials are needed, and also ensure organizations are making referrals.
This is a new goal for FY2025. STATUS: Outreach activities that were accomplished: ● Valley Health Meeting #1 1) Met with members of Marshall Health/Healthy Connections, Lily’s Place, Right from the Start, Healthy Families Mountain State, Prestera, Marshall Core, KVC Behavioral Health Care, and The Point Cafe (Recovery Point). 2) The meeting was held at the Cabell WIC Clinic.
3) From the pre and post test survey responses, by providing a presentation about WIC and making referrals, it increased confidence from average to excellence. Our partners’ greatest need was more education and feeling confident about understanding the WIC program. 4) At our one week follow up, the google referral form was shared, the powerpoint from the meeting, as well as our peer breastfeeding counselor shared some information on drug use and breastfeeding. 5) At the first point of contact the google form was shared with them again as well as the OR-11 WIC Clinic Contact Information card. They were also reminded that the WIC clinic is here for any questions about the referral process. Lastly, information was shared on new income guidelines in April as well as WIC participants using Farmer’s Market benefits. 6) Second round of email sent . Jun 2, 2024 7) Not completed at this time.
Meeting #2 1) Met with members of Prestera and Unicare. 2) The meeting was held at the Kanawha WIC Clinic. 3) From the pre and post test survey responses, by providing a presentation about WIC and making referrals, it increased confidence from average to excellence. Our partners’ greatest need was more education and feeling confident about understanding the WIC program. 4) At our one week follow up, the google referral form was shared, the powerpoint from the meeting, as well as our peer breastfeeding counselor shared some information on drug use and breastfeeding. 5) At the first point of contact the google form was shared with them again as well as the OR-11 WIC Clinic Contact Information card. They were also reminded that the WIC clinic is here for any questions about the referral process. Lastly, information was shared on new income guidelines in April as well as WIC participants using Farmer’s Market benefits. 6) Second round of email sent . Jun 2, 2024 7) Not completed at this time.
*Additional two meetings will be held later in the year.
● Shenandoah The first half of the fiscal year focused on planning, developing a flier, and reaching out to community partners who may be interested in attending one of the community partner presentations. Community partner presentations are planned for April 11, May 30, June 20, and July 18.
● Monongalia Meeting #1 1) Met with members of the Monongalia DHHR, Aetna, The Health Plan and Unicare. 2) Meetings were held In Monongalia County Health Department conference
room. 3) They needed more information about WIC and who is eligible and what services WIC provides. 4) OR-001, OR-004, and OR-31 literature were provided. 5) Touched base with them and asked if there were any questions. Questions were asked about breastfeeding support and we were told about potential themes of events coming up with Unicare (i.e. child safety). WIC will be invited once the event is established. 6) Invited to our 50th Celebration events held in our counties. 7) No referrals at this time. *Additional two meetings will be held later in the year.
● MOV The previous liaison in coordination with the state ORC and other local agency liaisons had created the action plan for these meetings. MOV plans for these to be accomplished within the second half of FY24.
● Wheeling/Ohio Meeting #1 1) Met with members of the Maternal Infant Health Outreach Workers(MIHOW), Head Start, Health Right, Wheeling Hospital, Northwood Health Systems and Ohio County Family Resource Network. 2) The meeting was held at the Ohio County WIC Clinic. Due to a state of emergency, the meeting was canceled. 3) Calls were made and in the process of rescheduling meetings. 4) Calls were made and in the process of rescheduling meetings. 5) Calls were made and in the process of rescheduling meetings. 6) Calls were made and in the process of rescheduling meetings. 7) MIHOW requested we attend some of their meetings.
Meeting #2 1) Met with members of the Marshall, Haven Maternity Home, Wellsprings Pregnancy Center and Casa. 2) The meeting was held at the Marshall County WIC Clinic. Participants were a no show. 3) Calls were made and in the process of rescheduling meetings. 4) Calls were made and in the process of rescheduling meetings. 5) Calls were made and in the process of rescheduling meetings. 6) Calls were made and in the process of rescheduling meetings. 7) MIHOW requested we attend some of their meetings. *Additional two meetings will be held later in the year.
● Randolph Elkins 1) Upshur and Lewis Counties are partnering with Buckhannon Housing Authority, Crosslines and Mt. Cap Family Support Centers; Randolph county is partnering with Centers Against Violence; Grant, Hardy, and Pendleton counties are partnering with recovery programs.
2) The presentation for the Buckhannon Housing Authority, Crosslines, and Mt. Cap Family Support Centers in Upshur and Lewis Counties will be held at the Buckhannon WIC Office; The Centers Against Violence presentation would not be held at a WIC clinic though they would be offered a tour of the WIC clinic- it was not specified where this presentation would be held; The presentation to partners that target individuals in recovery programs would be held at a regional PITAR (prevention, intervention, treatment, anti-stigma, and recovery) meeting and tours of the clinic would be offered. 3) Plan to utilize the tools that were created in ORQI in January (custom URLs, LAORL Guide to Relationship Building Tools, the customizable powerpoint etc.) 4) No results as of time of report. 5) No results as of time of report. 6) No results as of time of report. 7) No results as of time of report.
● Central Lists of community partners who work with the target populations compiled. Individuals of that target population were invited to attend a presentation, as well as explaining the purpose of the presentation. Four practice run-throughs of the presentation have been completed with Central staff. Two were completed virtually with LAD and LAAD. The third was virtually at a LA staff meeting and the fourth was in-person with LAD, LAAD and Braxton staff. The purpose of the run-throughs was to get more comfortable and learn the flow of the presentation, but also to keep staff informed of our outreach goal and to get their input. The first presentation is scheduled for June 18th at the Clay County Family Resource Network meeting at the Clay County Health Department.
● TSN 1. During the first six months, the following three organizations were met with to target high-need populations: 1-a. Mercer County DOHS Social Service Staff 1-b. WV FACT (Foster and Adoptive Care Training); 1-c. Region 2 Home Visitation Collaborative 2. Meetings were held at the Mercer County DOHS Field Office, Concord University, and the Word of Life Church in Logan, WV 3. An updated overview of the WIC program and encouragement from their organization's supervisor. 4. Links to the community partner referral pages and a WIC Thank You card. 5. The first point of contacting and collaborating with organizations in this FY 2024 outreach process is sending out the pre-presentation survey to staff within the organization who plan on attending the WIC presentation. This survey was sent to the person organizing the event (contact person) a few days prior to the presentation dates respectively of 2/21/2024, 3/1/2024, and 5/13/2024. The contact person would then send out the pre-presentation survey to their organization’s staff. Outreach materials are sent and/or delivered to community partner organizations on a regular basis. The three partners aforementioned have not requested any assistance with making referrals to WIC. 6. Both the first and second points of contact after the presentation for the first two
presentations listed above (the third presentation only occurred on 5/13, so a thank you email, and referral links were only sent out as the first point of contact today on 5/15) were sent via email and thank you cards, thanking the contact person for allowing WIC to present to their staff, offering any help if needed on further instructions when making referrals, etc. 7. For the third point of contact, occurring a month after each of the two presentations, DOHS’s was contacted and volunteered to follow-up with staff at an upcoming Staff meeting. WV FACT would not send out the pre-presentation survey. They had to be contacted numerous times to encourage sending out the referral link, which was completed. All materials and procedures were followed in the State 2024 OR plan to increase caseload within the areas of contact and help target populations in need.
This is a new goal for FY2025. Challenges: ● Difficulty getting forms in correct format in time to get forms in circulation to maximize attendance. ● New Outreach Coordinator’s onboarding processes being in the earlier stages. ● The number of referrals received from community partner presentations may need to be tracked into the next fiscal year. ● Difficult to get multiple key partner’s schedules to align to ensure high attendance levels. ● Weather and unforeseen circumstances such as state of emergency situations make for an issue that cannot be avoided.
This goal will be modified for FFY2025 to focus on support groups already established and in place within local communities.
VIII (A). CERTIFICATION, ELIGIBILITY AND COORDINATION OF SERVICES
GOAL: Streamline the certification process by 1) accessing the WV Health Information Network (WVHIN), a health information portal which would provide necessary program health surveillance, and 2) utilizing a document sharing and electronic signature portal for eligibility documentation, medical information, and referrals prior to appointment.
METHODOLOGY: The FY2022 WIC Infrastructure grant awarded to WV will support the medical liaison positions in each of our eight local agencies. The WV WIC Program will assess the effectiveness of the use of the WVHIN through the number of participants willing to allow WIC to access their health information. Currently, participants sign an authorization for release of health information that allows WIC to search the WVHIN for their health information. We hope that with the use of a document sharing portal and its functionality within our existing applications we are able to receive authorization from more participants which eliminates the burden of maintaining and returning physical paperwork. The WV WIC Program would define successful use of the WVHIN as receiving 20% of our authorizations for release of health information back from participants starting in year 1 and 40% by year 3. Effectiveness of the document sharing portal would be measured by reaching at least 50% of our average annual caseload by FY24 through the portal with the help of the interconnected existing WIC applications. We also plan to assess the effectiveness of the use of WVHIN through both the number of participants able to be located in the WVHIN and the number of heights, weights, and hemoglobins that are available for documentation at a WIC appointment. As we continue toward a post pandemic world we hope to see a return to more routine in person healthcare which would mean more readily available health data in the WVHIN. Successful use of the WVHIN would be that 10% or more of our participants have at least one available anthropometric or hematological measure within the appropriate date range for use at a WIC appointment.
EVALUATION: The State and local agency will utilize Crossroads reports and tracking documents to collect data on participant willingness to participate, document portal implementation, and available height, weight, and hemoglobin data.
Medical Liaisons will be tracking the number of records accessed in the WVHIN, the number of participants with up-to-date anthropometric measures, and the number of documents received via the portal.
STATUS: Nearly half of participants statewide, 43.71% (n= 14,915), have authorized their information to be in the HIN. And of those Local Agencies that have
medical liaisons, 70.87% (n=13,350) participants were authorized in the HIN. Since September 2023, only 5 of the 8 Local Agencies agreed to move forward utilizing the position of medical liaison since there were poor results yielded by the WVHIN. From September 2023 to July 2024, Statewide WVHIN was utilized 3.74% (n=1,447) of the time for updated bloodwork information and out of the 5 Local Agencies that utilize the position of medical liaison 6.47% (n=1,441) used WVHIN for updated bloodwork information. Updated height and weight measures were also obtained by medical liaisons. Statewide, WVHIN was utilized 8.02% of the time (n=4,830) and of the 5 Local Agencies that have the medical liaison position, 14.24% (n=4,810) utilized WVHIN to obtain updated heights and weights. The use of medical liaison positions will be discontinued at the conclusion of FY2022 WIC Infrastructure funding performance period 9/30/25. The duties of the medical liaisons will transition to other clinic staff. The transition of duties will vary from clinic to clinic due to staffing availability. The same utilization of the WVHIN will continue even after medical liaisons are phased out. WV ONS is also currently developing a pilot for the use of WVHIN as a referral tool for our local agencies.
XI.
CIVIL RIGHTS
GOAL: No goals for FY 2025.
I (A). FOOD DELIVERY
GOAL: To investigate a minimum 5% of the Program’s authorized vendors for compliance with federal regulations during the federal fiscal year.
METHODOLOGY: The compliance liaison, under the direction of the unit supervisor, manually selects vendors for investigation based upon participant and local WIC office complaints and high-risk reports generated from the Food Delivery Portal, Store Tracking and Redemption System (STARS), and/or Crossroads Management Information System. Investigation priority is determined according to the severity of the possible infractions to the program.
The State Agency (SA) will also develop policy and procedure as well as tools to institute inventory audits as a method of compliance investigations. Technical assistance will be sought from other states as recommended by the regional office through technical assistance site visits and/or review of approved procedures and tools.
EVALUATION: Regional office approval of the inventory audit policies, procedures and tools will be secured to initiate use of inventory audits for compliance investigations. The number of compliance investigation letters will be recorded to track the most common state violations or customer service issues. This information will inform quarterly newsletter items as well as state standards.
STATUS: The 5% minimum requirement will be completed by 9/30/24; 10 compliance investigations have been completed with 13 vendors and within the 4th quarter of FFY2024 all 13 investigations will be completed. The SA continues to utilize Policy 8.09 as well as the Compliance Buy Investigation Standard Operating Procedures, with revised reporting form and notification template letter. Written notification was mailed following every investigation regardless of result.
The development of 8.12 inventory audit policy, procedure and standard operating procedure were drafted and approved in January 2024. Inventory audits have begun as of May 2024 with 2 investigations. Unfortunately, vendors have not been forthcoming in producing requested records so to date no audit has been successful. Hence implementation of inventory audits is ongoing for FY 2025. Inventory audits will be utilized for all vendors designated high risk because of volume and redemption risk indicators. Compliance buys will be utilized for all vendors designated high risk for participant risk indicators and new vendors.
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I (B). FOOD DELIVERY
GOAL: To begin using an electronic signature platform for vendor agreements and applications.
METHODOLOGY: The Vendor Manager will research external platforms as well as continue to work with the Crossroads contractor to assess the best method to distribute documents, have vendors sign electronically, and receive and store documents without the need for paper mailings.
EVALUATION: Once the electronic platform has been decided upon, the Vendor Management Unit will assess the timeliness and ease of distributing and receiving documents and will poll vendors for feedback.
STATUS: Docusign was chosen as the electronic platform. The pilot was successfully conducted in January 2023, and the rollout is continuing as each region renews its agreements. Currently, the vendor unit is working to complete two additional regions in FY 2024. At the beginning of FY 2025, seven of eight agencies will be converted, with the last agency scheduled for conversion in June 2025.
This goal is ongoing for FY 2025.
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I (C). FOOD DELIVERY
GOAL: To modernize the Farmers’ Market Nutrition Program (FMNP) so that participants can purchase fresh, unprepared, locally grown fruits and vegetables from authorized farmers via electronic benefit transfer (EBT) through CDP’s Farm Market Direct program.
METHODOLOGY: The Vendor Management Unit, the WIC Program Specialist (now the Farmers Market Nutrition Program Coordinator), and the Food Insecurity Partnership Liaison will work with CDP to implement the Farm Market Direct program with all WIC participants and farmers’ markets participating in the WIC FMNP. This will be a fully mobile and electronic solution for transacting FMNP benefits, eliminating the need for a banking contract and paper vouchers.
EVALUATION: Successful implementation of the electronic solution will be assessed by review of four indicators: number of families, number of farmer users, benefit dollars issued, and benefit dollars redeemed.
STATUS: The electronic solution was fully implemented in the 2023 growing season by printed QR codes. During the FY2024 FMNP season which started on June 1 Farm Market Direct is accessed via QR code hosted on the WICShopper mobile app. This eliminated printing and mailing costs of QR codes. During FFY2023 the number of families receiving FMNP benefits via QR code was 13,563, the number of authorized farmers was 122, the benefit dollars issued was $564,842.00, and the benefit dollars redeemed was $127,935.10. Thus far for FFY2024, the number of families issued FMNP benefits was 19,031, the number of authorized farmers was 165, the benefit dollars issued was $782,280.00 and the benefit dollars redeemed as of July 31, 2024 was $140,333.40.
This goal is complete, and part of ongoing operations.
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I (D). FOOD DELIVERY
GOAL: To authorize farmers as WIC vendors and allow participants to purchase fresh, unprepared, locally grown fruits and vegetables with their regular monthly CVB through CDP’s Farm Market Direct program.
METHODOLOGY: The Vendor Management Unit will work with CDP to add CVB functionality for all WIC participants at authorized farmers’ markets to the existing QR code solution within the Farm Market Direct program.
EVALUATION: Successful implementation of the electronic solution will be assessed by review of three indicators: number of families, number of farmer users, and benefit dollars redeemed.
STATUS: Training sessions were conducted statewide in April 2024 for farmers and local agency FMNP liaisons on processing CVB transactions utilizing participants' QR codes available on either WICShopper app or new QR Code EBT Cards (pending printing), consistent with FMNP benefits. Effective June 1st, 2024, both FMNP benefits and CVB are accepted methods of payment at West Virginia farmers' markets and stands.
Thus far for FFY2024, the number of families who have redeemed CVB at a farmers market is 431, the number of authorized farmers conducting CVB transactions is 49 of 165 total authorized farmers, and the CVB benefit dollars redeemed as of July 31, 2024 was 6088.05.
This goal is complete, and part of ongoing operations.
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I (E). FOOD DELIVERY
GOAL: With the transition to the Maintenance and Enhancement (M&E) phase of the State Agency Model (Crossroads) as of February 1, 2017, the State Agency (SA) will continue to be involved with changes and updates to the system affecting Food Delivery during FY2024.
METHODOLOGY: The SA will continue to work closely with Voyatek (formerly Gainwell, CSC and DXC Technology) and the Crossroads User Group (Alabama WIC, West Virginia WIC, Virginia WIC, and Rhode Island WIC) as change requests are completed. As these updates take place, SA staff will educate Local Agency (LA) staff on the changes to the system as they occur, through additional training sessions and updated training materials.
EVALUATION: The effectiveness of the training content and materials will be determined through evaluation forms completed by attendees of subsequent training sessions.
STATUS: The SA continued requesting that trainees complete training evaluations via Survey Monkey regarding the Crossroads training during FY2024. The “Extended” Crossroads training which incorporates new updates to the MIS as they occur and addresses any issues that seem to come up frequently as Help Desk questions and calls will continue during years when a state training conference is not hosted by the SA or as needed. Although this training normally takes place during LA staff meetings twice per year and is facilitated by the SA trainer, in FFY2024 SA vacancies inhibited virtual or in person training sessions. Instead job aides and a Tips and Tricks Newsletter was released quarterly.
The new employee Crossroads training content was condensed to three full workdays, and a ½ day contributed solely to Nutrition Services. The SA transitioned the training back to in person. This goal is complete. Training curriculum will continue to be addressed as quality improvement; reference Nutrition Services II.(C) goals and objectives.
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I (F). FOOD DELIVERY
GOAL: Update the WIC food packages and Food Delivery business processes including Information System revisions, required to implement the Final Food Package Rule.
METHODOLOGY: The SA will work to implement the changes to the WIC food packages that are required with the Final Food Package Rule through collaboration with Voyatek and the Crossroads User Group, to facilitate revisions as soon as possible. The SA will develop participant education materials and provide training to Competent Professional Authorities/Nutritionists regarding prescription tailoring guidelines for participant preference, supporting health status, and addressing special medical needs.
EVALUATION: The implementation of all required updates to the WIC food packages that are required by the Final Food Package Rule.
STATUS: The majority of the updates to the WIC food packages required by the Final Food Package Rule have been implemented. The last update to be made in the Crossroads system is the functionality to prescribe and issue food package VII to a new pregnant woman who is breastfeeding to allow the substitution of 3.5 lbs of cheese. Currently, there is no functionality to allow for issuing food package VII to newly certified pregnant women who are breastfeeding; however, this functionality will be developed as time and money allows for the Crossroads project.
West Virginia implemented the increased Cash Value Benefit authorized through the Congressional appropriations.
Secondly, with USDA announcing intention to review WIC food packages beginning in fall 2023, the SA will ensure processes occur to implement per regulation timelines.
This will be an ongoing goal for FY 2025.
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I (G). FOOD DELIVERY
GOAL: To implement an online ordering system for WIC participants, enabling them to order and purchase WIC-eligible food items through approved online vendors.
METHODOLOGY: The WIC state office will participate in a multi-state consortium with Connecticut, Rhode Island, and Vermont through a Center for Nutrition and Health Impact online ordering planning grant. The SA will collaborate with Umoja and JPMA to integrate WIC benefits into WICShopper and an online shopping add-on. This involves developing a secure authentication system for participants, adapting the online shopping interfaces to include WIC-approved products, and ensuring compliance with federal and state regulations. Training sessions for both clinic staff and participants will be conducted to facilitate a smooth transition to the online ordering system.
EVALUATION: The success of the WIC Online Ordering initiative will be assessed through the following indicators:
● Number of WIC participants utilizing the online ordering system. ● Volume of WIC transactions processed through online vendors. ● Participant satisfaction rates measured through surveys. ● Reduction in physical store visits by WIC participants.
STATUS: This is a new goal for FY 2025.
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I (H). Food Delivery
GOAL: Knowledge and visibility about WIC will be expanded through WIC vendors and farmers to increase redemption of food benefits. The goal is to enhance awareness and understanding of the WIC program among WIC vendors and farmers aiming to boost the utilization of food benefits.
METHODOLOGY: Allocate resources to increase the presence of Local Agency Vendor and Farmers Market Nutrition Program Liaisons with WIC authorized providers (virtual or in person) to re-establish connections and deliver educational sessions on optimal practices. Improve comprehension of obstacles to retailer and farmer participation as well as participant redemption through an examination of the requirements and difficulties encountered by WIC vendors and farmers.
EVALUATION: The evaluation methods for Vendor and FMNP annual plan include conducting pre- and post-surveys with both vendors/farmers and participants to gather insights into their shopping experiences. This feedback will help gauge any changes or improvements throughout the implementation of the initiative. Additionally, tracking the frequency and nature of interactions with vendors/farmers will be crucial in assessing the effectiveness of increased engagement efforts. By monitoring these interactions, we aim to understand how well vendors/farmers are integrating new practices and support from Local Agency Vendor and FMNP Liaisons. Furthermore, a comparison of the dollar amounts redeemed in food benefits at the outset versus the conclusion of the planning period will provide a quantitative measure of impact. This contrast will help determine whether the initiative has successfully enhanced participation and usage of WIC benefits among vendors/farmers and participants alike. These evaluation methods are designed to provide comprehensive insights into the outcomes and effectiveness of the annual plan activities.
STATUS: This is a new goal for FY 2025.
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I. FOOD DELIVERY CHECKLIST I. FOOD DELIVERY
(Please indicate) State Agency: West Virginia
for FY 2025 The Food Delivery State Plan checklist collects information regarding vendor and farmer / farmers’ market management as well as food delivery systems, food instruments, and electronic benefits. This checklist has combined the previous years’ checklists “I. Vendor Management” and “IX. Food Delivery”. Many questions pertaining to paper food instruments were removed, and the checklist was revised to capture the EBT environment. All new questions which were not pulled from either of the previous checklists, and new options for SAs to select in certain questions, are highlighted for ease of identification. Vendor and farmer/farmers’ market management includes all those activities associated with selecting, authorizing, training, and monitoring, stores and farmers/markets participating in the WIC Program. Food delivery accountability includes the issuance, redemption, and monitoring of the Retail Food Delivery System, and the procurement and delivery of supplemental foods to participants in the Home Food and Direct Distribution Delivery Systems. During disasters, emergencies, public health emergencies, or a supply chain disruption, the State agency may request to implement existing and allowable regulatory flexibilities or waivers to support the continuation of Program benefits and services. Waivers granted under Access to Baby Formula Act of 2022 (codified at 7 CFR 246.4a(30)) or temporary provision(s) authorized by Congress are not permanent amendments to the State Plan and should not be reflected in answers below. Instead, waiver flexibilities impacting Program benefits and services should be recorded in Appendix C. However, State agencies should consider any historical amendments as the result of waivers granted under prior waiver authority to develop policies and procedures for current and future disasters.
I. GENERAL ADMINISTRATION
II. HOME FOOD DELIVERY SYSTEMS 7 CFR 246.4(a)(14), 7 CFR 246.4(a)(14)(viii), 7 CFR 246.12(m): Describe how the home delivery system operates including the types of authorized home food delivery contractors, the frequency of deliveries, and the procedures for documenting deliveries. Include a description of specialty infant formula, if applicable. ADDITIONAL DETAIL – Food Delivery Appendix and/or Procedure Manual (citation): I Appendix O- CAP Lancaster Formula Warehouse Agreement
1 February 2024
I. FOOD DELIVERY CHECKLIST III. DIRECT DISTRIBUTION FOOD DELIVERY SYSTEMS 7 CFR 246.4(a)(14), 7 CFR 246.12(n): Describe the methodology and procedures used in the direct distribution of supplemental foods, including types of foods distributed, warehouse and distribution centers, the verification process, and assurance of safety. Include a description of specialty infant formula, if applicable.
IV. RETAIL FOOD DELIVERY SYSTEMS: BENEFIT ISSUANCE AND FOOD INSTRUMENTS A. Electronic Benefit Transfer (EBT) Management – 7 CFR 246.12(y)(4)(ii): Describe updates on any active EBT projects. B. Food Instrument Overview – 7 CFR 246.4(a)(11)(iii), (14)(i), (vi), (xii): Describe the policies and procedures used by the State agency in producing, monitoring, and accounting for the use of food instruments. C. Benefit Issuance – 7 CFR 246.4(a)(11)(iii), (14)(xx); 7 CFR 246.12(r)(4); 7 CFR 246.4(a)(14)(i), (x), (xi), (xv): Describe the State agency's procedures for issuing food instruments to participants, including procedures for verifying identity, providing education on how to use food instruments, and proxy policies. Include alternative benefit issuance procedures for special circumstances. D. Food benefit redemption and disposition – 7 CFR 246.4(a)(14)(xiii), (xix): Describe the procedures used to monitor food benefit redemption and disposition and the management of lost/stolen/damaged food instruments. V. RETAIL FOOD DELIVERY SYSTEMS: VENDOR MANAGEMENT A. Participant Access –7 CFR 246.4(a)(14)(xiv), 7 CFR 246.12(l)(1)(ix): Provide information about the State agency's definition of participant access. B. Vendor Selection and Authorization – 7 CFR 246.4(a)(14), (15), 246.12(g)(3), (8); 7 CFR 246.12(h)(1)(ii): Describe limiting criteria, application periods, selection criteria, relevant exemptions (if applicable), how above-50-vendors are assessed, and if pharmacies are authorized. Attach a sample vendor agreement. Include description of peer groups, and a brief description of how the SA informs vendors of allowable infant formula providers. C. Vendor Cost Containment (including management of above 50 percent vendors) – 7 CFR 246.4(a)(14), 7 CFR 246.12(g)(4)(vi): If the State agency authorizes or plans to authorize any above-50-percent vendors, FNS must certify the State agency’s vendor cost containment system. For certification, the State agency must describe the competitive pricing and reimbursement methods implemented to ensure that average payments per food instrument to above-50-percent vendors do not exceed average payments per food instrument to comparable regular vendors. D. Vendor Agreements –7 CFR 246.4(a)(14)(iii): Describe information regarding the vendor agreement. E. Vendor Training – 7 CFR 246.4(a)(14), 7 CFR 246.12(i):
2 February 2024
I. FOOD DELIVERY CHECKLIST Describe State and local agency procedures for training WIC Program vendors. F. Routine monitoring – 7 CFR 246.4(a)(14), 7 CFR 246.12(j)(2): Describe the criteria used to select vendors for routine monitoring as well as the methods and scope of on-site routine monitoring activities. Include any relevant information about the State agency’s plans for improvement in the coming year. G. Administrative Review of State Agency Actions – 7 CFR 246.4(a)(14), (a)(18): Describe the procedures for conducting both full and abbreviated administrative reviews. VI. RETAIL FOOD DELIVERY SYSTEMS: FARMERS AND FARMERS’ MARKETS (if applicable) – 7 CFR 246.4(a)(14)(iii), (a)(14)(xii), (a)(14)(v); 7 CFR 246.12(v): If the State agency allows farmers / farmers’ markets to transact cash value benefits, describe the farmer / farmers’ market agreement, monitoring, and training procedures.
I. GENERAL ADMINISTRATION
1. Which of the following food delivery systems does your State agency operate? Be sure to consider how the State agency provides specialty formula to participants. ☒ Home Food Delivery (please fill out section II) ☐ Direct Distribution Food Delivery (please fill out section III) ☒ Retail Food Delivery (please fill out sections IV, V, and VI)
ADDITIONAL DETAIL – Food Delivery Appendix and/or Procedure Manual (citation): Food Delivery Appendix
II. HOME FOOD DELIVERY SYSTEMS
☐ Does not apply (proceed to next section)
1. The State agency uses home food delivery systems to: ☐ Provide all WIC program foods ☐ Reach select remote / rural participants ☐ Reach select participants with mobility or transportation concerns ☒ Provide specialty infant formula and/or medical foods ☐ Other (specify):
2. Home food deliveries take place: ☒ Monthly ☐ Bi-monthly ☐ Every three month ☒ Other (specify): When participants place an online order.
3 February 2024
I. FOOD DELIVERY CHECKLIST 3. Home food delivery vendors include: ☐ Dairies ☐ Private delivery service doing WIC business only ☒Private delivery service ☐ Infant formula providers Hospitals ☐ Other (specify): Click or tap here to enter text.
4. Participants who receive home food delivery: ☐ Are notified in writing of the types and quantities of food they will receive ☐ Indicate by authorized signature on FI, receipt, or signature device that supplemental foods were received ☒ Are delivered only a one-month supply of supplemental foods per delivery ☒ Other (specify): Participants verify benefits being deducted during online checkout. 5. Supplemental foods may be delivered: ☐ Only to the participant ☐ To the proxy ☐ To any adult at home during time of delivery ☒ To anyone at home during time of delivery ☐ Other (specify): Click or tap here to enter text.
6. Documentation:
a. The forms verifying delivery are reconciled against vendor invoices: ☐ Weekly ☐ Monthly ☒ Other (specify): Payment files are matched back to issuance. If participant indicates formula is missing, delivery method is researched with CAP Formula Warehouse and future orders must be shipped to the clinic..
b. Signatures of participants who sign the receipt are compared to signatures on file: ☐Yes
☒No
7. Please attach a list of the names of contractors/providers that the State agency works with to provide Home Delivery services: CAP of Lancaster, Umoja Supply.
ADDITIONAL DETAIL – Food Delivery Appendix and/or Procedure Manual (citation): Food Delivery Appendix III. DIRECT DISTRIBUTION FOOD DELIVERY SYSTEMS
☐ Does not apply (proceed to next section)
1. The State agency uses direct distribution food delivery systems to:
4 February 2024
I. FOOD DELIVERY CHECKLIST ☐ Distribute all WIC program foods ☒ Distribute specialty infant formula and/or medical foods ☐ Distribute foods to accommodate the needs of select participants ☐ Other (specify): N/A
2. The State agency uses: ☒ One central warehouse and delivers directly to local agencies ☐ One central warehouse from which foods are sent to one or more subsidiary warehouses before delivery to local agencies ☐ Other (specify):.
3. Warehouses are operated by: ☐ State agency ☐ Local agencies ☐ Other public agency ☒ Under contract with private business ☐ Other (specify): N/A
4. Warehouses used for WIC foods are also used to store other FNS program commodities (please specify which): ☐ Yes, Click or tap here to enter text.
☒ No
5. Foods are distributed to participants: ☐ Grocery store fashion ☒ Pre-packaged ☐ Other (specify): N/A
6. Upon receipt of foods, participants / caregivers / proxies are required to sign: ☐ A receipt for each food received ☐ A receipt for all foods received (as a whole package) ☒ Other (specify): Signature may not be that of the participant/parent/guardian.
7. Foods are distributed to participants: ☒ Monthly ☐ Every three months ☐ Other (specify): N/A
8. Participants with limited access to distribution sites can utilize: ☒ Home food delivery ☐ Cost-free transportation ☒ Other (specify): Most orders are shipped to the home; however, if there has been an issue with delivery in the past, the participant must pick up formula at the clinic.
9. Monitoring and Inventory Control: Describe the State agency’s methods for ensuring WIC
5 February 2024
I. FOOD DELIVERY CHECKLIST supplemental foods are adequately received, in stock, and issued. WV orders special formulas for clients a few days in advance to ensure that delivery will be timely for the clients. This allows the CAP formula warehouse to order formulas if needed. CAP Warehouse has run into issues with backordered formulas, WV gets a report twice a week of pending orders due to backordered formulas along with a list of available formulas and backorder status. WV works this report and notifies clinics for them to check with clients/doctors to see if another formula can be ordered. Once that is determined, WIC will need a new WIC53 (medical documentation) for the newly prescribed formula.
Please indicate the provisions the State agency includes in its inventory control policies for direct distribution contractors: ☐ Separation of duties for intake and inventory ☐ Stock rotation ☐ Performance of perpetual and physical inventory duties ☒ Reconciliation against issuance records ☐ Other (specify): N/A
10.Please attach a list of the names of contractors that the State agency works with to provide Direct Distribution Delivery services: CAP of Lancaster.
ADDITIONAL DETAIL – Food Delivery Appendix and/or Procedure Manual (citation): Food Delivery Appendix
IV. RETAIL FOOD DELIVERY SYSTEMS: BENEFIT ISSUANCE AND FOOD INSTRUMENTS
A. Electronic Benefit Transfer (EBT) Management
1. Does the State agency have any future EBT changes planned? ☒ Yes
☐ No
a. If yes, what type of changes: ☐ EBT contract re-procurement ☐ Self-checkout installation at vendors ☐ Offline to Online EBT transition ☒ Other (specify): Online ordering.
b. If yes, please provide a short description of the type of changes and when they are expected to be implemented. An online ordering platform in which participants use the WICShopper app to place and order. The foods are then shipped directly to the participant.
Additional information if applicable: N/A
6 February 2024
I. FOOD DELIVERY CHECKLIST
B. Food Instrument Overview 1. The State agency uses the following types of Food Instruments (check all that apply): ☒ EBT card ☒ QR code ☐ Other (e.g., paper voucher): Click or tap here to enter text.
2. Please provide a description of the State agency's system for ensuring the accountability and security of food instruments and electronic benefits. Attach and cite relevant policies and procedures. I Appendix-B- 3.02 Security of eWIC Benefit Cards
Additional information: Please provide a facsimile of the EBT card as an Appendix or cite the location in the State agency’s Food Delivery Policy: I Appendix- C - WV_eWIC_Card_v2 w QR.
C. Benefit Issuance 1. The State agency: ☒ Requires participants to pick up food instruments at the local agency when scheduled for an in-person nutrition education or a certification appointment ☒ Allows benefits to be issued remotely to participants except when the participant is scheduled for nutrition education or a certification appointment ☐ Mails food instruments to participants ☐ Other (specify): Click or tap here to enter text.
2. The State agency requires the following proof of receipt when issuing Food Instruments: ☐ Participant / caretaker / proxy signature confirming receipt ☐ Local agency staff initials ☐ Documented in MIS ☒ Other (specify): Electronic signature by participant, parent/guardian,caretaker, proxy, or WIC staff.
3. Mailing of Food Instruments:
a. The State agency provides local agencies with guidelines / procedures for mailing Food Instruments to participants: ☒ Yes
☐ No
b. The State agency has implemented the following policy regarding mailing Food Instruments (FI) (check all that apply) ☐ FI are sent first class mail *(first class is considered regular mail) ☐ FI are sent registered mail ☐ FI are sent certified mail ☐ FI are sent restricted mail
7 February 2024
I. FOOD DELIVERY CHECKLIST ☐ Return receipt is requested on FIs sent certified mail ☐ Envelope specifies, “do not forward, return to sender” or “do not forward, address correction requested” ☒ Other (specify): EBT can be mailed under extenuating hardship cases.
c. The State agency approves mailing Food Instruments under the following conditions: ☒ Participant resides in rural area ☒ Participant is unable to visit clinic during operating hours (e.g., due to employment or childcare) ☒ Clinic management (e.g., temporary clinic closure) ☒ Participant safety (e.g., circumstances where participant safety can’t be guaranteed at the clinic location) ☐ Cost effectiveness (e.g., the clinic is temporarily understaffed) ☒ Public Health Emergency ☒ Other (specify): WV does not typically mail. However, for reasons listed above, benefits may be remotely loaded to EBT cards without the client having to come to the clinic. Each situation is assessed on a case-by-case basis.
d. When mailing Food Instruments, documentation of issuance is: ☐ Signed by participant at the next in-person appointment ☐ Documented in the MIS by local agency staff ☒ Other (specify): Notated in the participant's record within Crossroads as to the reason and approval of the mailing of the EBT card to the participant.
e. Please describe how the state agency ensures program integrity in the mailing of food instruments: I Appendix-D- 3.09 Remotely Issuing Electronic Benefits and E-Mailing the Shopping List. Remotely Issuing Electronic Benefits and E-Mailing the Shopping List
4. The State agency requires local agency staff to educate each new participant / caretaker / proxy regarding: ☒ Authorized vendors / farmers ☒ Transaction procedures ☒ Transacting WIC-approved foods ☒ Use of a proxy ☒ Reporting problems / requesting assistance ☒ Participant violations (i.e., selling WIC benefits) ☒ Food Instrument security tips (i.e., regularly changing PIN) ☒ Other (specify): Rights and responsibilities.
5. The State agency’s proxy policy includes the following: ☐ Limits the number of participants a single proxy may sign for, except that a proxy may pick up Food Instruments for all homeless WIC participants in a facility ☐ Limits proxy to specified number of Food Instrument pick-ups
8 February 2024
I. FOOD DELIVERY CHECKLIST ☒ Limits proxy to a minimum age ☐ Limits proxy assignment to local WIC staff ☐ Proxies are required to show identification card at Food Instrument pick up ☒ Other (specify): Limits the number of proxies.
6. What are the State agency procedures for providing customer service during non-business hours for participant / vendor / farmer inquiries? ☒ EBT toll free number ☐ Other (specify): N/A
7. Special Food Instrument Issuance Accommodations
a. The State agency has established food delivery procedures in cases of natural disaster and emergencies including: ☐ Mailing food instruments ☒ Remote benefit issuance ☐ Direct distribution ☐ Home food delivery ☒ Other (specify): Load one month of benefits onto the EBT card if certification is active.
b. Does the State agency adapt its food delivery system to accommodate the needs of homeless individuals? ☒ Yes
☐ No If yes, please cite and attach policy: I Appendix-E-2.18 Services to Persons Affiliated with Institutions and Homeless Facilities. ADDITIONAL DETAIL – Food Delivery Appendix and/or Procedure Manual (citation): Food Delivery Appendix
D. Food Instrument Redemption and Disposition
1. The State agency system assures 100% disposition of all Food Instruments: ☒ Yes
☐ No If no, specify the circumstances that prevent 100% disposition: Click or tap here to enter text.
2. For EBT systems disposition, does the State agency link the Primary Account Number (PAN) associated with the electronic transaction to valid issuance records? (This can be done by matching the electronic benefit record for the household to redemptions by the EBT card number (PAN) at the aggregate household benefit level.) ☒ Yes
☐ No If no, specify how the State agency ensures disposition for EBT: Click or tap here to enter
9 February 2024
I. FOOD DELIVERY CHECKLIST text.
3. Does the disposition happen within 120 days of the first date of use for the participant? ☒ Yes
☐ No If no, specify when disposition occurs: Click or tap here to enter text.
4. Customer Service Standards
a. The State agency’s customer service procedures enable participants or proxies to do the following during non-business hours: ☒ Report a lost/stolen/damaged card ☒ Report other card or benefit issues ☒ Receive information on the EBT food balance ☒ Receive the current benefit end date ☐ Other (specify): N/A
b. Describe how the State agency responds to reports of lost/stolen/damaged cards within one business day of the date of the report. The State Agency will deactivate the card in the MIS immediately upon report. If after hours, EBT customer service representatives can deactivate the card upon report.
5. Lost / Stolen / Damaged Food Instruments - Please attach and cite the policies and procedures for replacing lost, stolen, or damaged Food Instruments, including how the associated benefits are transferred within seven business days. I Appendix-F- 3.07 Lost, Stolen and Damaged eWIC Benefit Cards
ADDITIONAL DETAIL – Food Delivery Appendix and/or Procedure Manual (citation): Food Delivery Appendix
V. RETAIL FOOD DELIVERY SYSTEMS: VENDOR MANAGEMENT
A. Participant Access
1. Please provide the State agency definition for participant access. Include full criteria, including geography, density, and any other parameters in your response: Participant access is defined in WV Policy and Procedure 8.03: To be considered inadequate participant access, one(1) of the following conditions must be indicated: Proximity of another authorized Vendor is more than three (3) miles driving distance; the Vendor serves ten (10) or more WIC participants whose specific nationality could not be properly served by another authorized Vendor located within a one (1) mile distance because of a language barrier; geographic barriers or conditions which would make
10 February 2024
I. FOOD DELIVERY CHECKLIST normal travel burdensome or impossible to another authorized vendor (i.e., an unbridged river,an expressway and frequent road closings because of bad weather); a significant number of WIC participants, generally twenty (20) or more, would be required to travel an unreasonable distance to another authorized Vendor in order to receiveWIC benefits; the participant has a physical disability that cannot be accommodated by alternative Vendors (For this condition to apply, the participant with a disability must have done more than half of the participant’s food benefit redemption in the previous six (6) months with this vendor.); or the need to provide adequate service to participants when circumstances make it necessary such as new clinic site opening, participant caseload increases, store closings, or currently authorized WIC stores cease operations.
ADDITIONAL DETAIL – Food Delivery Appendix and/or Procedure Manual (citation): Policy and Procedure 8.03 – Participant Access Assessment
B. Vendor Selection and Authorization 1. Number and Distribution of Authorized Vendors
a. Does the State agency use limiting criteria to limit the number of vendors it authorizes? ☐ Yes
☒ No
b. If yes, check and specify the type(s) of criteria used (e.g., vendor / participant ratio of 1:100 per county): ☐ Vendor / participant ratio ☐ Vendors / local agency ratio ☐ Vendors / local service area or county ratio ☐ Vendors / geographic area ☐ Vendor / State agency staff ratio ☐ Statewide cap on the number of vendors ☐ Other (specify): Click or tap here to enter text.
2. Vendor Application periods:
a. The State agency considers applications: ☒ On an ongoing basis ☐ Annually in Choose an item. for a new agreement that begins in Choose an item. ☐ Every two years (specify month): Choose an item. ☐ Every three years (specify month): Choose an item. ☐ Any time there is a participant access need The State agency is currently under a:
11 February 2024
I. FOOD DELIVERY CHECKLIST
☐ Federal Moratorium
☐ State agency – imposed deferral of application processing ☐ Other (specify): Click or tap here to enter text.
b. If the State agency does not accept applications on an ongoing basis, please explain how the State agency processes applications if it is determined there will otherwise be inadequate participant access: Click or tap here to enter text.
3. Vendor Selection and Authorization
a. The vendor selection criteria used to select vendors for program authorization includes:
Required criteria: ☒ EBT capable as defined in 7 CFR 246.12(aa)(4)(ii) ☒ Competitive price criteria based on:
☐ Market basket prices
☒ Vendor applicant prices
☒ WIC redemption data
☐ A State agency standard drawn from a price survey
☐ Other (specify): Click or tap here to enter text. ☒ Minimum stocking requirements (MSR) that include the federal minimum. MSR are:
☒ Statewide
☒ Peer group specific
Please attach a copy and cite: I Appendix-G- 8.11 Minimum Stock Requirements and Allowable Exemptions. ☒ A requirement to obtain infant formula only from sources included in the State agency’s list of State licensed infant formula wholesalers, distributors, and retailers and manufacturers registered with the U.S. Food and Drug Administration ☒ A business integrity criteria that includes: ☒ No history during the past six years, among the vendor’s owners, officers, or managers of criminal convictions or civil judgments for activities listed in 7 CFR 246.12(g)(3)(ii) ☒ No history of other business-related criminal convictions or civil judgments ☒ Other (specify): Compliance with tax, unemployment and workers compensation. ☒ Lack of current SNAP disqualification or civil money penalty for hardship per 7 CFR 246.12(g)(3)(iii) ☐ Incentive items management (if the State agency is certified to authorize A50 vendors) (specify): N/A
Optional criteria ☒ A requirement to stock a full range of foods in addition to WIC supplemental
12 February 2024
I. FOOD DELIVERY CHECKLIST foods ☐ Redemption of a minimum value/volume of food instruments and CVBs ☒ Satisfactory compliance with previous vendor agreement ☒ Certification by an approved State or local health department ☒ Proof of authorization as a SNAP retailer, including SNAP authorization number ☐ Lack of previous WIC sanctions ☒ Hours of operation which meet State agency criteria (specify): Suitable hours visibly posted and adhered to. ☐ Other (specify): Click or tap here to enter text.
b. Infant formula: Please attach or briefly explain the policies and procedures for compiling and distributing to authorized WIC vendors, on an annual or more frequent basis, a list of authorized infant formula wholesalers, distributors, and retailors: Annually WV reviews and distributes a list of authorized infant formula distributors. The list is updated based on FNS approved distributors and all previous distributors are contacted to verify contact information and continued ability to provide infant formula.
c. Does the State agency assess all vendor applications not meeting selection criteria for participant access? ☒ Yes
☐ No Describe or attach and as an appendix the procedures used for assessing vendor applications for participant access: I Appendix-H- 8.03 Participant Access Assessment; I Appendix I - 8.03 Attachment 1 PAA Form.
d. Does the State agency authorize mobile stores? ☐ Yes
☒ No If yes, please explain the special need: ADDITIONAL DETAIL – Food Delivery Appendix and/or Procedure Manual (citation): Food Delivery Appendix
C. Vendor Cost Containment 1. Assessing for above-50-percent (A50) status:
a. Does the State agency authorize any vendors that derive more than 50 percent of their annual food sales from WIC transactions (i.e. A50 vendors)? ☐ Yes, please attach a copy of the latest FNS-approved certification and cite as
13 February 2024
I. FOOD DELIVERY CHECKLIST an Appendix N/A ☒ No
b. When does the State agency assess vendors for above-50-percent status? ☒ At authorization ☒ 6 months after authorization ☒ Annually ☐ Other (specify): N/A
c. How does the State agency assess vendors for above-50-percent status? ☒ Use the Potential A50 Vendors report in FDP (previously WIC-6 in TIP) ☒ Collect food sales documentation from vendor ☐ Collect food sales documentation from another agency (specify): ☐ Other (specify): N/A
d. If the State agency authorizes above-50-percent vendors, please provide a copy of the State agency’s policies and procedures on incentive items in accordance with 7 CFR 246.12(g)(3)(iv).
2. Vendor Peer Groups (If the State agency has an exemption to use an alternative cost containment system instead of a vendor peer group system, proceed to question 3)
a. Does the State agency establish distinct competitive price criteria and maximum allowable reimbursement levels for each vendor peer group? ☒ Yes
☐ No
b. Briefly describe how the State agency considers participant access by geographic area when establishing competitive price criteria and maximum allowable reimbursement levels. The State agency ensures participant access by considering the geographic area when establishing competitive price criteria and maximum allowable reimbursement levels. They use an algorithm that calculates the Not-to-Exceed (NTE) price based on the average food prices within each peer group, adjusted weekly or bi-weekly according to sales data. This approach helps keep NTE prices close to the average food prices, ensuring consistency across different regions. The process involves setting a start price point and adjusting it based on sales, thus maintaining fair pricing and access for participants in various geographic areas.
c. Are vendors assigned to peer groups for selection / authorization? ☒ Yes
☐ No
d. Are vendors assigned to peer groups for reimbursement purposes? ☒ Yes
☐ No
14 February 2024
I. FOOD DELIVERY CHECKLIST e. Peer groups are based on the following: ☐ WIC sales volume ☐ Gross food sales ☐ Number of cash registers ☐ Square footage ☒ Type of Store ☒ Location of store ☒ Local agency service area
☐ City, county, or regional divisions
☐ Urban, suburban, rural, island
☐ ZIP codes
☒ Other (specify): Location of corporate headquarters, number of states served by chain.
f. Has the State agency received approval for an exemption from the requirement to use geography as one of the criteria for developing the peer groups? ☐ Yes - date of most recent FNS approval: Click or tap here to enter text. ☒ No
g. The State agency assesses the effectiveness of its peer group system and competitive price criteria to enhance system performance: ☒ Annually ☐ Biennially ☐ Every three years ☐ Other (specify): N/A
h. How does the State agency assess the effectiveness of its peer group system and competitive price criteria? For applicants, a food basket analysis utilizing the statewide average of the four most common WIC food packages plus a 15% inflation factor – based on the vendor price survey – is used to determine if an applicant is competitive within the specified vendor classification. Food basket analysis is then conducted using redemption data at reauthorization for all vendors..
i. Provide date of most recent FNS peer group assessment of effectiveness per 7 CFR 246.12(g)(4)(ii)(C): 7/10/2020.
ii. Using the Vendor Peer Groups Chart (see Attachment 1), describe the peer groupings that the State agency plans to use during the upcoming fiscal year (e.g., supermarkets, medium and small grocery stores, convenience stores). Mass Merchandisers, National Grocery Chains, Regional Grocery Chains, Local Grocery Chains, Rural Independent Grocers, Isolated Independent Grocers.
15 February 2024
I. FOOD DELIVERY CHECKLIST 3. Vendor Exemptions
a. If the State agency has no peer group system, and instead uses an alternative cost containment system:
i. Has the State agency received approval for an exemption from the vendor peer group system requirement (7 CFR 246.12(g)(4)(v))? ☐ Yes, date of most recent approved exemption Click or tap to enter a date.
☒ No
ii. Describe the State agency’s alternative system for comparing the prices of new vendor applicants and currently authorized vendors and selecting for authorization or reauthorization vendors that offer the program the most competitive prices: Click or tap here to enter text.
b. Does the State agency exempt from competitive price criteria pharmacies that provide only exempt infant formula or WIC-eligible medical foods to participants? ☐ Yes
☒ No If yes, please provide the notification sent to FNS explaining the exemption. N/A
c. Did the State agency exempt non-profit WIC vendors (other than health or human services agencies that provide food under contract with the State agency) from competitive price criteria? ☐ Yes
☒ No
D. Vendor Agreements
1. Please provide a copy of the State agency’s current standard vendor agreement as an appendix and cite: I Appendix-J- WV Vendor Agreement_9_12_23.
2. Describe how the State agency transmits to vendors the sanction schedule and the process for notification of violations. Vendor Handbook, which must be kept on hand by each vendor contains sanction schedule. Information on sanctions and violations is also reviewed during annual on authorization training.
3. Does the State agency use a nonstandard vendor agreement to meet any unique circumstances (e.g. commissaries, etc.)? ☐ Yes, if yes, please attach a copy of the agreement as an appendix and cite: Click or tap here to enter text.
16 February 2024
I. FOOD DELIVERY CHECKLIST ☒ No
4. Does the State agency delegate the signing of vendor agreements to its local agencies? ☐ Yes, provide a description of the supervision and instruction provided to local agencies to ensure the uniformity and quality of this activity: Click or tap here to enter text. ☒ No
ADDITIONAL DETAIL – Food Delivery Appendix and/or Procedure Manual (citation): Food Delivery Appendix
E. Vendor Training
1. Does annual vendor training cover the required content in 7 CFR 246.12(i)(2)? ☒ Yes
☐ No (please explain why): N/A
2. Vendors or vendor representatives receive training on the following occasions and / or through the following materials: ☒ On-site (in-store) meetings/conferences ☒ Off-site meetings/conferences ☒ During routine monitoring visits (e.g., educational buys) ☒ When specialized technical assistance is requested ☒ Written materials (e.g., newsletters) ☒ Audio or video recordings ☒ Teleconference, video conference, or webinars ☐ Vendor hotline ☐ Other (specify): N/A
3. Vendors or vendor representatives receive interactive training as follows: ☒ At or before initial authorization ☒ At least once every three years ☐ Annually or more frequently than once every three years
4. Delegation of Vendor training
a. The State agency delegates its vendor training to: ☒ None (State agency conducts all vendor training) ☐ Local agencies ☐ A contractor (specify): ☐ A vendor association / representative (specify):
☐ Other (specify):N/A
b. If not conducted by the State agency, please provide a description of the supervision
17 February 2024
I. FOOD DELIVERY CHECKLIST and instruction provided to the training party to ensure the uniformity and quality of training: Click or tap here to enter text.
5. Documentation of Vendor Training
a. Please describe how the State agency documents the content of and vendor participation in vendor training. Vendor training materials are saved and participation is documented within the MIS.
ADDITIONAL DETAIL – Food Delivery Appendix and/or Procedure Manual (citation): Food Delivery Appendix
F. Routine Monitoring
1. Routine monitoring visits
a. Visits are conducted by: ☒ State agency staff ☐ Local agency staff ☐ Contractor ☐ Other (specify): Click or tap here to enter text.
b. If not conducted by the State agency, please provide a description of the supervision and instruction provided to the monitoring party to ensure the uniformity and quality of monitoring: Click or tap here to enter text.
c. The following procedures are used in determining whether a vendor is selected for a routine monitoring visit: ☐ Random selection ☐ Periodic / scheduled training ☒ Periodic / scheduled review ☒ Complaints ☒ Other (specify): Previous fiscal year failed routine monitoring visit.
2. Vendor monitoring improvement plan - Please briefly describe the State agency’s plan to follow up on last year’s monitoring results in the coming fiscal year: Vendors that failed previous year monitoring are visited again for monitoring.
3. Vendor Sanctions
a. Attach the State agency’s sanction schedule and the process for vendor notification. Cite attachments: I Appendix-K- WV WIC Vendor Violations and Sanctions.
18 February 2024
I. FOOD DELIVERY CHECKLIST b. Does the State agency’s sanction schedule contain the required vendor sanctions as described under regulation 7 CFR 246.12(l)? ☒ Yes
☐ No If no, please explain why: N/A
c. Does the State agency impose civil money penalties in lieu of permanent disqualifications? ☒ Yes
☐ No If yes, please describe the instances in which this occurs: If a vendor is needed for participant access.
d. Pursuant to § 246.12(l)(1)(i) - In lieu of disqualifying a vendor for trafficking convictions, does the State agency choose to impose a civil monetary penalty when it determines and documents that: ☒ (A) Disqualification of the vendor would result in inadequate participant access; or ☐ (B) The vendor had, at the time of the violation, an effective policy in place to prevent trafficking; and the ownership of the vendor was not aware of, did not approve of, and was not involved in the conduct of the violation.
If yes, how many times has the State agency used this option in the previous two fiscal years? 0.
ADDITIONAL DETAIL – Food Delivery Appendix and/or Procedure Manual (citation): I Appendix-L- 8.04 Civil Money Penalty
G. Administrative Review of State Agency Actions
1. Please attach a copy of the administrative appeals process for vendors, farmers, and farmers’ markets (citation): I Appendix-M- 8.06 Fair Hearing Policy for Vendors.
ADDITIONAL DETAIL – Food Delivery Appendix and/or Procedure Manual (citation): Food Delivery Appendix VI. RETAIL FOOD DELIVERY SYSTEMS: FARMERS / FARMERS’ MARKETS
☐ Does not apply
1. Food instrument:
a. Please describe the type of food instrument used for CVB at farmers’ markets: ☐ QR code sticker ☒ QR code on mobile app
19 February 2024
I. FOOD DELIVERY CHECKLIST ☒ Printed QR code ☐ Mobile wallet ☒ EBT card ☐ Other (specify): N/A
2. General Management
a. Is CVB at farmers’ markets state-wide? ☒ Yes
☐ No, selected areas (specify): N/A
b. Does the State agency delegate any tasks related to the management of the Farmers or Farmers' Markets to another entity? ☒ Yes, to whom? WV Department of Agriculture.
☐ No If yes, which tasks? ☐ Authorization / agreements ☒ Monitoring ☒ Training ☐ Administrative reviews ☒ Other (specify): Printing of civil right posters and authorized foods lists.
c. Does the State agency authorize farmers / farmers’ markets to accept CVB based on authorization by the WIC Farmers’ Market Nutrition Program (FMNP)? ☒ Yes
☐ No If no, please describe the selection criteria: N/A
3. Agreements: Please provide a copy of the State agency’s current farmer / farmers’ market agreement as an appendix and cite: I Appendix-N- Farmer Agreement.
4. Training:
a. How often is training conducted for farmer / farmers’ markets? ☒ At or before initial authorization ☒ Annually ☒ At least every three years following initial authorization ☐ Other (specify): N/A
b. How is training conducted? ☐ Newsletter ☒ Web-Based Training ☒ Video Conference ☒ In person
20 February 2024
I. FOOD DELIVERY CHECKLIST ☐ Other (specify): N/A
c. Training is conducted by: ☒ State agency ☐ Local agency ☐ Contractor ☒ Other (specify): Department of Agriculture.
d. If training is conducted by an entity other than the State agency, please provide a description of the supervision and instruction provided to the entity responsible for training to ensure the uniformity and quality of this Training: The State Agency works in conjunction with the WV Dept of Agriculture to develop the training curriculum.
5. Monitoring:
a. Farmers/farmers' markets are included in the: ☒ FMNP sample of farmers / farmers’ markets for monitoring ☒ WIC sample of vendors for monitoring ☐ Other (specify):
b. Monitoring includes: ☒ Covert methods, such as compliance buys ☒ Overt methods, such as routine monitoring ☐ Other (specify): Click or tap here to enter text. ADDITIONAL DETAIL – Food Delivery Appendix and/or Procedure Manual (citation): Food Delivery Appendix
21 February 2024
Food Delivery Appendix Appendices: I Appendix- A- 3.16 Special Formula Distribution System.pdf I Appendix- B - 3.02 Security of eWIC Benefit Cards.pdf I Appendix- C - WV_eWIC_Card_v2 w QR.pdf I Appendix- D - 3.09 Remotely Issuing Electronic Benefits and E-Mailing the Shopping List.pdf I Appendix- E -2.18 Services to Persons Affiliated with Institutions and Homeless Facilities.pdf I Appendix- F - 3.07 Lost, Stolen and Damaged eWIC Benefit Cards.pdf I Appendix- G - 8.11 Minimum Stock Requirements and Allowable Exemptions.docx I Appendix- H - 8.03 Participant Access Assessment.pdf I Appendix- J - WV Vendor Agreement_9_12_23.pdf I Appendix- K - WV WIC Vendor Violations and Sanctions.pdf I Appendix- L - 8.04 Civil Money Penalty.pdf I Appendix- M - 8.06 Fair Hearing Policy for Vendors.docx I Appendix- N - Farmer Agreement.pdf I Appendix- O - CAP Lancaster Formula Warehouse Agreement.pdf Attachments: Attachment 1_Food Delivery Vendor Peer Group Description.docx
VI.
FOOD FUNDS MANAGEMENT
GOAL:
No goals for FY 2025.
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Section II: FY 2024 Policies Approved and Implemented
(Summary of Changes)
Date: 1/10/2024 8.12 Inventory Audits
New policy.
Date: 2/27/2024 8.05 Selection Criteria
Revised.
Date: 4/15/2024 2.06 Attachment #1 Income Eligibility Requirements
Revised Income Guidelines for FY 2025.
Date: 4/21/2024 2.01 Certification of Participants
Revised for changes in scanning medical excuse for physical presence.
Date: 5/2/2024 2.06 Income Eligibility Requirements Revised to include adjunct eligibility of newborn using the mother’s medical card.
Date: 5/2/2024 2.07 Certification of Foster Children Revised to include adoption documentation.
Date: 5/2/2024 2.15 Certification of Priority II Infants
Revised to include adjunct eligibility of newborn using the mother’s medical card.
Date: 6/18/2024 1.09 Waiting List
Revised and updated to utilize Crossroads.
Date 7/9/2024: 6/24/2024 2.12 Anthropometric Measurements Attachments 1-4
Revised for the addition of stadiometer and scale calibration logs.
Date: 7/9/2024: 5.04 The Nutrition Care Plan
Revised to include the required timeframe to complete nutrition care plan notes.
Date: 7/9/2024 1.02 Channels of Communication Revised to outline channels of communication for Local Agency staff to State Agency staff.
Date : 7/18/2024 2.12 Anthropometric Measurements
Revised for the addition of stadiometer and scale calibration logs.
Section II: Policies Approved and Not Implemented
No policies approved and not implemented.
Section II: FY 2024 Policies in Draft Submission
None in Draft Status
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West Virginia WIC Policy & Procedure 3.16 Effective Date: 7/5/2017 3.16 Special Formula Distribution System POLICY: Special formula will be provided by the State contracted distribution center. The distribution center will ship requested special formula to either the Local Agency clinic or the participant’s home considering which one is more appropriate. DEFINITIONS: Out-of-Date Formula: Formula is considered out-of date on the first day of the month labeled as the expiration date. PROCEDURE: A. Local Agency Determination of Special Formula Need The Local Agency will determine:
Participant eligibility to receive special formula;
Quantity and type of special formula to be issued to the participant; < Review whether formula is to be issued to the EBT card or the CAP Warehouse from the Food Package Reference Guide;
Location to which special formula will be shipped. B. Local Agency Special Formula Order The Local Agency Staff will:
Order the CAP Warehouse order through the Formula wizard button on the Crossroads Food Issuance Screen;
Ensure the WIC 53 is completely filled out and that it has not expired;
Obtain the participant’s signature on all formula food benefits issued to the participant;
Determine if the formula is to be shipped directly to the client’s physical address or clinic;
Will scan the WIC-53 into Crossroads on the Food Prescription Screen. C. Special Formula Shipment to Participant’s Home 1. When formula is sent to participant’s home, the distribution center must have a physical address (not a Post Office Box). A physical address must be documented in Crossroads for that participant. For special formula only, a rural route and box number is permissible as a physical address in Crossroads. 2. Local Agency clinic staff should inform the participant when to expect delivery. This will normally be 2-4 business days after the order is placed. 3. The participant should be instructed that if the order is not received within five (5) business days, the Local Agency clinic should be contacted. The clinic will then contact the distribution center to trace the order. Do not give the distribution center phone number to the participants. 1 of 5
West Virginia WIC Policy & Procedure 3.16 Effective Date: 7/5/2017 3.16 Special Formula Distribution System 4. Instruct the participant that should the need for special formula change or be discontinued, they must immediately notify the Local Agency and return the unused portion of the discontinued formula before receiving food benefits for a new formula. 5. Unused returned formula must be entered into the Crossroads System Inventory and also recorded on the Formula Tracking Form. 6. Notify the participant that if formula is out-of-date when received from the warehouse, they should return it to the Local Agency clinic for replacement. D. Special Formula Shipment to Local Agency Clinic 1. The special formula will be delivered to the Local Agency clinic when it is not feasible to send it to the participant’s home. 2. The participant may either contact the clinic when the product is due in (normally 2-4 business days after the order is placed) prior to picking it up or have clinic staff call when the product has been received. 3. Instruct the participant that should the need for special formula change or be discontinued they must immediately notify the Local Agency and return the unused portion of the discontinued formula before receiving food benefits for a new formula. 4. Unused returned formula must be entered into the Crossroads System Inventory and also recorded on the Formula Tracking Form. E. Damaged/Broken or Out-Of-Date Formula 1. Call the distribution center before placing a request for replacement, (717)293-0187x0. 2. Client must return formula to the clinic for disposal and reissuance. Photographs maybe used for severely damaged formula that is not easily brought into the clinic. The returned formula must be entered on the Formula Tracking Sheet. 3. The WIC Help Desk must be called for replacement. They will replace the damaged formula thru Crossroads and make a family alert stating that the formula was replaced. 4. Once documentation is completed, the labels on the infant formula should be removed and destroyed. The damaged or out-of-date special formula must then be discarded/ destroyed. 5. The Distribution Center will also track damaged formula from the shipper to insure that double reporting does not occur. F. Replacement of Special Formula 1. Special formula will only be replaced for the following reasons: 2 of 5
West Virginia WIC Policy & Procedure 3.16 Effective Date: 7/5/2017 3.16 Special Formula Distribution System
If formula is changed by the physician (providing the participant supplies a Prescription Formula Documentation Form, WIC-53) between cycles. The participant must return any unused formula prior to replacement issuance.
If formula is damaged or out-of-date; or
Non-receipt of initial order. In this case the replacement order and all future orders must be sent to the clinic site. 2. Instruct the participant that should formula need to be replaced for any of the above reasons, they must notify the Local Agency and return unused formula to the local clinic before new formula can be ordered. This must be tracked on the Formula Tracking form and non-damaged and out-of-date formula must be entered into Crossroads inventory. 3. The clinic site must contact the WIC Help Desk for replacement. G. Usage of Returned Special Formula 1. Special formula that is returned by a participant or is not needed once received from the Distribution Center can be issued to another participant. The returned formula is to be entered into the inventory within Crossroads. 2. To issue the returned formula to another client, the clinic staff will issue the formula from inventory within Crossroads on the food issuance screen. If there is not enough to fill the entire month, the remainder can be ordered thru the warehouse through the formula wizard. 3. If the product will go out of date within ninety (90) days, or if usage of the formula at the Local Agency is considered unlikely, notify the Help Desk and they can assist in finding another area that the formula may be used. a. The Local Agency, with the formula (sending Agency), will arrange with the appropriate Local Agency, needing the formula (receiving Agency) to ship the formula to that Local Agency, clinic site, or participant. b. The sending Local Agency will contact the shipper and incur shipping costs. The State Agency may be invoiced for shipping cost incurred. c. The receiving site will issue a request to transfer the formula from the original site through Crossroads. If they are in a different Local Agency, contact the WIC Help Desk staff for assistance. 3 of 5
West Virginia WIC Policy & Procedure 3.16 Effective Date: 7/5/2017 3.16 Special Formula Distribution System H. Distribution Center Processing of Orders 1. The Distribution Center will determine if requested product is in stock. 2. Distribution Center processing deadline for a business day will be 2 PM. The Distribution Center will process and ship all requests received within one business day of receipt. 3. If the product is not currently available from the warehouse, the Local Agency will contact the West Virginia State WIC Office. If the West Virginia State WIC Office approves, they will approve the authorization to the Distribution center to purchase the product. The Distribution Center staff will special order the product from the manufacturer, in a quantity equal to two (2) times the requested order. Special shipping will be authorized to expedite this process. The Local Agency clinic site which ordered the product will be notified by telephone of the expected arrival date. 3. If the product is normally stocked by the Distribution Center but is temporarily out of stock, the Distribution Center staff will research when and if the product has been ordered from the manufacturer. a. If the product has not been ordered, it will be ordered from the manufacturer. b. If the product has been ordered and is due in, the Distribution Center staff will contact the manufacturer for an expected delivery date and then notify the Local Agency clinic. c. If under any circumstances a special formula is determined to be out of stock from the manufacturer, the Distribution Center staff will notify the Local Agency clinic as soon as possible that the product is out of stock and when it is expected to become available from the manufacturer. I. Distribution Center Processing of Non-receipt of Shipped Special Formula 1. When the Distribution Center is notified by the Local Agency clinic of non-receipt of formula, the Distribution Center will pull the shipping information and trace the shipment through the carrier. The Local Agency clinic will be notified of the status of the order as reshipment must be sent to them, not the participant. 2. The Distribution Center will reconcile the original shipment with the shipper either through reimbursement, if the shipment was lost, or return of the shipment, if held for contact by participant due to unsuccessful delivery attempt. 3. The WIC Help Desk Staff will assist the clinic in reordering the formula. 4. If there are more than one instance of lost or stolen packages, the participant will be required to pick up their formula at the clinic. 4 of 5
West Virginia WIC Policy & Procedure 3.16 Effective Date: 7/5/2017 3.16 Special Formula Distribution System J. Maintenance of Documentation 1. The Local Agency clinic will maintain a copy of the Formula Tracking Log, 2. The WIC Help Desk will keep a record of all formula replacements due to damaged, out-of-date formula and lost orders. 3. The Distribution Center will maintain the following documentation:
All formula orders to the manufacturers;
All shipping receipt documents from the manufacturers;
All shipping information for shipments of formula sent by Distribution Center. K. State Agency Responsibilities 1. The Distribution Center staff will be made aware of any problems or concerns relating to the operations of the special formula Distribution Center. 2. The State Agency will maintain a special designation for the Distribution Center which will allow processing of the CAP Warehouse Payments. L. Reconciliation 1. Payment records must be reconciled with issuance files on a weekly basis. 2. Pending orders will be processed and received twice weekly. 3. Clients are required to report lost or stolen food items within 5 days of issuance. REFERENCES: 1. Pennsylvania Department of Health, WIC Policy and Procedure Number 4.05, effective 2022. 2. Prescription Formula Documentation Form (WIC-53) ATTACHMENTS: 1. Special Formula Warehouse Order Tracking Form. 5 of 5
1 of 1 West Virginia WIC Policy & Procedure 3.02 Effective Date: 3/3/2015 3.02
Security of eWIC Benefit Cards
POLICY:
The Local Agency is responsible for the security of all eWIC Benefit Cards until the time they are issued to participants, parents/guardians, or caretaker.
PROCEDURE:
A. Storage and Security of eWIC Benefit Cards
1. eWIC Benefit Cards must be stored in a secure area whenever they are not in use.
2. Access to storage closets, cabinets or drawers will be limited to designated WIC personnel.
B. Inventory of eWIC Benefit Cards
The Local Agency is responsible for maintaining an accurate inventory of all eWIC Benefit Cards at all times.
REFERENCES:
1. WIC Regulations 246.12, Food Delivery Systems
0000 0000 1234 5678
AUTHORIZED SIGNATURE Do not write your PIN on your card 31538C003/37412 WV WIC.F0111.R0211 9C03W7 000435 Gemalto MGY – U1080974A – 08/13 WVDHHR For account information call 1-888-220-9555 or visit dhhr.wv.gov/wic The WV eWIC card is the property of the State of West Virginia and is subject to the terms and conditions under which it is issued If found, please return or mail to: WIC, 350 Capitol Street, Room 519 Charleston, WV 25301
West Virginia WIC Policy & Procedure 3.09 Effective Date: 5/3/2022 3.09 Remotely Issuing Electronic Benefits and Mailing the Shopping List POLICY: Food benefits can be remotely issued to the eWIC card on a case-by-case basis, for certain appointment types and situations outlined below. Food benefits can only be issued to the eWIC card without the participant’s presence in the WIC clinic for initial and subsequent certification appointments with the required documentation from the participant’s healthcare provider, waiving their physical presence requirement (see Policy 2.01 Certification of WIC Participants). Note: The issuing WIC staff must confirm food benefits were issued correctly to ensure benefits were not under-issued or over-issued, and/or to protect against fraud. PROCEDURE: A. Remotely Issuing eWIC Benefits and Mailing the Shopping List to an Individual Participant or Family Staff may issue eWIC benefits without the participant’s, parent’s, guardian’s, or caretaker’s presence in clinic as outlined below: 1. Completion of a West Virginia (WV) WIC web-based nutrition education (JPMA WIC Smart) module (see policy 5.05 Nutrition Education Contacts and Documentation). a. The local WIC office must receive proof of completion of the WV WIC web-based nutrition education contact (see policy 5.05 Nutrition Education Contacts and Documentation); b. Staff must attempt to contact the participant, parent, guardian, or caretaker to verify the food package and to notify them that food benefits have been added to their eWIC benefit card. Staff must confirm contact information and the next appointment. c. Staff will document completion of the nutrition education contact in Crossroads and load benefits to the eWIC benefit card. Staff will sign their full name with the notation “NE” for “Nutrition Education”, as the reason for signing. d. Staff will offer to mail and/or email an appointment letter and their Shopping List to the participant, parent, guardian, or caretaker. i. If applicable, staff will encourage the downloading of the WIC Shopper App. 2. Completion of a one-on-one nutrition education contact via telephone (see policy 5.05 Nutrition Education Contacts and Documentation). a. Staff will attempt to verify the food package with the participant, parent, guardian, or caretaker. 1 of 4
West Virginia WIC Policy & Procedure 3.09 Effective Date: 5/3/2022 3.09 Remotely Issuing Electronic Benefits and Mailing the Shopping List b. Staff will document completion of the nutrition education contact in Crossroads and load benefits to the eWIC benefit card. Staff will sign their full name with the notation “NE” for “Nutrition Education”, as the reason for signing. c. Staff will offer to mail and/or email an appointment letter and their Shopping List to the participant, parent, guardian, or caretaker. i. If applicable, staff will encourage the downloading of the WIC Shopper App. 3. Minor food package changes that would not require the return of any contract infant formula, exempt infant formula or WIC-eligible nutritionals. a. Food package changes must be requested by the parent, guardian, or caretaker and prescribed by a Nutritionist/Nutrition Associate (CPA). b. Staff must attempt to contact the participant, parent, guardian, or caretaker to verify the food package and to notify them that food benefits have been added to their eWIC benefit card. c. Staff will load benefits to the eWIC benefit card. Staff will sign their full name with the notation “RBI” for “Remote Benefit Issuance”, as the reason for signing. d. Staff will offer to mail and/or email an appointment letter and their Shopping List to the participant, parent, guardian, or caretaker. i. If applicable, staff will encourage the downloading of the WIC Shopper App. 4. Other reasons that staff may issue eWIC benefits without the participant’s, parent’s, guardian’s, or caretaker’s presence in clinic include, but are not limited to: ● Physical disability or family with children with special health care needs ● Illness ● Imminent childbirth ● Quarantine, communicable disease, and/or immune disorder ● Inclement weather conditions ● Distance to travel, other travel challenges or transportation ● Education requirement met and participant will not be eligible for re-certification ● Participant unable to keep appointment which would result in missing an entire month of benefits a. The local WIC office must receive proof of completion of the WV WIC web-based nutrition education (JPMA WIC Smart) contact (see policy 5.05 Nutrition Education Contacts and Documentation); 2 of 4
West Virginia WIC Policy & Procedure 3.09 Effective Date: 5/3/2022 3.09 Remotely Issuing Electronic Benefits and Mailing the Shopping List b. Staff must attempt to contact the participant, parent, guardian, or caretaker to verify the food package and to notify them that food benefits have been added to their eWIC benefit card. Staff must confirm contact information and the next appointment. c. Staff will document completion of the nutrition education contact on Crossroads Nutrition Education Screen and load benefits to the eWIC benefit card. Staff will sign their full name with the notation “NE” for “Nutrition Education”, as the reason for signing. d. Staff will document completion of the mid-certification appointment and the reason the appointment and/or eWIC benefit issuance were completed remotely in the Crossroads Nutrition Care Plan. Staff will sign their full name with the notation “RBI” for “Remote Benefit Issuance”, as the reason for signing. e. Staff will offer to mail and/or email an appointment letter and their Shopping List to the participant, parent, guardian, or caretaker. i. If applicable, staff will encourage the downloading of the WIC Shopper App. B. Group Electronic Benefits Issuance 1. In situations where it is necessary for staff to do group electronic benefits issuance, one (1) month of benefits will be issued, and the appointment will be rescheduled. Justification for group benefit issuance includes, but is not limited to: a. Seasonally inclement weather or site closure; b. Extreme hardship that may be encountered by the target population; c. Event of a natural disaster, environmental hazard or destructive incident (i.e. gas line explosion, water main break); and d. Automated system failure, internet disruption or electrical problems that prohibit the issuance of food benefits on a given day. 2. Staff must attempt to contact the participant, parent, guardian, or caretaker to verify the food package and to notify them that food benefits have been added to their eWIC benefit card. 3. Staff will load benefits to the eWIC benefit card. Staff will sign their full name with the notation “RBI” for “Remote Benefit Issuance”, as the reason for signing. a. The Nutritionist/Nutrition Associate (CPA) will note the “Remote Benefit Issuance” reason in the Nutrition Care Plan. 4. Staff will offer to mail and/or email an appointment letter and their Shopping List to the participant, parent, guardian, or caretaker. 3 of 4
West Virginia WIC Policy & Procedure 3.09 Effective Date: 5/3/2022 3.09 Remotely Issuing Electronic Benefits and Mailing the Shopping List a. If applicable, staff will encourage the downloading of the WIC Shopper App. 5. Group food benefits issuance will be discontinued as soon as the reason for the group benefit issuance is resolved. C. Emailing Appointment Letters and/or Shopping Lists 1. When emailing the appointment letter and the Shopping List, the email shall contain the confidentiality notice and the USDA Nondiscrimination Statement: “This message, including any attachments, is for the sole use of the individual or entity named above. The message may contain confidential health and/or legally privileged information. If you are not the above-named recipient, you are hereby notified that any disclosure, copying, distribution, or action taken in reliance on the contents of this message is strictly prohibited. If you have received this message in error, please notify the sender immediately and destroy all copies of the original message”. “This institution is an equal opportunity provider.” 2. Staff will verify contact information in Crossroads before mailing and/or emailing appointment letters or the Shopping List. REFERENCES: 1. WIC Regulations 246.12, Food Delivery Systems 2. WIC Regulations 246.14, Program Costs 4 of 4
1 of 2 West Virginia WIC Policy & Procedure 2.18 Effective Date: 12/05/2011
2.18 Services to Persons Affiliated with Institutions and Homeless Facilities
POLICY:
Persons affiliated with institutions, such as schools, maternity homes, temporary shelters or any other residential facility where meals are provided as part of the usual service are eligible to participate in the WIC Program when they meet WIC Program eligibility criteria.
PROCEDURE:
A. Participation Criteria
To assure that the WIC Program benefits the participant rather than the institution and to ensure that the person participates in the WIC Program in the same manner and to the same degree as those without institutional affiliation, the following criteria must be met:
1. The institution may not accrue financial or in-kind benefit from a person’s participation in the WIC Program, such as transferring WIC food to general inventory or reducing the quantity of food provided to WIC participants;
2. Foods purchased with food benefits may not be used in communal food service, but will be available only to the participant for whom they were issued;
3. No institutional constraints may be placed on the ability of the participant to receive supplemental foods and all associated services made available by the Local Agency.
B. Monitoring Institution Compliance with Policy
1. The Local Agency Director must contact the institution by phone or by site visit annually or whenever a participant reports a problem to assure the above criteria are being followed.
2. The Local Agency will request that the institution and the homeless facility inform the Local Agency when the above conditions are not in compliance.
3. The Local Agency will discontinue issuance of WIC foods, except infant formula, when an institution has been determined to be noncompliant during the participant’s certification period until compliance is achieved or alternative shelter arrangements are made. The participant will continue to receive all other WIC benefits and may be certified again.
4. When the State or Local Agency determines that an institution fails to meet the conditions of this policy during a follow-up contact within ten (10) days after noncompliance is detected or the site declares that it will not attempt to comply with policy, it will refer all participants using the facility to any other facility in the area which meets these conditions.
2 of 2 West Virginia WIC Policy & Procedure 2.18 Effective Date: 12/05/2011
2.18 Services to Persons Affiliated with Institutions and Homeless Facilities
5. The Local Agency Director will keep on file the Institution/Homeless Facility Compliance Contact form (see Attachment #1 2.18) for each institution serving WIC participants in the Local Agency area.
C. Food Package Prescription
1. Participants residing in an institution which provides refrigeration, food storage/preparation facilities will be issued the standard food package which is appropriate for their category or one that is tailored for their individual needs.
2. The homeless food package may be issued to those participants who do not have access to refrigeration and food storage/preparation facilities.
REFERENCES:
1. WIC Regulations 246.7, Certification of Participants 2. FNS Instruction 803-13, Eligibility of Persons Affiliated with Institutions 3. SFP 92-178, WIC: Final Homeless Rule
ATTACHMENTS:
1. Institution/Homeless Facility Compliance Contact
West Virginia WIC Policy & Procedure 3.07 Effective Date: 9/14/2016 3.07
Lost, Stolen and Damaged eWIC Benefit Cards
1 of 1 POLICY:
The purpose of this policy is to provide procedures for the replacement of eWIC Benefit Cards.
PROCEDURE:
A. Instruction for the WIC Parent/Guardian or Caretaker
1. The parent/guardian or caretaker will be informed to report lost, stolen or damaged eWIC Benefit Cards by calling the toll-free number on the back of the benefit card or by notifying the local WIC clinic.
2. The parent/guardian or caretaker must be informed that replacement food benefits will not be issued if the eWIC benefits have expired.
B. Replacement of eWIC Benefit Cards
1. When a participant reports a lost, stolen or damaged eWIC Benefit Card to the local WIC clinic, the clinic staff will then deactivate the participant’s eWIC Benefit Card.
2. The participant must come to the clinic to receive the replacement card.
3. All unused benefits still remaining for the current month will be loaded to the new eWIC Benefit Card.
4. Benefits purchased by unauthorized users will not be replaced.
REFERENCES:
1. WIC Regulations 246.12, Food Delivery Systems 2. SFP 95-067, WIC Disaster Policy and Coordination 3. SFP 95-135, Revision to WIC Disaster Policy and Coordination 4. SFP 96-035, Revision of WIC Disaster Policy 5. SFP 96-042, Addition of Cross Reference to SFP 96-035
West Virginia WIC Policy & Procedure 8.11 Effective Date: 10/01/18 8.11
Minimum Stock Requirements and Allowable Exemptions ______ POLICY: The West Virginia WIC Program establishes minimum requirements for vendors regarding the variety and quantity of the approved WIC eligible foods which a store must stock in order to be authorized and/or continue the current authorization. Federal requirements include that the vendor stock at least two different fruits, two different vegetables, and at least one whole grain cereal authorized by the West Virginia WIC Program. The vendor agrees to maintain stock on the shelves or have products immediately available on-site to satisfy the West Virginia WIC minimum stock requirements at all times during the agreement period. The specific package size and quantities required are listed in Attachment 1 Peer Group Minimum Stock Requirements. WIC approved foods must be located in an area readily accessible to WIC customers or available at the vendor location (i.e. stock room). Outdated or expired food will not be considered during minimum stock assessments. The West Virginia WIC Program has established minimum stock requirements for the following food categories: ● Infant Formula ● Eggs ● Peanut Butter ● Cereal ● Infant Food ● Cheese ● Whole Grains ● Juice ● Infant Cereal ● Milk including Yogurt ● Fresh Produce ● Beans
Vendors are strongly encouraged to stock as many varieties of WIC approved foods as possible. For WIC approved foods for which a Minimum Stock Requirement does not exist (e.g., canned fish, evaporated milk), the authorized vendor is expected to stock a sufficient supply of these products based on customer demand. Authorized vendors must purchase contract and special infant formulas from a WIC-approved supplier. A listing of approved distributors and suppliers may be downloaded from the West Virginia WIC Program website at dhhr.wv.gov/wic.
Vendors may request exemptions from minimum stock requirements from the Vendor Management Unit via an email to dhhrvuwic@wv.gov, by calling 304-558-1115 or submission via the website at http://dhhr.wv.gov/wic. The Vendor Management Unit may also recommend a minimum stock requirements exemption for an authorized store. Vendor Management Unit exemption requests will be reviewed and decided by the Vendor Manager. Exemptions from minimum stock can be requested for individual food categories or to a lower peer group minimum stock requirement. A Minimum Stock Requirements Exemption approval is for a single store location, and is for the indicated product(s) or food categories only. If a WIC customer or WIC staff member requests a contract infant formula, the requested product will be ordered at once. Every effort will be made to make the requested product available to WIC participants within 72 hours of the request. If the item(s) will not be available within 72 hours of the request, the Vendor must notify the Vendor Management Unit within 24 hours so the participant access issue may be resolved. It is also the responsibility of the Vendor to communicate directly with the Vendor Management Unit Page 1 of 2
West Virginia WIC Policy & Procedure 8.11 Effective Date: 10/01/18 8.11
Minimum Stock Requirements and Allowable Exemptions ______ concerning the availability of exempted items once a need has been identified. The Vendor Management Unit may require submission of invoices, receipts or purchase orders from a WIC-approved supplier to document the items requested were ordered within the specified time period. Any abuse of an exemption may result in the revocation of the exemption and may also result in disciplinary action against the vendor. An exemption approval may be revoked at any time at the discretion of the West Virginia WIC Program. PROCEDURE: A. Minimum stock requirements are calculated by using average monthly redemption per peer group for a 12-month period. Refer to Policy 8.05 Selection Criteria for information on vendor peer group classification.
B. Minimum stock exemptions may be provided for WIC food items or food categories which are not purchased by WIC customers on a regular basis. However, the vendor agrees to order exempted contract formula immediately, and other exempted WIC stock within 72 hours of a WIC customer request to redeem WIC benefits. A Local WIC Agency or Vendor Management Unit request may also prompt the vendor to order exempted stock within 72 hours.
C. Approval for exemption from minimum stock is granted by the Vendor Management Unit within 14 business days of an authorized vendor. The Vendor Management Unit will conduct a participant access assessment as well as review 12 months of store redemption records when considering an exemption request.
D. The Vendor Management Unit has sole discretion in granting an exemption from minimum stock to the vendor. Minimum stock exemptions are issued on a case-by-case basis and will be granted for a maximum of three years (i.e. an agreement period). A copy of the Minimum Stock Exemption Approval letter must be on file at the vendor’s location. The original will be maintained in the vendor Crossroads record as scanned documents in the Vendor Authorization Screen as well as filed in the paper record in the Authorization section.
E. An alert will be added to the vendor Crossroads record noting the dates of an active minimum stock requirement exemption. REFERENCES: 1. WIC Regulations 7 CFR 246.12 Food Delivery Methods Page 2 of 2
1 of 4 West Virginia WIC Policy & Procedure 8.03 8.03 Participant Access Assessment Effective Date: 4/7/2021
POLICY:
The West Virginia WIC Program shall not discriminate against an applicant or vendor on the basis of race, color, national origin, age, sex, handicap, disability, or other impermissible basis as set forth in applicable state or federal law. Federal regulations require the West Virginia WIC Program ensure that all WIC participants have adequate access to purchase their WIC food benefits.
As a steward of public funds, the West Virginia WIC Program must balance the need for participant access with the duty to obtain the lowest fair prices for WIC foods and to prevent fraud. Hence, the West Virginia WIC Program will establish standards to secure a sufficient number and distribution of vendors which ensure reasonable participant access and permit effective management of the program.
The State WIC Office has the final decision-making authority to establish criteria used to determine what constitutes inadequate participant access. Inadequate participant access is determined and documented on a case-by-case basis when considering whether the West Virginia WIC Program should:
1. Retain a retail store in lieu of termination or disqualification;
2. Make an authorization exception decision;
3. Waive the selection criteria for the initial authorization of an applicant; or,
4. Provide financial assistance to obtain eWIC capability (i.e. provide a Point of Sale device for WIC transactions) and assist with ongoing maintenance and operational costs.
PROCEDURE:
A. Determination of Inadequate Participant Access
1. Determination of Inadequate Participant Access
a. The State WIC Office shall complete a written Participant Access Assessment (PAA) on a case-by-case basis prior to a retail store being terminated or disqualified for documented program abuse.
b. This type of assessment shall be completed for each new applicant applying for WIC authorization when the established state limiting criteria has been met.
c. A PAA shall be completed at reauthorization for each vendor granted an authorization exception, selection criteria waiver, or a Point of Sale device for WIC transactions during the previous Agreement period. Regardless of the adequacy of participants’ access, the State WIC Office shall deny authorization if, after being provided with one opportunity to correct the deficiency, the Applicant does not meet the criteria for minimum stock.
2 of 4 West Virginia WIC Policy & Procedure 8.03 8.03 Participant Access Assessment Effective Date: 4/7/2021
2. The applicant’s original application and related attachments shall be evaluated under the inadequate participant access criteria stated in Section C when determining if denial of authorization for any of the selection criteria (other than minimum stock requirements) would result in inadequate participant access.
3. Any determination finding inadequate participant access shall be made in consultation with the applicable local agency unless inadequate participant access is a result of the geographic location of the next nearest authorized retail store location exceeding three (3) miles driving distance.
To augment the PAA 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 PAA 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.
B. Completing a Participant Access Assessment
1. Prior to taking denial actions against an applicant the Vendor Operations and Training Specialist completes an Participant Access Assessment (PAA) Form (Attachment #1). Prior to taking termination or disqualification actions against an authorized retail store, the Vendor Authorization and Monitoring Specialist completes a PAA Form. Specific background information related to the affected store is sent (i.e., hard copy or email) directly to the WIC Vendor Manager. Along with the completed PAA Form, a geographic map should be included for his/her review as well as other optional attachments.
2. The State Vendor Manager or his/her designee shall review and respond within 10 business days of receipt. In the “comments” section of the PAA Form, the State Vendor Manager shall indicate in his/her completed response agreement and/or disagreement to the recommendations being made by the Vendor Operations and Training Specialist or Vendor Authorization and Monitoring Specialist.
3. The State WIC Office shall retain and maintain originals of all responses and paperwork related to assessments which will be filed in Section Two of the Vendor paper record. All documents will also be scanned into the Vendor Crossroads (XR) record on the Vendor Authorization Screen.
4. Under no circumstances should the State WIC Office or any local agency personnel inform a retailer and/or store personnel that administrative action is under consideration. All information contained in the PAA is considered confidential.
3 of 4 West Virginia WIC Policy & Procedure 8.03 8.03 Participant Access Assessment Effective Date: 4/7/2021
C. Conditions which must exist for Inadequate Participant Access
To be considered inadequate participant access rather than “participant inconvenience,” one (1) of the following conditions must be indicated:
1. Proximity of another authorized Vendor is more than a three (3) miles driving distance;
2. The Vendor serves ten (10) or more WIC participants whose specific nationality could not be properly served by at least one (1) authorized Vendor within a one (1) mile radius because of a language barrier;
3. Geographic barriers or conditions which would make normal travel burdensome or impossible to another authorized WIC Vendor. Geographic barriers include, but are not limited to: mountains, rivers, bridges or interstate highways not open to foot traffic, highways with limited access for crossing by vehicle or foot, lack of an expressway, and frequent road closings because of bad weather;
4. The participant has a physical disability that cannot be accommodated by alternative Vendors (i.e., the Vendor in question has a wheelchair ramp while other Vendors in the area are not so equipped and a wheelchair-bound participant regularly shops at that Vendor). For this condition to apply, the participant with a disability must have done more than half of the participant’s food benefit redemption in the previous three (3) months with this vendor as revealed in eWIC transaction history; or
5. The need to provide adequate service to participants when circumstances make it necessary. Those circumstances may include, but are not limited to, the following:
a. New clinic site opening; b. Participant caseload increases; c. New participant population center; d. Store closings, either voluntary or due to catastrophe; or, e. Currently authorized WIC stores cease operation; f. Natural disaster or public health emergency.
D. Appeal of State Agency Participant Access Assessments
1. The State Agency’s determination of inadequate participant access is not subject to administrative review.
ATTACHMENTS:
1. Participant Access Assessment Form
REFERENCES:
1. WIC Regulations 7 CFR 246.12 Food Delivery Methods 2. Implementation of the Electronic Benefit Transfer-Related Provisions of PL 111-
4 of 4 West Virginia WIC Policy & Procedure 8.03 8.03 Participant Access Assessment Effective Date: 4/7/2021
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5 of 4 West Virginia WIC Policy & Procedure 8.03 8.03 Participant Access Assessment Effective Date: 4/7/2021
Participant Access Assessment (PAA) Form Attachment #1, 8.03
Revised May 2018 Store/Applicant’s Name: Vendor #: Address: Applicant #: City, State Peer Group: Zip Code County: # of Unique Participants Served: WIC Revenue Earned: *Report Period: Local Agency: BACKGROUND - Other WIC Authorized Retailers in Area: Vendor # Retailer Name: Driving Distance # of Unique Participants Served*
Vendor Management Unit Staff to complete the following questions: 1. During the last month, were 20 or more participants served? Yes □ or No □ 2. If response to #1 is yes, does the travel distance exceed three (3) miles to another authorized store? Yes □ or No □ 3. Are there participants whose specific nationality cannot be properly served by at least one authorized Vendor? Yes □ No □ or Unknown □ 4. 4. Are there barriers or other conditions which make travel to another WIC retailer dangerous or difficult for participants? Yes □ or No □ If yes, what geographic barrier(s) apply?_________________________________ 5. Is there a participant with a disability, who regularly shops at this store, needing an accommodation not available at other authorized vendor locations? Yes □ No □ or Unknown □ 6. 6. Are there circumstances which increase the need for participant access (i.e. new clinic site, store closings, etc.? Yes □ or No □ If yes, what circumstances apply?_____________________________________________
Continued next page:
Participant Access Assessment (PAA) Form Attachment #1, 8.03
Revised May 2018
Vendor Management Unit Staff
Vendor Manager Assessment Completed By: _______________________________________ Date: ________ Approval Completed By: _______________________________________ Date: ________ WIC Vendor Manager or designee to complete the following questions: 1. Local Agency Response included/attached: Yes □ or No □ or Not Applicable □
2. State WIC Office Findings: Inadequate Participant access would exist: Yes □ or No □
3. Map(s) Provided: Yes □ or No □
4. Administrative Attachments: Yes □ or No □ or Not Applicable □
5. Comments: 7. Has the State Office received two or more complaints within the last twelve months re: procedural errors and/or customer service issues concerning other authorized Vendors serving the county? Yes □ or No □ 8. Local Agency consulted? Yes □ No □ or N/A □ Person Contacted: _________________________________ 9. Comments:
Attach separate page for additional comments if necessary
VENDOR AGREEMENT WEST VIRGINIA DEPARTMENT OF HEALTH AND HUMAN RESOURCES THE SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN (WIC) Vendor Number: SNAP Number: County: Name of Vendor: Address: City: State: Zip Code: Email Address: Telephone Number: This Agreement is for the period of XXXXX to XXXXX. The Vendor named above is authorized to participate in the West Virginia Special Supplemental Nutrition Program for Women, Infants and Children under administration of the West Virginia Department of Health and Human Resources subject to the following terms and conditions: A. The WV WIC Program Agrees To The Following: 1. The WV WIC Program will accept applications and authorize Vendors to maximize Program benefits while ensuring participant access, statewide coverage and fair treatment. 2. The WV WIC Program will use the same standards for vendor application and participation in the WIC Program for everyone regardless of race, color, national origin, age, sex, or disability. The State Agency will compile data, maintain records and submit reports as required to permit effective enforcement of the nondiscrimination laws. 3. The WV WIC Program will provide Vendors with training and guidance regarding Program requirements annually and once every three (3) years, or, on a more frequent basis as indicated by error patterns or violations. Consideration will be given to Vendor requests for additional training at the discretion of the WV WIC Program. 4. The WV WIC Program will ensure that an account is maintained with sufficient funds to cover daily banking activity. 5. The WV WIC Program will establish and apply limits on the purchase price and/or amount of reimbursement allowed for WIC food items and Vendor redemption requests. In setting allowable reimbursement levels, the WV WIC Program must consider participant access in a geographic area and may include a factor to reflect fluctuations in wholesale prices. 6. The WV WIC Program will provide Vendors with WV WIC Program materials including but not limited to the WIC Window decal, The WIC Approved Shopping Guide, shelf labels, the Vendor Handbook and any Vendor training materials. 7. The WV WIC Program will provide technical assistance and monitoring to ensure Vendors are operating in compliance with WV WIC Program requirements. 8. The WV WIC Program will maintain a fair hearings process to hear appeals related to denial of application to become an authorized Vendor, any adverse action which affects participation during the term of the Vendor Agreement and Vendor disqualification. 9. The WV WIC Program will notify Vendor in writing via email or regular mail of changes to Federal or State statutes, regulations, policies, or procedures governing the WV WIC Program at least sixty (60) days prior to implementation. The Vendor must comply with the Vendor Agreement and Federal and State statutes, regulations, policies, and procedures governing the Program, including any changes made during the Agreement period. Page 1 of 12
B. The Vendor Agrees To The Following: Food Items and WIC Materials 10. Vendor shall carry the required minimum quantity and variety of food items per food category from the WV WIC Approved Food List as determined by the WV WIC Program. Such food shall not be stale, spoiled, or remain available for purchase beyond the expiration date. Vendor shall maintain an inventory record (paper, electronic and/or digital) showing the availability of WV WIC Approved foods throughout the period that this Agreement is in effect. 11. Vendor shall order WIC approved infant formula only from the Manufacturers, Wholesalers, Distributors, and Retailers on the list provided annually by the WV WIC Program to ensure product integrity. The Vendor must notify the State Agency within 30 days, if their primary source of WIC Approved formula has changed from what was reported at the time of application or previously reported. 12. Vendor shall ensure prices on all WV WIC approved food items are clearly marked. Vendor shall maintain a record of shelf prices on WV WIC Approved Foods throughout the period that this Agreement is in effect. 13. Vendor shall remain price competitive based on Vendor’s peer group and competitive price criteria throughout the period of this Agreement. Furthermore, Vendor shall not derive more than 50 percent of its total annual food sales revenue from eWIC transactions. A Vendor’s failure to remain price competitive, or designation as an above-50-percent WIC Vendor, is cause for termination of the Vendor Agreement, even if actual payments to the vendor are within the maximum reimbursement amount. 14. Vendor shall provide suitable hours, visibly posted and adhered to, and environment for participant access. 15. Vendor shall use WV WIC Program materials as specified by the WV WIC Program, including but not limited to the WIC Window decal, which must be prominently displayed and seen from the outside of the store; the WIC Approved Shopping Guide, which must be easily accessible to cashiers at each register; and the Vendor Handbook and any Vendor training materials, all of which must be kept on-site and available for inspection upon request during any monitoring visit. Training 16. Vendor, its manager(s) and/or authorized representative(s), shall attend interactive training concerning WV WIC Program requirements: 1) prior to or at time of initial authorization; 2) at least once every three (3) years when the Vendor Agreement is nearing expiration date; and 3) more frequently if the WV WIC Program deems it necessary. The WV WIC Program will have sole discretion to designate the date, time, and location of all interactive training although at least one alternative date shall be provided for the Vendor to attend such training. 17. The WV WIC Program must provide training annually to each authorized Vendor. At least one (1) Vendor representative must participate in this annual training. Annual vendor training may be provided in a variety of formats, including newsletters, videos, and interactive training. If annual training is provided by training video(s) or training newsletter, the State Agency will allow the Vendor thirty (30) days to view this material. The Vendor will be required to confirm in writing that annual training was provided. 18. Vendor shall inform and train cashiers and other staff regarding WV WIC Program requirements. 19. Vendor shall be accountable for any violations committed by its owners, officers, managers, agents, representatives, and employees, whether acting legally or illegally as well as with or without Vendor's knowledge. Family Benefits 20. Vendor shall provide only WV WIC Approved Foods as specified on the WV WIC Approved Food List. Vendor shall provide this food in the size, form, brand, and quantities stated on the eWIC benefit card. This includes only providing the authorized infant formula, which the Vendor has obtained from sources included on the list described in Article 11 of this agreement to participants in exchange for eWIC benefits specifying infant formula. Page 2 of 12
21. Vendor may not provide refunds or permit exchanges for authorized supplemental foods obtained with the eWIC benefit card, except for the replacement of an identical authorized supplemental food item when the original authorized supplemental food item is defective, spoiled, or has exceeded its “sell by”, “best if used by” or other date limiting the sale of use of the food item. An identical authorized supplemental food item means the exact brand and size as the original authorized supplemental food item obtained and returned by the participant. Vendor understands that the WV WIC Program is not obligated to reimburse Vendor for benefits when substitutions have been made. 22. Vendor may not provide unauthorized food items or non-food items in exchange for eWIC benefits, nor permit any unauthorized product or service to be paid for with a eWIC benefit card. 23. Vendor shall not provide cash or credit (including rain-checks) for redemption of food benefits in addition to and/or in lieu of authorized food. Vendor shall not allow the eWIC benefit card to be used to pay on a charge account or due bill instead of providing the food listed on the WIC Approved Food List. Vendor understands that the WV WIC Program is not obligated to reimburse Vendor for benefits when such redemption is made. 24. Vendor shall not compel participants to buy store brands, to buy a lesser quantity than specified on the eWIC benefit card or compel participants to buy a lesser or more expensive brand, with the exception of milk which must be the least expensive brand due to State cost containment policies, as long as the selected food(s) is WV WIC approved and complies with the quantity and type of food(s) specified on the eWIC benefit card. 25. Vendor shall provide the supplemental food at the current shelf price or at less than the current shelf price charged to other customers. Vendor understands that any charge for an item of more than the shelf price made by any agent, representative, employee or equipment of the Vendor, whether intentional or unintentional, will be considered an overcharge. The purchase price and requested reimbursement for WIC purchases must include only the authorized supplemental food items actually provided to the WIC customer. 26. Vendor shall accept eWIC benefit cards only from participants, parents or caretakers of infant and child participants, or authorized proxies during their specified benefit time period. Vendor shall not require identification other than the eWIC card and Personal Identification Number (PIN). Keep all eWIC cardholder information confidential. 27. Vendor shall offer the WV WIC Program and participants, parents or caretakers of infant and child participants, or authorized proxies the same courtesies as offered to other customers. Vendor shall offer a sales receipt (paper, digital, or electronic), honor manufacturer coupons, store reward/loyalty cards, extend a sale or any other promotional or discount offers to the WV WIC Program and participants as offered or extended to other customers. 28. An eWIC receipt, at a minimum must: show the last four digits of the card number, store name and address, the date and time of the transaction, purchased food items including quantity, description and unit of measure, unit cost, total purchase price, benefit expiration date, and the remaining balance of available benefits. 29. Vendor shall not collect sales tax on WV WIC food purchases. The only exception to this policy is overage of the fruit and vegetable benefit. The participant will be responsible for any dollar amount over the value of the fruit and vegetable benefit. The vendor must allow the participant, authorized representative or proxy to pay the difference when a fruit and vegetable purchase exceeds the value of eWIC benefits (also known as a split tender transaction). 30. Vendor shall not charge participants, parents or caretakers of infant and child participants, or authorized proxies’ money for food purchased with the eWIC benefit card. Acceptance of eWIC for payment of purchase of WV WIC approved food constitutes payment in full to the Vendor. The only exception to this policy regards an overage of a fruit and vegetable benefit. The participant will be responsible for any dollar amount over the value of the fruit and vegetable benefit. The vendor must allow the participant, authorized representative or proxy to pay the difference when a fruit and vegetable purchase exceeds the value of eWIC benefits (also known as a split tender transaction). 31. Vendor shall not provide incentive items, vendor discounts, coupons or other promotions to WIC customers that are not offered to non-WIC customers. This includes any food, merchandise or service provided by a Vendor to attract WIC customers or encourage customer loyalty. Page 3 of 12
32. Cashiers can manually enter the payment card number (PAN) if they identify the eWIC benefit card cannot be read by their point of sale (POS) system. Under no circumstances can the 16 digit PAN be manually entered without the eWIC cardholder presenting the actual eWIC benefit card and entering a PIN. Cashiers should encourage the eWIC cardholder to contact the local agency so that the benefit card can be replaced. If further help is needed pertaining to this issue, ask for management assistance. Food Delivery System 33. Vendor must be WIC EBT capable with use of a Point of Sale (POS) device, integrated system or mobile application. Transactions may be supported through in-lane procedures, self-checkout, scan and go, curbside pickup and online ordering with curbside or in-store payment and pickup. Regardless of checkout method, personnel familiar with WIC transactions must be present for assistance, and customer must manually enter their Personal Identification Number (PIN) when completing the payment. 34. Vendor must comply with the Electronic Benefits Transfer (EBT) operating rules, standards and technical requirements of the WV WIC EBT system, and United States of Agriculture (USDA), Food and Nutrition Service (FNS) regulations. 35. Vendor shall not charge the WV WIC Program any third-party commercial processing costs and fees incurred from Electronic Benefits Transfer (EBT) multi-function equipment. Commercial transaction processing costs and fees imposed by a third-party processor which the Vendor elects to use to connect to the EBT system of the WV WIC Program shall be the responsibility of the Vendor. The WV WIC Program shall not pay for ongoing maintenance, processing fees or operational costs for vendor integrated systems to support WIC EBT. 36. The WV WIC Program will not pay or reimburse the Vendor for interchange fees related to WIC EBT transactions. 37. Point of Sale (POS) terminals used to support the WIC Program and participant access will be deployed in accordance with the minimum lane coverage provisions of §246.12(z)(2). At its discretion, on a case-by-case basis, the WV WIC Program may pay the ongoing maintenance, processing fees or operational costs, as outlined in the WV WIC third party processor contract, of POS terminals utilized solely for WIC transactions, or, multi-function POS terminals at Vendor locations necessary for participant access. Any costs shared by the WV WIC Program will be proportional to the POS terminal usage for the WIC Program. The WV WIC Program may remove excess terminals if actual redemption activity warrants a reduction consistent with the redemption levels outlined in §246.12(z)(2)(i) and (z)(2)(ii): ● Class 1 and Class 2 stores (Superstores and Supermarkets) One POS terminal for every $11,000 in monthly WIC redemption up to a total of four POS terminals, or the number of lanes in the location; whichever is less. At a minimum, terminals shall be installed in monthly WIC redemption threshold increments as follows: one terminal for $0 to $11,000; two terminals for $11,001 to $22,000; three terminals for $22,001 to $33,000; and four terminals for $33,001 and above. ● All other Vendors One POS terminal for every $8,000 in monthly redemption up to a total of four POS terminals, or the number of lanes in the location; whichever is less. At a minimum, terminals shall be installed in monthly WIC redemption thresholds as follows: one terminal for $0 to $8,000; two terminals for $8,001 to $16,000; three terminals for $16,001 to $24,000; and four terminals for $24,001 and above. The monthly redemption levels used for the installation formula shall be the average redemptions based on a period of up to 12 months of prior redemption. 38. Vendor must return state issued POS terminals within thirty (30) days when a WIC Vendor Agreement is terminated. The WV WIC Program will provide a pre-paid return shipping label. 39. Vendor shall apply the WV WIC Approved Product List (APL) to their integrated processing systems when retrieved, and no later than within 48 hours of the APL file create date and time as recorded in the APL file header record in accordance with provisions of Section 11.5 of the FNS Operating Rules. Payment of Redeemed Food Benefits Page 4 of 12
40. The WV WIC Program may make price adjustments to the purchase price on benefits or redemption requests submitted by the Vendor to ensure compliance with the price limitations applicable to the Vendor’s peer group and competitive price criteria. 41. The WV WIC Program may deny payment for improperly transacted eWIC purchases or may initiate a claim for payments already made on improperly redeemed eWIC purchases. When the WV WIC Program determines the Vendor has committed a violation which affects the payment to the Vendor, the WV WIC Program will delay payment or establish a claim. The WV WIC Program may delay payment or establish a claim in the amount of the full purchase price of each transaction that contained the Vendor overcharge or other error. The WV WIC Program will provide an opportunity for the Vendor to justify or correct an overcharge or error even though the Vendor must pay any claim assessed by the WV WIC Program. In collecting a claim, the WV WIC Program may offset the claim against current or subsequent amounts to be paid to the Vendor. In addition to denying payment or assessing a claim, the WV WIC Program may sanction the Vendor for overcharges or other errors in accordance with the WV WIC Sanction Policy and Listing. 42. Vendor shall notify the WV WIC Program of any out-of-balance discrepancy or transaction that is erroneously handled, or is believed to be erroneously handled, by the processing system within ten (10) business days from the original transaction date. Merchant shall supply the WV WIC Program with any supporting documentation upon request. Failure to notify the WV WIC Program within such ten (10) business day’s period waives any right to an adjustment. In addition, the WV WIC Program may initiate adjustments where a WIC participant submits a substantiated claim within ninety (90) calendar days of the date of a transaction or where other system errors have been identified. Out of balance discrepancies are between the Vendor and WV WIC Program, and are not client or retailer adjustments that must comply with the timeframes as specified in the federal regulations. 43. Vendor shall notify the WV WIC Program promptly of any erroneously settled funds to Vendor’s account and repay such erroneously settled funds to the WV WIC Program within ten (10) days after its discovery of the erroneous settlement. 44. Vendor shall not seek any contribution from participant, parent or caretaker of infant and child participants, or authorized proxies on a valid purchase when the purchase amount exceeds the established maximum allowable reimbursement level. Nor may Vendor refuse acceptance of the eWIC benefit card or restrict quantity or type of food being purchased as long as the foods selected are WV WIC approved and meet with the specific food message on the eWIC benefit card. 45. Vendor may not seek restitution from participants, parents or caretakers of infant and child participants, or authorized proxies for eWIC purchases for which the WV WIC Program has denied payment or provided partial payment. WV WIC purchases are conditional payment instruments, which must meet specific requirements for payment. All payment issues are strictly between the Vendor and the WV WIC Program. 46. Vendor shall permit the WV WIC Program to transfer reimbursements by electronic funds transfer into Vendor's designated bank account. Routine Monitoring 47. Vendor understands that it may be monitored by the WV WIC Program and/or the USDA/FNS for compliance with WV WIC Program requirements. That monitoring includes, but is not limited to, the Program's authority to conduct covert compliance purchases to determine improper Vendor practices. 48. The Vendor must maintain inventory records (paper, electronic or digital) used for Federal tax reporting purposes and other records the State Agency may require throughout the course of the Vendor Agreement for a period of three (3) years. Upon request, the Vendor must make available to representatives of the State Agency, USDA, and the Comptroller General of the United States, at any reasonable time and place for inspection and audit all Program related records (paper, electronic or digital). 49. During a monitoring visit or at any other time, Vendor shall provide the WV WIC Program with inventory reports. Reports must demonstrate correct shelf prices and stock varieties and amounts required for Program participation, shelf price records and wholesale purchase invoices throughout the existing Agreement period which details the list of WV WIC food items purchased by Vendor, and access to all of Vendor's WV WIC Program related records. 50. Vendor shall provide access to eWIC redemptions negotiated the day of the monitoring visit at the request of the Page 5 of 12
reviewer. 51. The Vendor must maintain and make available purchasing records to the WV WIC Program within 21 calendar days of a written request from the State Agency. The purchasing records (paper, electronic, and/or digital) must show the source and date of purchase of all WIC Approved formulas and foods. Governing Regulations and Policies 52. Vendor shall comply with federal and state civil rights legislation and regulations. 53. A Vendor who commits fraud or abuse of the WV WIC Program is liable for prosecution under applicable federal, state or local laws. Vendors who have willfully misapplied, stolen or fraudulently obtained WV WIC Program funds shall be subject to a fine of not more than $25,000 or imprisonment for not more than five years or both, if the value of the funds is $100 or more. If the value is less than $100, the penalties are a fine of not more than $1,000 or imprisonment for not more than one year or both. 54. Vendor understands the WV WIC Program shall refer Vendors who abuse the Program to federal, state or local authorities for prosecution under applicable statutes, where appropriate. 55. Vendor understands the WV WIC Program will terminate the Agreement if the WV WIC Program identifies a conflict of interest, as defined by applicable State laws, regulations, and policies, between the Vendor and the WV WIC Program or its Local Agencies. 56. Vendor shall comply with the nondiscrimination provisions of the USDA’s Regulations found at 7 C.F.R. parts 15, 15a and 15b. 57. Vendor shall comply with the Vendor Agreement, Federal and State statutes, regulations, policies, and procedures governing the Program, including any changes made during the Agreement period, and to the conditions specified in the WV WIC Vendor Handbook, incorporated herein by reference. Vendor agrees that it is subject to the sanctions mandated by USDA and the sanctions established by the WV WIC Program. Vendors shall be subject to the WV WIC Sanction Policy and Listing found in the WV WIC Vendor Handbook, incorporated herein by reference. Vendor Agreement 58. Vendor understands that the WV WIC Program will immediately terminate the Agreement if it determines that the Vendor has provided false information in connection with its application for authorization. 59. Vendor understands that this Agreement shall not be modified by the Vendor in any manner and that any alterations made to the terms and conditions set forth herein shall be null and void and the terms, as originally set forth herein, shall remain in full force and effect. 60. Vendor understands that the Agreement does not constitute a license or a property interest. If the Vendor wishes to continue to be authorized beyond the period of its current Agreement, the Vendor must reapply. If the Vendor is disqualified, the WV WIC Program will terminate the Vendor's Agreement, and the Vendor will have to reapply for authorization after the disqualification period is over. The Vendor will be subject to the Vendor selection and limiting requirements in effect at the time of the reapplication. 61. Vendor shall notify the WV WIC Program of change in ownership or store location or cessation of operation. Vendor understands that authorization is non-transferable; if ownership changes, this Agreement shall be terminated. Vendor shall provide such notification in writing at least thirty (30) days in advance so that another Vendor may be authorized if deemed appropriate by the WV WIC Program. Vendor understands that the WV WIC Program is not obligated to authorize the new ownership. The WV WIC Program may permit Vendors to move short distances without terminating the Agreement, but the WV WIC Program has discretion to determine whether a change in location qualifies as a short distance, and whether a change in business structure constitutes a change in ownership. 62. Vendor understands that it must return its original signed Agreement for approval and acceptance by the WV WIC Program. Vendor Agreements may be mailed to the WV WIC Program, Vendor Management Unit or returned at the time the Vendor's representatives, agents and/or employees attend Vendor authorization training. Vendor shall be approved to accept eWIC benefits on the same day as authorization. Page 6 of 12
63. Vendor understands that it must notify the WV WIC Program of any changes, i.e., a decrease or increase in number of cash registers, which may affect an authorized WIC Vendor’s peer group classification. The WV WIC Program may change the Vendor’s peer group classification due to changes in methodology being used to determine classification or updated Vendor information. 64. Vendor understands that it must comply with the vendor selection criteria throughout the Agreement period, including any changes to the criteria. Failure by Vendor to meet these criteria will result in sanction assessment and/or termination of the Agreement. Using the current vendor selection criteria, the WV WIC Program may reassess the Vendor at any time during the Agreement period. 65. Vendor understands that the use of any USDA service mark, including the WIC acronym may not be used in a manner which states or implies that the Vendor itself is affiliated with or sponsored by the State Agency, USDA or WIC Program. Vendor Sanctions and Appeals Process 66. Vendor shall have the right to appeal the WV WIC Program's decision pertaining to denial of application to become an authorized Vendor, disqualification or any other adverse action which affects participation during the period of the Vendor Agreement. All adverse actions which may be subject to administrative appeal are listed in the WV WIC Program's Fair Hearing Policy for Vendors located in the Vendor Handbook. All adverse actions not subject to administrative appeal are: i. The validity or appropriateness of the State agency's vendor limiting criteria or vendor selection criteria for minimum variety and quantity of supplemental foods, business integrity, and current Supplemental Nutrition Assistance Program (SNAP) disqualification or civil money penalty for hardship (§246.12(g)(3)); ii. The validity or appropriateness of the State agency's selection criteria for competitive price, including, but not limited to, vendor peer group criteria and the criteria used to identify vendors that are above-50-percent vendors or comparable to above-50-percent vendors; iii. The validity or appropriateness of the State agency's participant access criteria and the State agency's participant access determinations; iv. The State agency's determination to include or exclude an infant formula manufacturer, wholesaler, distributor, or retailer from the list required pursuant to §246.12(g)(11 v. The validity or appropriateness of the State agency's prohibition of incentive items and the State agency's denial of an above-50-percent vendor's request to provide an incentive item to customers pursuant to §246.12(h)(8) vi. The State agency's determination whether to notify a vendor in writing when an investigation reveals an initial violation for which a pattern of violations must be established in order to impose a sanction, pursuant to §246.12(l)(3) vii. The State agency's determination whether a vendor had an effective policy and program in effect to prevent trafficking and that the ownership of the vendor was not aware of, did not approve of, and was not involved in the conduct of the violation (§246.12(l)(1)(i)(B)) viii. Denial of authorization if the State agency's vendor authorization is subject to the procurement procedures applicable to the State agency ix. The expiration of a vendor's agreement x. Disputes regarding food instrument, EBT, or cash-value voucher payments and vendor claims (other than the opportunity to justify or correct a vendor overcharge or other error, as permitted by §246.12(k)(3) 67. Vendor understands the WV WIC Program may disqualify and/or sanction a Vendor for reasons of Program abuse as set forth in the WV WIC Vendor Handbook, WV WIC Sanction Policy and Listing, and this Agreement. Vendor further understands that the sanctions found in the WV WIC Sanction Policy and Listing have been structured in such a way as to take into account the relative severity and type of conduct listed. Vendor shall be familiar with those violations found in the WV WIC Vendor Handbook, Sanction Policy and Listing, and this Agreement to take appropriate measures in implementing safeguards to prevent their occurrence. 68. Vendor understands the sanctions found in WV WIC Sanction Policy and Listing do not take into account whether the violations represented Vendor policy, occurred with or without management knowledge, were the actions of an individual, agent, employee or representative who did not understand WV WIC Program rules, or if prior warning and an opportunity for correction was provided to the Vendor. Page 7 of 12
69. Payment of a Vendor claim does not absolve the Vendor for violations which give rise to sanctions whenever the Vendor violation meets the conditions set forth in the WV WIC Vendor Sanction Policy and Listing. Vendor further understands that the WV WIC Program considers certain violations, i.e. overcharge, trafficking, etc., to be of such serious nature to warrant disqualification at any level or degree of the violation. 70. Vendor understands that its disqualification from participating in the WV WIC Program may result in its disqualification from SNAP, and that this disqualification is not subject to administrative or judicial review under SNAP. 71. Vendor understands that its disqualification from participation in SNAP shall result in its disqualification from the WV WIC Program, unless, at its discretion, the WV WIC Program determines that such disqualification would result in inadequate participant access as defined by WV WIC Program policy. A Vendor’s disqualification from the WV WIC Program as a result of disqualification from SNAP is not subject to administrative or judicial review under the WV WIC Program. 72. Vendor understands if SNAP imposes a civil money penalty in lieu of program disqualification, the WV WIC Program may impose a disqualification period equal to the length of SNAP’s original proposed length of disqualification. 73. Vendor understands the provision of sanctions for WV WIC Program violations shall not be construed as excluding or replacing any additional penalties or sanctions available to WV WIC Program or any criminal or civil sanctions or other remedies that may be applicable under any federal or state statute or local ordinance. 74. Vendor understands a potentially hearable issue shall not be considered at a later hearing if this issue was: (a) not challenged at a previously offered opportunity; or, (b) challenged but then abandoned by the Vendor and/or representative; or, (c) challenged and a final decision was rendered. 75. In addition to claims collection, the Vendor may be sanctioned for Vendor violations in accordance with the WV WIC Program's sanction schedule. Sanctions may include administrative fines, disqualifications, and civil money penalties in lieu of disqualification. The WV WIC Program must notify a Vendor in writing when an investigation reveals an initial violation for which a pattern of occurrences must be established in order to impose a sanction, before another such incidence is documented, unless the WV WIC Program determines, in its discretion, on a case-by-case basis, that notifying the Vendor would compromise an investigation. 76. To ensure that civil money penalties (CMPs) are applied consistently and proportionately for violations of WV WIC Program regulations, the penalty will be calculated by Multiply the product from paragraph (l)(1)(x)(B) of this section by the number of months for which the store would have been disqualified. This is the amount of the civil money penalty, provided that the civil money penalty shall not exceed the maximum amount specified in § 3.91(b)(3)(v) of this title for each violation. For a violation that warrants permanent disqualification, the amount of the civil money penalty shall be the maximum amount specified in § 3.91(b)(3)(v) of this title for each violation. When during the course of a single investigation the State agency determines a vendor has committed multiple violations, the State agency must impose a CMP for each violation. The total amount of civil money penalties imposed for violations investigated as part of a single investigation may not exceed the amount specified in § 3.91(b)(3)(v) of this title as the maximum penalty for violations occurring during a single investigation. 77. Vendor understands a Vendor resignation will not be accepted to avoid mandatory training, sanction point assessment, and/or disqualification. Vendor also understands that any sanctions assessed to the Vendor will remain with the Vendor throughout the period of the current Vendor Agreement and will be reinstated and be part of the Vendor's sanction record should Vendor resign and then regain authorization as a WV WIC Vendor within this aforementioned Agreement period. General Conditions 78. Upon expiration of this Agreement, the Vendor may reapply for consideration for Vendor authorization. Vendor understands that renewal or reauthorization of Vendor status is not automatic. 79. Vendor understands neither the WV WIC Program nor the Vendor has an obligation to renew the Vendor Agreement. Page 8 of 12
80. This Agreement may be terminated by mutual agreement of all parties at any time. 81. The WV WIC Program shall provide the Vendor with not less than fifteen (15) days advance notice of the expiration date of the Vendor Agreement. 82. Except when a sanction action is pending, Vendor may terminate this Agreement at any time upon thirty (30) days written notice to the WV WIC Program. Failure to notify the WV WIC Program at least thirty (30) days prior to such termination could result in denial of any future application for participation by the Vendor. 83. Either the WV WIC Program or the Vendor may terminate the Agreement for cause after providing advance written notice of a period of not less than fifteen (15) days. 84. The WV WIC Program reserves the right to modify the terms and conditions of this Agreement at any time. When it desires to modify the terms and conditions of this Agreement, the WV WIC Program shall notify the Vendor, in writing, 60 days in advance of the effective date of the new Agreement. The term of the revised Agreement will be from the revised effective date through the revised expiration date of the original Agreement. 85. This Agreement shall be performed in accordance with the provisions of Title VII of the Civil Rights Act of 1964, current federal WIC Program regulations and/or WV WIC Program policies and regulations. Vendor shall acknowledge that Program participants may not be discriminated against based on race, color, national origin, sex, disability, age, or reprisal or retaliation for prior civil rights activity in any program or activity conducted or funded by USDA. The following Nondiscrimination Statement is provided for any person seeking to file a civil rights complaint. Nondiscrimination Statement In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, sex, disability, age, or reprisal or retaliation for prior civil rights activity in any program or activity conducted or funded by USDA. Persons with disabilities who require alternative means of communication for program information (e.g. Braille, large print, audiotape, American Sign Language, etc.), should contact the Agency (State or local) where they applied for benefits. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English. To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, (AD-3027) found online at: http://www.ascr.usda.gov/complaint_filing_cust.html, and at any USDA office, or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by: (1) Mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; or (3) email: program.intake@usda.gov. This institution is an equal opportunity provider. 86. The Vendor hereby agrees that it will comply with Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.), Title IX of the Education Amendments of 1972 (20 U.S.C. 1681 et seq.), Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), Age Discrimination Act of 1975 (42 U.S.C. 6101 et seq.); Title II and Title III of the Americans with Disabilities Act (ADA) of 1990 as amended by the ADA Amendment Act of 2008 (42 U.S.C. 12131-12189) as implemented by Department of Justice regulations at (28 CFR Parts 35 and 36); Executive Order 13166, "Improving Access to Services for Persons with Limited English Proficiency." (August 11, 2000), all provisions required by the implementing regulations of the U.S. Department of Agriculture (7 CFR Part 15 et seq); Page 9 of 12
and FNS directives and guidelines to the effect that no person shall, on the ground of race, color, national origin, age, sex (including gender identity and sexual orientation), or disability, or reprisal or retaliation for prior civil rights activity be excluded from participation in, be denied the benefits of, or otherwise be subjected to discrimination under any program or activity for which the Agency receives Federal financial assistance from FNS; and hereby gives assurance that it will immediately take measures necessary to effectuate this agreement. By providing this assurance, the Vendor agrees to compile data, maintain records and submit records and reports as required to permit effective enforcement of the nondiscrimination laws, and to permit Department personnel during normal working hours to review and copy such records, books and accounts, access such facilities, and interview such personnel as needed to ascertain compliance with the non-discrimination laws. If there are any violations of this assurance, the Department of Agriculture shall have the right to seek judicial enforcement of this assurance. This assurance is given in consideration of and for the purpose of obtaining any and all Federal financial assistance, grants, and loans of Federal funds, reimbursable expenditures, grant, or donation of Federal property and interest in property, the detail of Federal personnel, the sale and lease of, and the permission to use Federal property or interest in such property or the furnishing of services without consideration or at a nominal consideration, or at a consideration that is reduced for the purpose of assisting the recipient, or in recognition of the public interest to be served by such sale, lease, or furnishing of services to the recipient, or any improvements made with Federal financial assistance extended to the Program applicant by USDA. This includes any Federal agreement, arrangement, or other contract that has as one of its purposes the provision of cash assistance for the purchase of food, and cash assistance for purchase or rental of food service equipment or any other financial assistance extended in reliance on the representations and agreements made in this assurance. This assurance is binding on the Vendor, its successors, transferees, and assignees as long as it receives assistance or retains possession of any assistance from the Department. The person or persons whose signatures appear below are authorized to sign this assurance on the behalf of the Vendor. 87. The Vendor shall immediately inform the State Agency of: a. Any conviction of a storeowner on a felony charge, b. Any investigation of a storeowner by SNAP, c. Any suspected or observed improper use of eWIC cards or Cash Value Benefits by a participant; and d. Any other circumstance impacting service to participants or the Program. 88. If any provision of this Vendor Agreement, WV WIC Vendor Handbook or Sanction Policy and Listing is adjudged by any court of competent jurisdiction to be invalid, such judgment shall not affect, impair or invalidate the remainder of the Vendor Agreement, WV WIC Vendor Handbook, or Vendor Sanction Policy and Listing, but shall be confined in its operation to the provisions thereof directly involved in the controversy in which such judgment shall have been rendered, and the applicability of such provision to other persons or circumstances shall not be affected thereby. Page 10 of 12
VENDOR AGREEMENT WEST VIRGINIA DEPARTMENT OF HEALTH AND HUMAN RESOURCES THE SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN (WIC) Vendor Number: SNAP Number: County: Name of Vendor: Address: City: State: Zip Code: Email Address: Telephone Number: The undersigned representative for the Vendor specified on this Agreement, do hereby acknowledge that I have read the WV WIC Vendor Agreement and agree to the requirements as set forth by the WV WIC Program and this Vendor Agreement. I acknowledge that I or my designated representative(s) has attended Vendor Authorization Training. I have had sufficient opportunity to review and consider this Agreement, consult with legal counsel, and ask questions of WV WIC Program representatives regarding such requirements. I acknowledge that I have reviewed the WV WIC Vendor Handbook, Vendor Sanction Policy, and Vendor Sanction Listing and that I fully understand that violations of WV WIC Policy by employees, representatives, or agents of the above-named Vendor will result in disqualification from the WV WIC Program. Vendor Representative: _______________________________________________ ___________________________ Signature of Vendor Representative Date WV WIC Representative: _______________________________________________ _________________________ Signature of WV WIC Program Representative Date Page 11 of 12
Effective: November 15, 2019 Page 12 of 12
West Virginia WIC Vendor Violations and Sanctions MANDATORY FEDERAL SANCTIONS VIOLATION DESCRIPTION CORRESPONDING SANCTION 1ST INCIDENCE 2ND INCIDENCE 3RD INCIDENCE Federal/USDA 246.12(l)(1)(i) Vendors convicted of buying or selling eWIC benefits for cash (trafficking); selling firearms, ammunition, explosives or controlled substances [as defined in section 102 of the Controlled Substances Act (21 U.S.C. 802)] in exchange for eWIC food benefits or cash-value benefits. Termination of Vendor Agreement and Permanent Disqualification Permanent Disqualification N/A N/A Federal/USDA 246.12(l)(1)(vii) Vendor is disqualified from the Supplemental Nutrition Assistance Program (SNAP). Termination of the Vendor Agreement and Disqualification for the same length of time as the SNAP disqualification but may begin at a later date Disqualification for the same length of time as the SNAP disqualification N/A N/A Federal/USDA 246.12(l)(i)(ii)(A) One incidence of buying or selling eWIC benefits or cash-value benefits for cash (trafficking). Termination of Vendor Agreement and 6-year disqualification 6-year disqualification N/A N/A Federal/USDA 246.12(l)(i)(ii)(B) One incidence of selling firearms, ammunition, explosives or controlled substances [as defined in section 102 of the Controlled Substances Act (21 U.S.C. 802)] in exchange for eWIC food benefits or cash-value benefits. Termination of Vendor Agreement and 6-year disqualification 6-year disqualification N/A N/A Federal/USDA 246.12(l)(i)(ii)(iii)(A) One incidence of sale of alcohol or alcoholic beverages or tobacco products in exchange for eWIC food benefits or cash-value benefits. Termination of Vendor Agreement and 3-year disqualification 3-year disqualification N/A N/A Page 1 of 9
West Virginia WIC Vendor Violations and Sanctions Federal/USDA 246.12(l)(i)(ii)(iii)(B) A pattern of claiming reimbursement for the sale of an amount of a specific supplemental food item which exceeds the store’s documented inventory of that supplemental food item for a specific period of time. Termination of Vendor Agreement and 3-year disqualification WL WL and MRT 3-year disqualification MANDATORY FEDERAL SANCTIONS VIOLATION DESCRIPTION CORRESPONDING SANCTION 1ST INCIDENCE 2ND INCIDENCE 3RD INCIDENCE Federal/USDA 246.12(l)(i)(ii)(iii)(C) A pattern of vendor overcharges. Charging WIC customers more than non-WIC customers or charging more than current shelf and/or sale price. This includes system programming inaccuracies. Termination of Vendor Agreement and 3-year disqualification WL WL and MRT 3-year disqualification Federal/USDA 246.12(l)(i)(ii)(iii)(D) A pattern of receiving, transacting, and/or redeeming eWIC food benefits or cash-value benefits outside of authorized channels, including the use of an unauthorized vendor and/or an unauthorized person. Termination of Vendor Agreement and 3-year disqualification WL WL and MRT 3-year disqualification Federal/USDA 246.12(l)(i)(ii)(iii)(E) A pattern of charging for supplemental food not received by the WIC participant. Termination of Vendor Agreement and 3-year disqualification WL WL and MRT 3-year disqualification Federal/USDA 246.12(l)(i)(ii)(iii)(F) A pattern of providing credit or non-food items, other than alcohol, alcoholic beverages, tobacco products, cash, firearms, ammunition, explosives, or controlled substances as defined in 21 U.S.C. 802, in exchange for eWIC food benefits or cash-value benefits. Termination of Vendor Agreement and 3-year disqualification WL WL and MRT 3-year disqualification Page 2 of 9
West Virginia WIC Vendor Violations and Sanctions Federal/USDA 246.12(l)(i)(ii)(iii)(iv) A pattern of providing unauthorized food items in exchange for eWIC food benefits or cash-value benefits, including charging for supplemental foods provided in excess of those listed on the eWIC food benefits or cash-value benefits. Termination of Vendor Agreement and 1-year disqualification WL WL and MRT 1-year disqualification Federal/USDA 246.12(l)(i)(ii)(iii)(iv)(B) A pattern of providing prohibited incentive items to customers, other than items obtained by the vendor at no cost or the total value of multiple incentive items provided during one shopping visit does not exceed the less-than-$2 nominal value limit. Termination of Vendor Agreement and 1-year disqualification WL WL and MRT 1-year disqualification MANDATORY STATE SANCTIONS VIOLATION DESCRIPTION CORRESPONDING SANCTION 1ST INCIDENCE 2ND INCIDENCE 3RD INCIDENCE A pattern of a vendor failing to purchase infant formula from licensed wholesalers, distributors and retailers listed with West Virginia WIC Program or from infant formula manufacturers registered with the Food and Drug Administration. Termination of Vendor Agreement and 1-year disqualification WL WL and MRT 1-year disqualification A pattern of a vendor failing to remit payment for overcharges as requested by the Program. This includes return of reimbursement check issued for payment the bank for insufficient funds. Termination of Vendor Agreement and 1-year disqualification WL WL and MRT 1-year disqualification A pattern of vendor refusing to allow WIC State Agency Representatives the opportunity to review eWIC transactions or pertinent records, or fails to provide evidence of proofs-of-purchase (invoices) of WIC foods within 21 calendar days of the date of the request during investigations, or provided documentation is altered, incorrect or fabricated. *Invoices or receipts to Termination of Vendor Agreement and 1-year disqualification WL WL and MRT 1-year disqualification Page 3 of 9
West Virginia WIC Vendor Violations and Sanctions verify the purchase of WIC foods from an Approved Supplier/Distributor should be maintained for a period of the three (3) year Vendor Agreement. A pattern of scanning (or manually entering) UPCs that are not affixed to authorized food items being purchased by the WIC customer. Termination of Vendor Agreement and 1-year disqualification WL WL and MRT 1-year disqualification A pattern of a vendor issuing “rain checks” or due bills in exchange or in lieu of eWIC benefits. Administrative Fine OR Termination of Vendor Agreement and 1-year disqualification WL WL and MRT $400 Administrative Fine OR 1-year disqualification for second pattern established within consecutive 12-month period MANDATORY STATE SANCTIONS VIOLATION DESCRIPTION CORRESPONDING SANCTION 1ST INCIDENCE 2ND INCIDENCE 3RD INCIDENCE A pattern of a vendor requiring other cash purchases or a minimum purchase as a condition to use eWIC benefits. Administrative Fine OR Termination of Vendor Agreement and 1-year disqualification WL WL and MRT $400 Administrative Fine OR 1-year disqualification for second pattern established within consecutive 12-month period A pattern of a vendor contacting WIC customers to recoup funds for the eWIC benefits not paid by WIC. Administrative Fine OR Termination of Vendor Agreement and 1-year disqualification WL WL and MRT $400 Administrative Fine OR 1-year disqualification for second pattern established within consecutive 12-month period A pattern of a vendor requiring WIC customers to contribute cash or provide copayment on any portion of the total purchase amount of an eWIC transaction excluding overage of cash-value benefits. Administrative Fine OR Termination of Vendor Agreement and 1-year disqualification WL WL and MRT $400 Administrative Fine OR 1-year disqualification for second pattern established within consecutive 12-month period MANDATORY STATE SANCTIONS VIOLATION DESCRIPTION CORRESPONDING SANCTION 1ST INCIDENCE 2ND INCIDENCE 3RD INCIDENCE Page 4 of 9
West Virginia WIC Vendor Violations and Sanctions A pattern of a vendor limiting the choices and quantities of authorized food items listed on a customer’s eWIC benefits card (i.e. not allowing participant to utilize entire food package, requiring purchase of a single brand when other WIC approved brands are available). Administrative Fine OR Termination of Vendor Agreement and 1-year disqualification WL WL and MRT $400 Administrative Fine OR 1-year disqualification for second pattern established within consecutive 12-month period A pattern of a vendor providing cash or credit for the return of items purchased with eWIC benefits. Administrative Fine OR Termination of Vendor Agreement and 1-year disqualification WL WL and MRT $400 Administrative Fine OR 1-year disqualification for second pattern established within consecutive 12-month period A pattern of a vendor allowing the exchange of authorized WIC foods for authorized foods other than the exact same brand and size. Administrative Fine OR Termination of Vendor Agreement and 1-year disqualification WL WL and MRT $400 Administrative Fine OR 1-year disqualification for second pattern established within consecutive 12-month period A pattern of vendor with integrated point of sale system inappropriately mapping or failing to map items to WIC cash value benefits. Administrative Fine OR Termination of Vendor Agreement and 6-month disqualification WL WL and MRT $200 Administrative Fine OR 6-month disqualification for second pattern established within consecutive 36-month period MANDATORY STATE SANCTIONS VIOLATIONS DESCRIPTION CORRESPONDING SANCTION 1ST INCIDENCE 2ND INCIDENCE 3RD INCIDENCE A pattern of a vendor requiring WIC customers to provide identification. Administrative Fine OR Termination of Vendor Agreement and 6-month disqualification WL WL and MRT $200 Administrative Fine OR 6-month disqualification for second pattern established within consecutive 36-month period A pattern of a vendor refusing to allow WIC customers the same courtesies as offered to other $200 Administrative Fine OR 6-month disqualification for Page 5 of 9
West Virginia WIC Vendor Violations and Sanctions customers, including but not limited to use coupons, Buy One Get One Free offers, sales promotions, discount offers or store loyalty program. This does not include sale price as vendors are required to charge WIC customers the sale price or be considered overcharging which a federal sanction. Administrative Fine OR Termination of Vendor Agreement and 6-month disqualification WL WL and MRT second pattern established within consecutive 36-month period A pattern of a vendor misusing the WIC acronym or facsimiles in the name of the vendor or in advertising or other promotional materials. Administrative Fine OR Termination of Vendor Agreement and 6-month disqualification WL WL and MRT $200 Administrative Fine OR 6-month disqualification for second pattern established within consecutive 36-month period A pattern of a vendor not displaying a “WIC Authorized” or similar shelf label within a section of the store, an entire food category, and/or on more than 25 approved WIC products. Administrative Fine OR Termination of Vendor Agreement and 3-month disqualification WL WL and MRT $200 Administrative Fine OR 3-month disqualification for second pattern established within consecutive 36-month period MANDATORY STATE SANCTIONS VIOLATION DESCRIPTION CORRESPONDING SANCTION 1ST INCIDENCE 2ND INCIDENCE 3RD INCIDENCE A pattern of failing to display prices or clearly mark the prices for all WIC foods on the shelf, product or nearby area. Administrative Fine OR Termination of Vendor Agreement and 3-month disqualification WL WL and MRT $100 Administrative Fine OR 3-month disqualification for second pattern established within consecutive 36-month period A pattern of failing to maintain the minimum variety and inventory of WIC approved foods and infant formula.***** Administrative Fine OR Termination of Vendor Agreement and 3-month disqualification WL WL and MRT $100 Administrative Fine OR 3-month disqualification for second pattern established within consecutive 36-month period A pattern of allowing WIC Approved products to remain in the customer purchase area which is beyond manufacturer’s expiration date. Administrative Fine OR Termination of Vendor Agreement WL WL and MRT $100 Administrative Fine OR 3-month disqualification for second pattern established within Page 6 of 9
West Virginia WIC Vendor Violations and Sanctions and 3-month disqualification consecutive 36-month period A pattern of violating WIC customer’s confidentiality. Administrative Fine OR Termination of Vendor Agreement and 3-month disqualification WL WL and MRT $100 Administrative Fine OR 3-month disqualification for second pattern established within consecutive 36-month period A pattern of a vendor failing to provide WIC customers a printed receipt at the end of each eWIC transaction. Administrative Fine OR Termination of Vendor Agreement and 3-month disqualification WL WL and MRT $100 Administrative Fine OR 3-month disqualification for second pattern established within consecutive 36-month period A pattern of a vendor failing to maintain and keep an up to date Approved Product List (APL) file within their point of sale system/device resulting in a WIC item not being able to be scanned/purchased. Administrative Fine OR Termination of Vendor Agreement and 3-month disqualification WL WL and MRT $100 Administrative Fine OR 3-month disqualification for second pattern established within consecutive 36-month period A pattern of a vendor displaying a “WIC Authorized” or similar shelf label on an unauthorized WIC food item. Administrative Fine OR Termination of Vendor Agreement and 30-day disqualification WL WL and MRT $50 Administrative Fine OR 30-Day disqualification for second pattern established within consecutive 36-month period A pattern of a vendor with integrated point of sale system failing to provide WIC customers with a mid-transaction receipt. Administrative Fine OR Termination of Vendor Agreement and 30-day disqualification WL WL and MRT $50 Administrative Fine OR 30-Day disqualification for second pattern established within consecutive 36-month period A pattern of failing to post the Authorized WIC Vendor door decal conspicuously facing the outside Administrative Fine OR Termination of Vendor Agreement WL WL and MRT $50 Administrative Fine OR 30-Day disqualification for second pattern established within Page 7 of 9
West Virginia WIC Vendor Violations and Sanctions parking lot at each entrance to the store. and 30-day disqualification consecutive 36-month period A pattern of failing to have WIC materials available in the store which includes current Vendor Handbook, Cashier Training Manual, and the WIC Authorized Shopping Guide at each cashier checkout station. Administrative Fine OR Termination of Vendor Agreement and 30-day disqualification WL WL and MRT $50 Administrative Fine OR 30-Day disqualification for second pattern established within consecutive 36-month period A pattern of failing to have at least one lane open during operating hours to process WIC EBT transactions. Administrative Fine OR Termination of Vendor Agreement and 30-day disqualification WL WL and MRT $50 Administrative Fine OR 30-Day disqualification for second pattern established within consecutive 36-month period A pattern of failing to provide WIC customers a printed eWIC balance inquiry upon request. Administrative Fine OR Termination of Vendor Agreement and 30-day disqualification WL WL and MRT $50 Administrative Fine OR 30-Day disqualification for second pattern established within consecutive 36-month period MANDATORY STATE SELECTION CRITERIA SELECTION CRITERION DESCRIPTION CORRESPONDING SANCTION Vendor fails to notify the WIC Program with change of ownership or location or cessation of operations***. Termination of agreement**** Vendor has conflict of interest with the WIC Program. Termination of agreement**** Vendor is unable to process split tender for cash-value benefits. Termination of agreement**** Vendor fails to submit competitive prices on the vendor price survey. Termination of agreement**** Vendor knowingly provides false information to the WIC Program. Termination of agreement**** Vendor threatens and/or verbally abuses State/Federal staff. Termination of agreement**** Vendor refuses to permit State/Federal personnel to perform onsite compliance monitoring. Termination of agreement**** Vendor does not have a valid State of West Virginia business license to operate as a food retailer in West Virginia. Termination of agreement**** Page 8 of 9
West Virginia WIC Vendor Violations and Sanctions Vendor fails to have a valid Public Health permit. Termination of agreement**** Vendor or authorized vendor representative fails to attend mandatory WIC training sessions as scheduled by the State Agency. This includes mandatory retraining, authorization training and/or annual training. Termination of agreement**** Any activity by vendor officers, managers, employees or representatives which violates any provision of the Vendor Agreement not specifically addressed in this violation list will be considered a breach of contract. Termination of agreement**** Vendor does not maintain or has a lapse in SNAP authorization. Termination of agreement**** Legend ● WL = Warning Letter ● MRT = Mandatory Retraining at location designated by the State Office ● Also subject to reimbursement for improperly redeemed eWIC food benefits and cash-value benefits. ● **State agency sanctions are based on a pattern of 2 or more violation incidences and may include disqualifications, civil money penalties assessed in lieu of disqualification, or administrative fines. ● ***Vendor ceasing operation for any reason except due to temporary closure from casualty losses, natural disaster, or renovations for improvements. ● ****Termination of agreement does not include period of disqualification. ● *****Out of date food items DO NOT count toward minimum stock ● Disqualification includes termination of contract. In instances of disqualification as a result of SNAP disqualification, the WIC disqualification shall be for the same length as SNAP disqualification period but may begin later than the imposed SNAP disqualification. ● A pattern of violations must be established in order for the State to impose a federal sanction. A pattern of violations is established by 2 or more instances of the same violation. ● Second mandatory sanction. When a vendor, who previously has been assessed a sanction for any violation, receives another sanction for any one of those same violations, the State agency will double the second sanction. Civil money penalties may only be doubled up to the limits allowed. ● Third or subsequent mandatory sanction. When a vendor, who previously has been assessed two or more sanctions or any violation, receives another sanction for any one of those violations, the State agency will double the third sanction and all subsequent sanctions. The state agency will not impose civil money penalties in lieu of disqualification for third or subsequent sanctions for violation(s). Page 9 of 9
West Virginia WIC Policy & Procedure 8.04 Effective Date: 03/11/2013 8.04
Civil Money Penalty
Page 1 of 4
POLICY:
As an alternate sanction, a civil money penalty may be assessed against Vendors in lieu of disqualification in order to emphasize the seriousness of WIC Program compliance and to allow the Vendor to continue to serve an otherwise uncovered participant group.
PROCEDURE:
A. Determination of Eligibility for a Civil Money Penalty
Under special circumstances, the State Agency may choose to waive disqualification of an abusive or non-compliant Vendor. The State Agency is not required to offer a civil money penalty to a Vendor in the process of disqualification for major offenses or while maintaining a disqualification on a Vendor who had accumulated a number of minor offenses.
1. A civil money penalty will only be offered to a Vendor in lieu of disqualification when inadequate participant access would otherwise occur (see Policy 8.03 Inadequate Participant Access).
2. Determination of eligibility of a Vendor for a civil money penalty will be made by the State Agency prior to the notification of disqualification so that the Vendor will be made aware of any alternative at the time of notification.
3. The State Agency must assure that a Vendor selected to pay a civil money penalty can be monitored successfully.
4. The potential for inadequate participant access must be examined each time a Vendor is disqualified through a review and documentation of the authorization status of all Vendors within a ten (10) mile distance of the disqualified Vendor as well as a review and documentation of any geographical barrier(s) which would restrict participant access.
B. When a Civil Money Penalty Will Not be Offered
1. Regardless of inadequate participant access, a civil money penalty will not be offered when the disqualification is based on:
a. A Vendor is convicted of trafficking in SNAP or WIC food benefits;
b. A Vendor is convicted of selling firearms, ammunition, explosives, or, controlled substances (as defined in Section 102 of the Controlled Substances Act (21 U.C.S. 802)) in exchange for food stamps or WIC drafts;
c. A Vendor has been disqualified or received a civil money penalty for two or more sanctions that are federally mandated (see Sanction Listing);
West Virginia WIC Policy & Procedure 8.04 Effective Date: 03/11/2013 8.04
Civil Money Penalty
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d. A Vendor has been assessed a civil money penalty from the SNAP Program in lieu of disqualification;
e. A Vendor’s refusal to be monitored or refusal to supply the WIC Program with supplier invoices;
f. A Vendor’s refusal to accept mandatory training;
C. Written Notice of Disqualification Action
1. The State Agency will send the Vendor a written notice of the disqualification action including:
a. The cause(s) for the disqualification;
b. The effective date of the action;
c. The Vendor’s right to appeal;
d. The procedures to be followed to file an appeal; and
e. Notification that the State Agency has decided to offer a civil money penalty in lieu of disqualification and that they will be contacted to schedule a conference to discuss the offer.
D. Vendor Conference to Discuss a Civil Money Penalty
1. The State Agency will contact the Vendor to schedule a conference to offer the alternative of the civil money penalty in lieu of the disqualification.
2. The conference will cover the following:
a. The amount of the civil money penalty;
b. The method of payment of the penalty available to the Vendor; and
c. Discussion of all compliance issues, not just those brought about by the disqualification.
3. The Vendor will be advised of the following during the conference:
a. That acceptance/payment of the civil money penalty settles all past compliance issues, but does not relieve the Vendor of its obligation to document the resolution of the identified problem(s) or protect the Vendor from future sanctions or disqualification for continued non-compliance;
b. That a civil money penalty does not relieve the Vendor of financial liability for previous compliance issues such as outstanding overcharge recoveries or
West Virginia WIC Policy & Procedure 8.04 Effective Date: 03/11/2013 8.04
Civil Money Penalty
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payments due for sale of unauthorized foods. Such outstanding liabilities must be paid in addition to the civil money penalty;
c. That the past violations settled by the civil money penalty may be considered, at the discretion of the State Agency, if additional violations of the same nature occur in the future;
d. That the Vendor has fifteen (15) days after the conference to accept the civil money penalty in lieu of disqualification; and
e. That this civil money penalty settlement does not prohibit further WIC investigations.
E. Calculating a Civil Money Penalty
1. The State Agency will calculate all civil money penalties using a standard formula, in accordance with the federal guidelines specified in § 3.91(b)(3)(v) of this title.
2. The civil money penalty shall not exceed the maximum amount specified in § 3.91(b)(3)(v) per violation, and the total penalties for violations investigated as part of a single investigation shall not exceed the maximum amount for such investigations, even if the formula indicates that a higher penalty is warranted.
3. The calculation formula is as follows:
a. The State Agency shall determine the average monthly redemptions for the most recent six (6) month period ending with the month immediately preceding the month during which the notice of administrative action is dated.
b. Multiply the average monthly redemptions by 10% (.10).
c. Multiply the product from Step 2 by the number of months for which the store would have been disqualified.
4. Example: A Vendor receives notification of a one (1) year disqualification in October 20__. The civil money penalty in lieu of disqualification would be calculated as follows:
• $4,884.17 (average monthly redemptions) x 10% = $488.42
• $488.42 x 12 months (disqualification period) = $5,861.04
Month Redemptions September $4,650 August $4,075 July $5,120 June $5,580 May $4,890 April $4,990 Total $29,305 Average $4,884.17
West Virginia WIC Policy & Procedure 8.04 Effective Date: 03/11/2013 8.04
Civil Money Penalty
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5. For violations warranting permanent disqualification, the penalty will be the maximum amount specified in § 3.91(b)(3)(v) of this title for each violation. If multiple violations are found during a single investigation, the State Agency will impose a civil money penalty (CMP) for each violation. However, the total amount of penalties for violations found in a single investigation shall not exceed the maximum penalty specified in § 3.91(b)(3)(v) for such investigations.
F. Payment of a Civil Money Penalty
1. The State Agency will determine the method of a civil money penalty payment by one of the following: a. A lump sum payment of the civil money penalty which must be received on or before the date that the disqualification was to be effective; or
b. By installment payments in which the following conditions must be met:
2. The first payment must be received by the State Agency on or before the date that the disqualification was to be effective; and
3. Subsequent installment payments which will be of equal amounts, the total number of which cannot exceed one half the number of months of the alternative disqualification, and must be received at the State Office by the fifteenth (15th) of the prior month to maintain eligibility for the coming month; and
A Vendor who does not make any installment payment by the due date will be notified by the State Agency that the civil money penalty balance is due within ten (10) days or the disqualification action will be enforced.
4. All payments (lump sum or installment) must be made by certified check or money order to:
West Virginia WIC Program
Room 519
350 Capitol Street
Charleston, WV 25301-3717
All payments must include the Vendor’s name and authorization number.
1. A Vendor who does not pay, only partially pays, or fails to timely pay a civil money payment including installment payments will be disqualified for the length of the disqualification period corresponding to the violation for which the civil money penalty was assessed.
West Virginia WIC Policy & Procedure 8.06 Effective Date: 03/11/2013 8.06 Fair Hearing Policy for Vendors_____________________ POLICY: The State Agency will provide a hearing procedure whereby a food Vendor adversely affected by a State Agency action may appeal the action. PROCEDURE: A. Notification of Right to Request a Fair Hearing 1. The right to request a fair hearing will be granted when a food Vendor's application to participate is denied or, during the course of the vendor agreement, when a Vendor is disqualified or other adverse action which affects participation is taken. 2. Expiration of a vendor agreement with a food Vendor and/or sanctions which do not pertain to disqualification will not be subject to appeal. 3. The Vendor must be informed in writing of their right to request a fair hearing and the method to request a fair hearing when they are found to be ineligible, or they are disqualified from participation in the WIC Program. B. Notification of WIC Program Policies and Federal Regulations 1. The Vendor may request a pre-hearing conference to discuss the topic(s) prior to the actual fair hearing. a. The pre-hearing conference is an informal meeting between the State Agency and the Vendor representative. b. The State Agency will explain the reason(s) for the action taken and the Vendor representative will be allowed to share any pertinent information which the Vendor believes that the State Agency should be informed about. c. The pre-hearing conference is an option offered to the Vendor to resolve misunderstandings or it may simply act to define or consolidate the issues to be addressed during the fair hearing. 2. If, as a result of the pre-hearing conference, the State Agency representative finds that the information upon which the State Agency based its action is incorrect, or if for any other reason the State Agency representative determines that the action taken is inappropriate, the State Agency may reverse or modify the action. 3. If the State Agency finds that the action was appropriate, the proposed action will remain in effect unless it is reversed at the fair hearing. 4. When the Vendor continues to want a fair hearing after the pre-hearing conference, the State Agency will distribute to the Vendor: a. Information on fair hearing procedures; Page 1 of 8
West Virginia WIC Policy & Procedure 8.06 Effective Date: 03/11/2013 8.06 Fair Hearing Policy for Vendors_____________________ b. A discussion of their rights and responsibilities; c. The role of the Hearing Officer; and d. Other pertinent information. C. Time Limit for Requesting a Fair Hearing 1. The Vendor must request a fair hearing within fifteen (15) days of the date the State Agency mails or otherwise delivers written notice of adverse action to the Vendor. 2. The Vendor must use the Appeals Request form (see Policy 8.06 Attachment #1) to request a fair hearing. No other form or method of requesting a fair hearing will be accepted in lieu of this form. D. Denial or Dismissal of Request 1. The State Agency will not deny or dismiss a Vendor’s right to request a fair hearing involving a sanction assessment, denial of participation, or, disqualification unless: a. The request is not received within the fifteen (15) day time limit; b. The request involves a previous action taken by the agency in which a fair hearing has already been held and a decision rendered; c. The request involves a previous action taken by the agency in which a request was made but not held as it was either abandoned or withdrawn by the Vendor or their representative; d. The request involves a disqualification from the WIC Program which is a result of Vendor being disqualified from SNAP; e. The request involves the State Agency’s determination on what constitutes inadequate participant access; f. The request is withdrawn in writing by the Vendor or their representative; or g. The Vendor or their representative fails, without good cause, to appear at the scheduled hearing. E. Continuation of Vendor Authorization The Vendor found to be ineligible for WIC Program participation at any time during the vendor agreement period will be notified in writing fifteen (15) days before termination of the vendor agreement of the reason(s) for termination of the agreement. 1. When the Vendor appeals the termination of their vendor agreement within the fifteen (15) days advance adverse notice period, they may continue to accept food drafts from the WIC Program participants until the Hearing Officer reaches a Page 2 of 8
West Virginia WIC Policy & Procedure 8.06 Effective Date: 03/11/2013 8.06 Fair Hearing Policy for Vendors_____________________ decision. a. The Vendor will immediately cease accepting food benefits and will be liable for all over charges and erroneous payments incurred both before and after the fifteen (15) days following the receipt of the notification of the adverse action if the hearing decision is against the Vendor. b. Once a hearing decision to uphold the State Agency’s action to terminate the vendor agreement has been made, the Vendor will be notified of the date that the disqualification will go into effect. c. The Vendor will no longer be authorized to accept food benefits once the hearing decision to uphold the State Agency’s action is rendered unless the vendor elects to proceed to the Judicial Review level. d. No payments will be made for food benefits accepted after the termination date unless the vendor has elected to proceed to the Judicial Review level. 2. The Vendor has the option not to redeem food benefits during the hearing process. a. The vendor must inform the State in writing if it chooses not to redeem benefits during the hearing process. b. If the vendor chooses not to redeem benefits during the hearing process, they will be considered disqualified. This means: i. They cannot redeem benefits until the hearing official renders a decision. ii. If the decision is in favor of the vendor, they may resume redeeming benefits. iii. If the decision is not in favor of the vendor, the disqualification remains in effect. F. Policy and Procedure The State Agency will process each request for a fair hearing according to policy and will make the fair hearing policies and procedures available for public inspection and copying. 1. A copy of Policy 8.06 Fair Hearing Policy for Vendors, and the Appeals Request Form (see Attachment #1) will be issued to the Vendor upon receipt of a request for a fair hearing. 2. The Appeals Request Form (see Attachment #1) will be completed by the Vendor representative and sent to the State Agency to request a fair hearing. 3. The State Agency will immediately notify the State Board of Review of receipt of a request for a fair hearing. G. State Agency Page 3 of 8
West Virginia WIC Policy & Procedure 8.06 Effective Date: 03/11/2013 8.06 Fair Hearing Policy for Vendors_____________________ The State Agency will send the personnel who make the decisions regarding the appellant to the fair hearing in order to explain why the appellant was denied participation, disqualified, or terminated from the WV WIC Program. State Agency personnel will: 1. Appear at the fair hearing to testify regarding the sanction action, denial, disqualification, or termination. 2. State exactly how they came about making the decision regarding the appellant. 3. Explain each step within the decision-making process as it pertains to the appellant. 4. Inform the Hearing Officer of the policy and procedure upon which they relied to make the decision regarding the appellant. H. Hearing Officer Fair hearings will be conducted by an officer of the WV Department Of Health And Human Resources, Office Of Inspector General, State Board of Review who does not have any personal stake or involvement in the decision and who was not directly involved in the initial determination of the action being contested. The Hearing Officer is responsible for the following: 1. To notify the appellant and the State Agency Director of the hearing location, date and time with a minimum of ten (10) days advance written notice. a. The fair hearing will be held in Charleston, West Virginia, unless otherwise agreed to by the State Agency and the Hearing Officer. b. The initial hearing will be scheduled within thirty (30) days from the date the State Agency received the request for a fair hearing. c. The Vendor may reschedule a hearing date a maximum of one (1) time. A third hearing date will be granted only if the State Agency determines that the Vendor has shown good cause for failure to attend the first two (2) hearings. 2. To maintain an updated copy of the West Virginia WIC Policy and Procedure Manual. A copy of the fair hearing policy will be included with the written notice to the appellant. 3. To administer oaths of affirmation. 4. To ensure all relevant issues are considered. 5. To request, receive and make part of the hearing record all evidence determined necessary to decide the issues being raised. Page 4 of 8
West Virginia WIC Policy & Procedure 8.06 Effective Date: 03/11/2013 8.06 Fair Hearing Policy for Vendors_____________________ 6. To regulate the conduct of the fair hearing to be consistent and orderly. I. Conduct of the Hearing 1. The Vendor or their representative will have an opportunity to: a. Examine the evidence to support the decision under appeal prior to and during the hearing; b. Be assisted or represented by an attorney (at the Vendor's own expense) or other person; c. Bring witnesses; d. Advance arguments without undue interferences; e. Question or refute any testimony or evidence, including an opportunity to confront and cross examine adverse witnesses; and f. Submit evidence to establish all pertinent facts and circumstances in the case. J. Hearing Decisions 1. Decisions of the Hearing Officer will comply with Federal Law, 7 CFR §246.18, State WIC Policy, WV WIC Vendor Handbook, and will be factually based on the hearing record. 2. The decision will be binding on the State Agency and will summarize the facts of the case, specify the reasons for the decision, identify supporting evidence and relevant regulations or policy. The decision will become a part of the record. 3. The decision of the Hearing Officer will not be based upon the appropriateness of a State Agency policy, but instead will be made on the fair, correct and equitable application of established policies and procedures. 4. Within ninety (90) days of receiving the hearing request by the Vendor, the Vendor or the Vendor's representative and the State Agency Director will be notified in writing of the decision. The Vendor may continue to operate as an authorized West Virginia WIC Vendor when the decision is in their favor. In accordance with 7 CFR §246.18(b)(9) this ninety (90) day timeframe is only an administrative requirement for the State Agency and does not provide a basis for overturning the State Agency’s adverse action if a decision is not made within the specified timeframe. 5. All State Agency hearing records will be available to the appellant or representative at any reasonable time period. Page 5 of 8
West Virginia WIC Policy & Procedure 8.06 Effective Date: 03/11/2013 8.06 Fair Hearing Policy for Vendors_____________________ a. All records will be kept on file until all issues are resolved, or until the end of a three (3) year and one-hundred fifty (150) day period, whichever is later. 6. The fair hearing records can include but are not limited to: the verbatim transcript or recording of testimony; an official report containing the substance of what transpired at the hearing; and all papers and requests filed in the proceeding. 7. If the decision results in disqualification of the Vendor, the State Agency will also terminate the Vendor Agreement. K. Appeal of Unfavorable Fair Hearing Decision 1. The fair hearing will be conducted in conformance with USDA Regulations. 2. If the decision of the Hearing Office is unfavorable to the Vendor, the decision will include explanation of appellant’s right to pursue Judicial Review. L. Adverse Actions Subject to Administrative Appeal 1. Denial of authorization based on the application of the vendor selection criteria for minimum variety and quantity of authorized supplemental foods (246.12(g)(3)(i)), or on a determination that the vendor is attempting to circumvent a sanction (246.12(g)(6)); 2. Termination of an agreement for cause; 3. Disqualification; and 4. Imposition of a fine or a civil money penalty in lieu of disqualification. 5. Denial of authorization based on the vendor selection criteria for business integrity or for a current SNAP disqualification or civil money penalty for hardship (246.12(g)(3)(ii) and (g)(3)(iii): 6. Denial of authorization based on the application of the vendor selection criteria for competitive price (246.12(g)(4); 7. The application of the State Agency’s vendor peer group criteria and the criteria used to identify vendors that are above-50-percent vendors or comparable to above-50-percent vendors; 8. Denial of authorization based on a State agency-established vendor selection criterion if the basis of the denial is a WIC vendor sanction or a SNAP withdrawal of authorization or disqualification; 9. Denial of authorization based on the State Agency’s vendor limiting criteria (246.12(g)(2)); Page 6 of 8
West Virginia WIC Policy & Procedure 8.06 Effective Date: 03/11/2013 8.06 Fair Hearing Policy for Vendors_____________________ 10. Denial of authorization because a vendor submitted it’s application outside the timeframes during which applications are being accepted and processed as established by the State agency under 246.12 (g)(8); 11. Termination of an agreement because of a change in ownership or location or cessation of operations (246.12(h)(3)(xvii)); 12. Disqualification based on a trafficking conviction (246.12(l)(l)(i); 13. Disqualification based on the imposition of a SNAP civil money penalty for hardship (246.12(l)(2)(ii); and 14. Disqualification or a civil money penalty imposed in lieu of disqualification based on a mandatory sanction imposed by another WIC State Agency (246.12(1)(2)(iii). 15. A civil money penalty imposed in lieu of disqualification based on a SNAP disqualification under 246.12(l)(l)(vii) and, 16. Denial of an application based on a determination of whether an applicant vendor is currently authorized by SNAP. M. Adverse Actions Not Subject to Administrative Appeal 1. The validity or appropriateness of the State Agency’s vendor limiting criteria (246.12(g)(2) or vendor selection criteria for minimum variety and quantity of supplemental foods, business integrity, and current Supplemental Nutrition Assistance Program disqualification or civil money penalty for hardship (246.12 (g)(3); 2. The validity or appropriateness of the State Agency’s selection criteria for competitive price (246.12(g)(4), including, but not limited to, vendor peer group criteria and the criteria used to identify vendors that are above-50-percent vendors or comparable to above-50-percent vendors; 3. The validity or appropriateness of the State Agency’s participant access criteria and the State Agency’s participant access determinations; 4. The State Agency’s determination to include or exclude an infant formula manufacturer, wholesaler, distributor, or retailer from the list required pursuant to 246.12(g)(11); 5. The validity or appropriateness of the State Agency’s prohibition of incentive items and the State Agency’s denial of an above-50-percent vendor’s request to provide an incentive item to customers pursuant to 246.12(h)(8); 6. The State Agency’s determination whether to notify a vendor in writing when an Page 7 of 8
West Virginia WIC Policy & Procedure 8.06 Effective Date: 03/11/2013 8.06 Fair Hearing Policy for Vendors_____________________ investigation reveals an initial violation for which a pattern of violations must be established in order to impose a sanction, pursuant to 246.12(l)(3); 7. The State Agency’s determination whether a vendor had an effective policy and program in effect to prevent trafficking and that the ownership of the vendor was not aware of, did not approve of, and was not involved in the conduct of the violation (246.12(l)(l)(i)(B); 8. Denial of authorization if the State Agency’s vendor authorization is subject to the procurement procedures applicable to the State Agency; 9. The expiration of a vendor’s agreement; 10. Disputes regarding food instrument or cash-value voucher payments and vendor claims (other than the opportunity to justify or correct a vendor overcharge or other error, as permitted by 246.12(k)(3); and 11. Disqualification of a vendor as a result of disqualification from SNAP (246.12(l)(l)(vii). REFERENCES: 1. WIC Regulation: 7 CFR 246.18 Administrative Review of State Agency Actions ATTACHMENTS: 1. Appeals Request Page 8 of 8
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WV WIC FARMER AUTHORIZATION APPLICATION Each farmer applying for WIC authorization must fill out an Authorization Application. All information MUST be complete in order to properly assess the eligibility of each farmer. Incomplete applications will not be considered for authorization. All farmers applying for authorization must understand the rules and regulations of the WIC Program since compliance with these procedures is the responsibility of each authorized farmer. The State WIC Office will immediately terminate the agreement if it is determined that false information has been provided in connection with an application for authorization. Completion of the application does not constitute approval to accept WV WIC Farmer’s Market Nutrition Program or Cash Value benefits. If you have questions, please contact the Vendor Management Unit: Phone: 304-558-1115 Email: dhhrwicvu@wic.gov Please send completed application to: WV WIC Program Vendor Management Unit 350 Capitol St Rm 515 Charleston, WV 25301
***To receive WIC authorization, the applicant must have cellular service or WiFi at their market and be willing to use a personal cell phone/mobile device in order to process electronic transactions.
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West Virginia Farmer Application 2024
Applying as: Farmer Farmers Market Farm Stand Local Farmer Cooperative Farmer’s Name: _______________________________________________________ Farm Name:___________________________________________________________ Mailing Address:
City/State/Zip:
Telephone:
Email Address:
Locations of Markets or Selling Locations: Please list the EXACT locations where you will be operating to accept FMNP and CVB benefits?
LOCATION
DAY(S)
TIMES (include county) (Example M – F) (Example 7 am – 6 pm)
1.___________________________________________________________________
2.___________________________________________________________________
3.___________________________________________________________________
4.___________________________________________________________________
Market Master(s) (if applicable):____________________________________________ _____________________________________________________________________ _____________________________________________________________________
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What year did you last receive FMNP training?
I In Person Online If training was conducted in 2024, please complete the following: Training conducted by: ________________ Date:____________________________
Do you, the farmer, grow at least some of the fresh produce offered for sale? Yes No
Do you have cellular service and/or Wi-Fi at your market location? Yes No
FARMER AGREEMENT This agreement, hereinafter “Agreement” or “Farmer Agreement” is entered into between the West Virginia WIC Program and, by and through its owner/officer, hereinafter “Farmer”. The purpose of this Agreement is to provide authorized foods to eligible persons through the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), the WIC Farmers’ Market Nutrition Program (FMNP) and other nutrition programs as requested. The period of this Agreement is from the last date signed below until April 1, 2026. A. Farmer Responsibilities: 1. Display a sign stating that the Farmer is authorized to redeem WIC cash value fruit and vegetable benefits and WVFMNP benefits. 2. Accept checks and electronic food benefits of the respective programs for which the farmer is authorized. Benefits will only be accepted from eligible participants, parents/caretakers of infant and child participants, or proxies. 3. Provide eligible fruits and vegetables at the same quality and current price or less than current price charged to other customers. 4. Assure that benefit check and electronic benefit transactions are only for eligible foods. 5. Keep all information of authorized WIC/FMNP shoppers confidential. 6. Accept training on check and electronic benefits procedures and provide training to all employees on such procedures. 7. Provide such information as the participating Nutrition Services Programs may require for periodic reports to USDA Food and Nutrition Service.
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8. Agree to be monitored for compliance with the West Virginia WIC program requirements, including both overt and covert monitoring. 9. Be accountable for actions of Farmer’s employees in the provision of authorized foods and related activities. 10. Reimburse the West Virginia WIC Program for any checks/electronic benefits transacted in violation of this Agreement. 11. Offer eligible participants, parents, caretakers of child participants, and proxies the same courtesies as other customers. Ensure participants are not required to use special checkout areas that are not used by other customers. 12. Comply with the non-discrimination provisions of USDA regulations as provided in 7 CFR §248.7,§248.10(a)(6), §247.7, §249.10(a)(9). 13. Notify the West Virginia WIC Program if any Farmers’ Market or Farm Stand ceases operation prior to the end of the authorization period and of any address changes or corrections. 14. Agree to actually grow at least one type of fruit or vegetable offered for sale. The Farmer cannot participate if all fruits and vegetables that are sold were purchased from a third party. 15. Agree that all fruits and vegetables sold shall be grown in West Virginia or within 50 miles of the West Virginia border. 16. Agree to not collect sales tax on eligible purchases. 17. Ensure that participants, parents, caretakers or infant and child participants or proxies are not required to purchase the full amount on a check or an electronic benefit. 18. Agree to not seek restitution from eligible participants, parents, caretakers of child participants, or proxies for checks/electronic benefits not paid or partially paid by the West Virginia WIC Program. 19. Agree to not issue cash change, rain check, or IOU for purchases that are in an amount less than the value of the electronic benefit and/or check. However, the eligible participants, parent, caretaker of child participant, or proxy may pay cash or other form of payment for any amount that goes over the allotted amount of the electronic benefit or amount printed on the check. 20. Agree to not offer or accept trafficking of check/electronic benefits. 21. Report participant fraud or violations to the West Virginia WIC Program. 22. Ensure the participant, parent or caretaker of an infant or child participant, or proxy signs the check in the presence of the cashier. There is no signature necessary for an electronic benefit. 23. Comply with the program operating rules, standards and technical requirements established by the West Virginia WIC Program. B. West Virginia WIC Program Responsibilities: 1. Distribute checks/electronic benefits to each eligible participant, redeemable in appropriate increments during contracted years. 2. Monitor authorized Farmers’ Markets for compliance with applicable laws, regulations, policies, and procedures. 3. Provide training for Farmers’ Market personnel on regulations, policies, and procedures of nutrition programs.
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4. Notify Farmer of any changes to Federal or state statutes, regulations, policies, or procedures governing these programs before the changes are implemented. C. General Terms 1. Neither the West Virginia WIC Program nor the Farmer has an obligation to renew the Agreement. Either the West Virginia WIC Program or the Farmer may terminate the Agreement for cause after providing a fifteen (15) day advance written notice to the non- terminating party. 2. The West Virginia WIC Program may deny payment to the Farmer for improperly redeemed checks and may require refunds for payments already made on improperly redeemed checks or electronic transactions. 3. The West Virginia WIC Program may disqualify a Farmer for program abuse. A Farmer that commits fraud or engages in other illegal activity is liable to prosecution under applicable Federal, State and/or local laws. 4. The Farmer has the right to appeal a denial of an application to participate, a disqualification, or a program sanction by the West Virginia WIC Program. 5. The West Virginia WIC Program ensures that a farmer that is disqualified from the FMNP at one market or roadside stand shall not participate in the FMNP at any other farmers' market or roadside stand in the State agency's jurisdiction during the disqualification period. 6. Expiration of an agreement with a Farmer and claims actions under 7 CFR 246.18(a)(1)(iii)(I) and 7 CFR 246.18(a)(1)(iii)(J) are not subject to appeal (other than the opportunity to justify or correct a farmer overcharge or other error as permitted by 7 CFR §246.12(k)(3). 7. Farmer assures that no conflict of interest with the West Virginia WIC Program exists as a result of the execution of this Agreement. The West Virginia WIC Program shall immediately terminate without notice the Agreement if a conflict of interest, as defined by applicable State laws, regulations, and policies, between the Farmer and the West Virginia WIC Program or its local agencies are identified.
8. Both parties hereby stipulate and agree that either party may discuss non-confidential aspects of the party’s experience with the other party, however neither party shall in any shape, form or fashion whatsoever, make any disparaging remarks of any sort or otherwise communicate any disparaging information about the other party or its employees, officers nor agents in their professional capacities herein to any third party, including but not limited to statements on social or any other media. Further, both parties agree to take no action of any nature which is intended, or would reasonably be expected, to harm the other party or its reputation or which would reflect negatively or reasonably lead to unfavorable publicity to the other.
9. The West Virginia WIC Program shall not pay or reimburse the Farmer for banking fees related to Nutrition Services check transactions or electronic transactions.
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10. This Agreement does not constitute authorization to accept eWIC for other types of foods other than eligible fruits and vegetables.
11. Farmers who do not comply with program requirements are subject to claims and/or sanctions, which includes disqualification from the program.
12. Farmer acknowledges that, in addition to any sanction and/or consequence under this Agreement, a Farmer who commits fraud or abuse in the West Virginia WIC Program is liable to prosecution under applicable Federal or State laws. Those who have willfully misapplied, stolen or fraudulently obtained program funds will be subject to a fine of not more than $25,000 or imprisonment for not more than five years or both, if the value of the funds is $100 or more. If the value of the funds is less than $100, the penalties are fines of not more than $1,000 or imprisonment for not more than one year or both. Assurance of Civil Rights Compliance The Farmer hereby agrees that it will comply with Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.), Title IX of the Education Amendments of 1972 (20 U.S.C. 1681 et seq.), Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794), Age Discrimination Act of 1975 (42 U.S.C. 6101 et seq.); Title II and Title III of the Americans with Disabilities Act (ADA) of 1990 as amended by the ADA Amendment Act of 2008 (42 U.S.C. 12131-12189) as implemented by Department of Justice regulations at (28 CFR Parts 35 and 36); Executive Order 13166, "Improving Access to Services for Persons with Limited English Proficiency." (August 11, 2000), all provisions required by the implementing regulations of the U.S. Department of Agriculture (7 CFR Part 15 et seq); and West Virginia Department of Health directives and guidelines to the effect that no person shall, on the ground of race, color, national origin, age, sex (including gender identity and sexual orientation), or disability, or reprisal or retaliation for prior civil rights activity be excluded from participation in, be denied the benefits of, or otherwise, be subjected to discrimination under any program or activity for which the farmer receives Federal financial assistance from West Virginia Department of Health; and hereby gives assurance that it will immediately take measures necessary to effectuate this agreement. By providing this assurance, the farmer agrees to compile data, maintain records and submit records and reports as required to permit effective enforcement of the nondiscrimination laws, and to permit West Virginia Department of Health personnel during normal working hours to review and copy such records, books and accounts, access such facilities, and interview such personnel as needed to ascertain compliance with the non-discrimination laws. If there are any violations of this assurance, the West Virginia Department of Health shall have the right to seek judicial enforcement of this assurance. This assurance is given in consideration of and for the purpose of obtaining any and all Federal financial assistance, grants, and loans of Federal funds, reimbursable expenditures, grant, or donation of Federal property and interest in property, the detail of Federal personnel, the sale and lease of, and the permission to use Federal property or interest in such property or the furnishing of services without consideration or at a nominal consideration, or at a consideration that is reduced for the purpose of assisting the recipient, or in recognition of the public interest to be served by such sale, lease, or furnishing of services to the recipient, or any improvements made with Federal financial assistance extended to the farmer applicant by West Virginia Department of Health. This includes any Federal agreement, arrangement, or other contract that has as one of its purposes the
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provision of cash assistance for the purchase of food, and cash assistance for purchase or rental of food service equipment or any other financial assistance extended in reliance on the representations and agreements made in this assurance. This assurance is binding on the farmer, its successors, transferees, and assignees as long as it receives assistance or retains possession of any assistance from the West Virginia Department of Health. The person or persons whose signatures appear below are authorized to sign this assurance on the behalf of the farmer.
Farmer must reapply at the expiration of this Agreement. The West Virginia WIC Program will provide the Farmer not less than 15 days’ advance written notice of the expiration of this Agreement. Neither party to this Agreement is obligated to renew the Agreement; thus, non-renewal of this Agreement by either party may be without cause. In the event of non-renewal due to expiration of the Farmer Agreement, the Farmer shall not be entitled to a hearing or an appeal to contest the non- renewal.
Notice may be mailed to: Or emailed to:
___________________________________ ____________________________________ Heidi Staats Farmer/Owner/Market Master Signature Director, Office of Nutrition Services
___________________________________ _____________________________________ Date Date West Virginia Office of Nutrition Services Heather King, FMNP Coordinator Attn: WIC FMNP heather.n.king@wv.gov 350 Capitol St Rm 515 Charleston, WV 25301 Or fax to: 304-558-1541 Attn: Heather King
III. MANAGEMENT INFORMATION SYSTEM (MIS) State Agency: West Virginia for FY: 25. This section, Management Information System (MIS) involves the planning, documentation, security/ confidentiality, and production of the necessary reports relating to program operations through the utilization of automated data processing services at the State and local level. During disasters, emergencies, public health emergencies, or a supply chain disruption, the State agency may request to implement existing and allowable regulatory flexibilities or waivers to support the continuation of Program benefits and services. Waivers granted under Access to Baby Formula Act of 2022 (codified at 7 CFR 246.4a(30)) or temporary provision(s) authorized by Congress are not permanent amendments to the State Plan and should not be reflected in answers below. Instead, waiver flexibilities impacting Program benefits and services should be recorded in Appendix C. However, State agencies should consider any historical amendments as the result of waivers granted under prior waiver authority to develop policies and procedures for current and future disasters. A. System Planning and Operation – 246.4(a)(11)(iv): Describe the procedures for planning, approving and monitoring Automated Data Processing (ADP) goods and services, and any interaction with other statewide ADP operations which may take place, including system costs for services and security. B. Participant Characteristics Minimum Data Set (MDS) – 246.4(a)(11)(i): All State agencies currently collect all required Minimum Data Set items. Please confirm that your State agency will continue to do so. For the Supplemental Data Set (SDS), which varies by the capacity of State systems, please describe the data items which are reported electronically regarding participant characteristics and whether these items are currently being collected or if there are plans to collect them in the future. C. WIC Systems Functional Requirements Checklist – 246.4(a)(8); (9); (11); (12); (13); (14); (15); and (18): Describe those functions which are currently incorporated into the MIS or which are planned to be incorporated in the future.
A. System Planning and Operation (Online and Offline) 1. Management Information System Planning a. The WIC State agency is included in the following comprehensive Statewide ADP plan(s): ☐Title IVa (TANF) ☐Title V (MCH) ☐Title XIX (Medicaid) ☐Supplemental Nutrition Assistance Program (SNAP) ☒Other (specify): http://www.technology.wv.gov ☐None If no, please provide a copy of the WIC State agency's ADP utilization plan. b. The State agency has written procedures for monitoring and approving local agency requests for ADP goods and services. If yes, please provide a copy of written procedures. ☒Yes ☐No ADDITIONAL DETAIL: Management Information System Appendix and/or Procedure Manual (cite): Appendix III - A Policy and Procedure 6.11 – Expenditure – Purchasing Regulations. 2. System Documentation a. The State system is fully documented in accordance with (check all that apply): ☒USDA/FNS Advance Planning Document Handbook No.901 ☐USDA/FNS ADP Security Guide ☐Other (specify): N/A. b. The State agency maintains overall system documentation (check all that apply): ☒A general design ☒User's manual ☒Method for updating documentation for system changes/modifications ☒A detailed design ☐Maintenance manual Note: These documents are NOT required for FNS review or submission with the State plans but should be available if requested. ADDITIONAL DETAIL: Management Information System Appendix and/or Procedure Manual (cite): State Agency (SA) maintains Crossroads documentation on site and will be made available to FNS upon request. 2
3. Automated Data Processing Services a. Indicate below whether the following ADP functions, if applicable, are performed by State agency staff or are contracted to an outside firm. Function Performed Performed Contracted to Outside Firm SA Staff LA Staff (specify company name): Data entry ☒ ☐ N/A. Food instrument production ☒ ☐ N/A. EBT Data Reports ☒ ☐ N/A. Feasibility study ☒ ☐ N/A. ADP development ☒ ☐ N/A. ADP system hardware operation ☒ ☐ N/A. Custom software development ☐ ☐ Voyatek Custom software maintenance ☐ ☐ Voyatek Printing forms/FIs ☐ ☐ FIS - EBT cards Backup computer facility ☐ ☐ WV OT/OSA MIS Other (specify): ☐ ☐ N/A. N/A. ☐ ☐ N/A. N/A. ☐ ☐ N/A. N/A. ☐ ☐ N/A. b. The State agency has a contract in effect (check all that apply). Please provide a copy of agreement. Appendix III - B VDH-21-707-0156_Contract_FINAL_ratified Statewide Computer Contract: http://www.state.wv.us/admin/purchase/swc/IP.htm ☒Equipment ☒Services ☐Software c. The State agency has methods in place for ensuring that the costs of equipment or services used by WIC and other programs are equitably prorated among funding sources. Appendix III - C Policy and Procedure 6.11 – Expenditure – Purchasing Regulations Attachment #3 ☒Yes ☐No d. The State agency periodically reviews system costs billing. ☒Yes ☐No e. The State agency acquires banking services through: ☐Competitive bids among banks within the State ☒Competitive bids among in State and out-of-State banks ☐Use of State agency designated bank ☐Other: N/A. 3
f. The State agency acquires EBT services through: ☒Competitive bids among EBT processors ☐State hosted EBT services ☐Other: N/A. ADDITIONAL DETAIL: Management Information System Appendix and/or Procedure Manual (cite): Equipment purchased by WIC funds are used for WIC only purposes West Virginia Purchasing Division http://www.state.wv.us/admin/purchase/swc/default.html and Statewide Contract http://www.state.wv.us/admin/purchase/swc/IP.htm 4. System Security/Data Confidentiality a. To ensure that data files and computer programs are protected, the State agency ensures that (check all that apply): ☒There is a separate organizational area/individual to control access to electronic storage media. ☒Access to WIC Program data files is controlled through password access or similar control. ☒Operational personnel are limited to only those jobs for which they are responsible. ☒Passwords are protected. ☒Passwords are changed periodically. ☒The system access procedures are audited at least once a year. Please provide a copy of access procedures. ☒Procedures are implemented for timely removing passwords, ID's etc. when personnel leave. ☒Biennial security reviews are performed by MIS. Twice a year MIS staff perform a network audit. They pull a list of users within the ONS group reviewing the last login date. MIS contacts the director of any staff member that has not logged in recently to verify if they are still employed. If an employee is no longer employed, a deprovision form is completed to remove network access and access to Crossroads is disabled. ☒Periodic risk assessments are performed by MIS. ☒Data uploaded to mobile applications, participant portals, etc. are secure and participant information is protected. ☐Other (specify): N/A. b. To ensure that disaster contingency plans (e.g., file storage, backup hardware, and software procedures) are sufficient to allow the management information and electronic benefit transfer systems to recover and continue processing after fire, flood or similar disaster, the State agency ensures that (check all that apply): ☒Backup copies of files and program are stored off-site in a secure location. Please provide address of location. 1740 Union Carbide Drive South Charleston, WV 25303 4
☒Backup copies are kept up to date. ☐There is an agreement with another processing unit with compatible hardware to provide services in an emergency. Please provide copy of agreement. ☒A contingency plan is in place in the event of service interruption. Appendix III D - West Virginia Contingency Plan ☐A recent test of the WIC system or mock disaster recovery operation has been conducted at the backup facility. Please provide a written summary of the conducted test. ☐Other (specify): N/A. ADDITIONAL DETAIL: Management Information System Appendix and/or Procedure Manual (cite): Appendix III E -Policy and Procedure 1.26 – Security Policy (specifically B.1 and G.4); Appendix III F– Authorized User Report for WIC Staff; Appendix II G – Local Agency Security Survey; Appendix III H – Site Security and Site Description Summary 5. Description of MIS changes that occurred in the past year: The Crossroads System is in the Maintenance and Enhancement (M&E) phase. System changes have included bug fixes and change requests. 6. Description of MIS changes planned for the upcoming year: The Crossroads System is in the Maintenance and Enhancement (M&E) phase. System changes will include bug fixes and change requests. B. Participant Characteristics Minimum Data Set The Participant Characteristics (PC) Minimum Data Set (MDS) contains data items which are reported to FNS electronically by State agencies in April in even numbered years on all or a State-representative sample of participants. The MDS has required data items which must be collected and reported. The Supplemental Data Set (SDS) is comprised of data items which State agencies have agreed are desirable to collect and report at the national level. Please check MDS or SDS data items the State agency currently collects in its Information Systems and those MDS or SDS data items it is planning to collect within the next two years. State Agency IS Collects: ☒State Agency ID. A unique number that permits linkage to the WIC State agency where the participant was certified. ☒Local Agency ID. A unique number that permits linkage to the local agency where the participant was certified as eligible for WIC benefits. or ☒Service Site ID. A unique number that permits linkage to the service site where certified. Either 5
local agency ID or service site ID may be reported according to the level the State Agency feels appropriate. At a minimum, State agencies must provide agency names and addresses for each ID provided on their files. ☒Case ID. A unique record number for each participant which maintains individual privacy at the national level. (This may not be the case number used in the State agency's MIS for the individual.) Participant or Case IDs for each participant should continue to maintain individual privacy at the national level. ☒Client Date of Birth. Month, day and year of participant's birth reported in MMDDYYYY format. ☒Client Race/Ethnicity. The classification of the participant into one of the five (5) racial/ethnic categories: For race: American Indian or Alaskan Native; Asian; Black or African American; Native Hawaiian or Other Pacific Islander; and White. For ethnicity: Hispanic or Latino; Not Hispanic or Latino. ☒Certification Category. The category---one of five (5) possible categories---under which a person is certified as eligible for WIC benefits: pregnant woman; breastfeeding woman; postpartum woman (not breastfeeding); infant (under 12 months); or child (12-59 months). ☒Expected Date of Delivery or Weeks Gestation. For pregnant women, the projected date of delivery (MMDDYYYY format) or the number of weeks since the last menstrual period as determined at WIC Program certification. ☒Date of Certification. The date the person was declared eligible for the most current WIC Program certification. Month, day, and year should be reported in MMDDYYYY format. ☒Sex. For infants and children, male or female. ☒Priority Level. Participant priority level for WIC Program certification. ☒Participation in TANF, SNAP, Medicaid. The participant's reported participation in each of these programs at the time of the most recent WIC Program certification. ☒Migrant Status. Participant migrant status according to the federal WIC Program definition of a migrant farm worker (currently counted in the FNS 798 report). ☒Number in Family/Household or Economic Unit. The number of persons in the family/household or economic unit upon which WIC income eligibility was based. A self-declared number in the family/household or economic unit may be reported for participants whose income was not required to be determined as part of the WIC certification process. These participants include adjunctively income-eligible participants (due to TANF, SNAP, or Medicaid participation) and those participants deemed income eligible under optional procedures available to the State Agency in Federal WIC Regulations, Section 246.7(d)(2)(vi-viii) (means-tested programs identified by the State for automatic WIC Program income eligibility, income eligibility of Indian and 6
in-stream migrant farmworker applicants). ☒Family/Household or Economic Unit Income. For persons for whom income is determined during the certification process, the income amount that was determined to qualify them for the WIC Program during the most recent certification. For descriptive purposes only, for participants whose income was not required to be determined as part of the WIC Program certification process, the self-reported income at the time of certification. These participants include adjunctively income-eligible participants and those persons deemed eligible under optional procedures available to the State Agency in Federal WIC Regulations, Section 246.7(d)(2)(vi-viii). Zero should not be used to indicate income values that are missing or not available. Zero should indicate only an actual value of zero. ☒Nutrition Risk(s) Present at Certification. Up to 10 highest priority nutritional risks present at the WIC Program certification ☒Hemoglobin or Hematocrit. That value for the measure of iron status that applies to the WIC Program certification. It is assumed that the measure was collected at the time of certification or within ninety (90) days of the certification date. ☒Date of Blood Measurement. The date of the blood measurement that was used during the most recent WIC Program certification in MMDDYYYY format. ☒Weight. The participant's weight measured according to the CDC nutrition surveillance program standards [nearest one-quarter (1/4) pound]. If weight is not collected in pounds and quarter pounds, weight may be reported in grams. ☒Height. The participant's height (or length) measured according to the CDC nutrition surveillance program standards [nearest one-eighth (1/8) inch]. If height is not collected in inches and 1/8 inches, height may be reported in centimeters. ☒Date of Height and Weight Measure. The date of the height and weight measures that were used during the most recent WIC Program certification in MMDDYYYY format. ☒Currently Breastfed. Information is needed for all infant participants ages six through thirteen months, whether or not the infant is currently receiving breastmilk. ☒Ever Breastfed. Information is needed for all infant participants ages six through thirteen months, whether or not the infant was ever breastfed. ☒Length of Time Breastfed. For infants ages six through thirteen months, the number of weeks the infant received breastmilk. ☒Date Breastfeeding Data Collected. For infants ages six through thirteen months, the date on which breastfeeding status was reported in MMDDYYYY format. 7
☒Food Packages. The food package code(s) for the WIC food package or for all food instruments prescribed for the participant during the month. OPTIONAL: Supplemental Data Set State State Agency IS Agency IS Collects Plans to Collect ☒ ☐ Date of First WIC Certification. Date the participant was first certified for the WIC Program in MMDDYYYY format. For pregnant, breastfeeding and postpartum women, this applies to the current/most recent pregnancy and not to prior pregnancies. ☒ ☐ Educational Level. For pregnant, breastfeeding and postpartum women, the highest grade or year of school completed. For infants and children, the highest grade or year of school completed by mother or primary caretaker. ☒ ☐ Number in Family/Household on WIC. The number of people in the participant's family/household receiving WIC benefits. ☒ ☐ Date Previous Pregnancy Ended. For pregnant women, the date previous pregnancy ended in MMDDYYYY format. ☒ ☐ Total Number of Pregnancies. For pregnant women, the total number of times the woman has been pregnant, including this pregnancy, all live births and any pregnancies resulting in miscarriage, abortion or stillbirth. ☒ ☐ Total Number of Live Births. For pregnant women, the total number of babies born alive to this woman, including those who may have died shortly after birth. ☒ ☐ Pre-pregnancy Weight. For pregnant women only, the participant's weight immediately prior to pregnancy. Pre-pregnancy weight may be reported either in pounds and ounces or in grams. ☒ ☐ Participant's Weight Gain During Pregnancy. For breastfeeding and postpartum women, the participant's weight gain during pregnancy as taken immediately at or prior to delivery. Weight gain during pregnancy may be reported in either pounds and ounces or in grams. 8
☒ ☐ Birth Weight. For infants and children, the participant's weight at birth measured according to the CDC nutrition surveillance program standards (lbs/oz). Birth weight may be reported in either pounds or ounces, or in grams. ☒ ☐ Birth Length. For infants and children, the participant's length measured according to the CDC nutrition surveillance program standards (1/8 inches). Birth length may be reported in either inches and eighth inches or in centimeters. ☐ ☐ Participation in the Food Distribution Program on Indian Reservations. The participant's reported participation in this program. C. WIC Systems Functional Requirements Checklist The following checklists were taken from the WIC Functional Requirements Document (FRED) which is provided as guidance to State agencies on functions they should consider incorporating into their Information Systems. Please check those functions/capabilities which the State agency system currently performs or plans to perform within the next two years. State State Agency Agency System System Performs Planned Automated Core Function/Capabilities ☒ ☐ 1. Calculates the date certification is due to expire. ☒ ☐ 2. Assigns the participant a nutritional risk code and assigns a priority level (CPA confirms the code is correct.) ☐ ☐ 2a. Assigns one risk code. ☐ ☐ 2b. Assigns up to 3 risk codes. ☐ ☐ 2c. Assigns up to 6 risk codes. ☒ ☐ 2d. Assigns more than 6 risk codes. ☒ ☐ 3. Calculates the applicant's household income and flags individuals whose income exceeds program standards. ☒ ☐ 3a. Converts incremental income (weekly, monthly) to an annual figure. ☒ ☐ 4. Associates family members. ☒ ☐ 5. Statewide data is maintained to facilitate families transferring within the State. 9
☒ ☐ 6. Transfers certification data to the central computer facility electronically either in real time or batch mode. ☒ ☐ 7. Captures or documents the nutrition education provided each participant as well as the topics covered. ☒ ☐ 8. Uses table-driven food packages. ☒ ☐ 8a. Uses standard predefined food packages. ☒ ☐ 8b. Enables easy food package tailoring. ☒ ☐ 8c. Performs edits to prevent over-issuance during food package creation. ☒ ☐ 9. Enables food instruments to be issued when the participant is present for pick-up, i.e., on-demand. ☒ ☐ 10. Captures or documents the name of the programs to which the participants was referred. ☒ ☐ 11. Performs food instrument reconciliation. ☒ ☐ 12. Produces standard Dual Participation Report. ☒ ☐ 13. Produces standard Food Delivery Portal (FDP) Report. ☒ ☐ 14. Produces standard Rebate Billing Report. ☒ ☐ 15. Produces standard Participation Report. ☒ ☐ 16. Produces Participant Characteristics Datasets. ☒ ☐ 17. Captures basic transaction data by vendor. State Agency System Performs State Agency System Planned Automated Core Function/Capabilities ☒ ☐ 18. Flags high-risk vendors through peer group analysis of redemption data. ☒ ☐ 18a. Identifies vendors with high average food instrument redemptions. ☒ ☐ 18b. Identifies vendors with a narrow variation in redemptions. ☒ ☐ 19. Assigns a maximum value for each food instrument type (paper) or each item/UPC (EBT). ☒ ☐ 19a. Receives data about the amount a vendor requests for each food instrument (paper) or item/UPC (EBT) redeemed. ☒ ☐ 20. Captures source of income. ☒ ☐ 21. Has the capability of annualizing household income occurring at more 10
than one frequency. ☐ ☐ 22. Performs automated dietary assessment. ☒ ☐ 23. Has automated growth charts. ☒ ☐ 24. Has point of certification data entry, i.e., a personal computer at each “station” within the clinic. ☒ ☐ 25. Allows for ad hoc reporting. 11
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IV. ORGANIZATION AND MANAGEMENT
(Please indicate) State Agency:Click or tap here to enter text. for FY: Click or tap here to enter text.
Organization and management involve the procedures for the documentation of staff time at the State level devoted to the various WIC functions, the evaluation and selection of local agencies, the documentation of local agency staffing standards and data, as well as disaster planning. During disasters, emergencies, public health emergencies, or a supply chain disruption, including infant formula recalls, the State agency may request to implement existing and allowable regulatory flexibilities or waivers to support the continuation of Program benefits and services. Waivers granted under Access to Baby Formula Act of 2022 (codified at 7 CFR 246.4a(30)) or temporary provision(s) authorized by Congress are not permanent amendments to the State Plan; however, State agencies should consider any historical amendments as the result of waivers granted under prior waiver authority to develop policies and procedures for current and future disasters.
A. State Staffing – 7 CFR 246.3(e), 246.4(a)(4) and (24): describe the information relating to State level staff requirements and utilization as it relates to WIC Program functions and how the State agency will provide a drug-free workplace.
B. Evaluation and Selection of Local Agencies – 7 CFR 246.4(a)(5)(i) and (7) and 246.5: describe the procedures and criteria utilized in the selection and authorization of local agencies.
C. Local Agency Staffing – 7 CFR 246.4(a)(4): describe the State staffing standards which apply to the selection of local agency staff and the means used by the State agency to track and analyze local level staffing data.
D. Plan of Alternate Operating Procedures (Disaster Plan) –7 CFR 246.4(a)(30) the plan of alternate operating procedures in preparation for a disaster and/or public health emergency.
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A. State Staffing
1. State Level Staff (7 CFR 246.3(e)) a. Record below the current total full-time equivalent staff (FTEs) available for each position listed or attach equivalent information in the section’s Appendix noted here: Click or tap here to enter text. Note the following when completing this section. State agencies should consider best practices to meet their optimal operating goals: A full-time WIC director is required when monthly participation levels are 1,500 or half- time or equivalent when participation exceeds 500. A full-time Nutrition Coordinator is required when participation exceeds 1,500 or half- time or equivalent when participation exceeds 500. A full-time or equivalent Program specialist for each 10,000 participants above 1,500 up to 8 staff. Position FTE WIC FTE In-Kind Total FTE Director
Nutrition Coordinator
Vendor Specialist
Program Specialist
Financial Specialist
Breastfeeding Coordinator
(MIS/EBT) Specialist
Intern
Other (specify):
Click or tap here to enter text. Other (specify):
Click or tap here to enter text. Other (specify):
Click or tap here to enter text.
b. Does the State agency include a WIC organizational chart showing all positions (including position descriptions, titles, and staff names) in their State Plan? ☐ Yes ☐ No
c. Does the State agency describe the WIC Program's relationship within the State Health Department or Indian Tribal Organization in their State Plan?
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☐ Yes ☐ No
2. Does the State agency estimate the average percent of State staff time devoted to fulfilling the following functions? ☐ Yes ☐ No
Function Percent of Total Staff Time Certification, including nutrition risk determination Click or tap here to enter text. Breastfeeding training/promotion and support Click or tap here to enter text. Nutrition education Click or tap here to enter text. State food list Click or tap here to enter text. Monitoring of local agencies Click or tap here to enter text. Fiscal reporting Click or tap here to enter text. Food delivery system management Click or tap here to enter text. Vendor management, including vendor training Click or tap here to enter text. Staff training and continuing education Click or tap here to enter text. (MIS/EBT) system development and maintenance Click or tap here to enter text. Civil Rights Click or tap here to enter text.
Coordination with and referrals to other assistance Click or tap here to enter text.
programs and social service agencies
Other (specify): Click or tap here to enter text.
Total staff time Click or tap here to enter text. 3. Drug-Free Workplace (7 CFR 246.4(a)(25)) a. Does the State agency have a plan to achieve a drug-free workplace? ☐ Yes ☐ No
B. Evaluation and Selection of Local Agencies
☐ Does not apply because the State agency has only one location or no local agency(ies). (PROCEED TO NEXT SECTION)
1. Local Agencies Authorized
Number of local agencies authorized to provide WIC services last fiscal year Click or tap here to enter text. Number of local agencies planned to provide WIC services this fiscal year Click or tap here to
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enter text.
2. When does the State agency accept applications from potential local agencies? ☐ Annually
☐ Biennially
☐ On an on-going basis ☐ Other (specify) Click or tap here to enter text.
3. Does the State agency require existing local agencies to reapply and compete with new applicant agencies for authorization? ☐ Yes ☐ No If yes, what is the frequency? ☐ Annually
☐ Biennially
☐Not applicable ☐Other (specify) Click or tap here to enter text.
4. Selection Criteria a. The State agency uses the following criteria in selecting local agencies in new service areas and/or in reviewing applications from existing service areas: (Check all that apply) New Service Areas Existing Service Areas
☐ ☐ Coordination with other health care providers ☐ ☐ Projected cost of operations/ability to operate with available funds ☐ ☐ Location/participant accessibility ☐ ☐ Financial integrity/solvency ☐ ☐ Relative need in the area ☐ ☐ Range and quality of services ☐ ☐ History of performance in other programs ☐ ☐ Ability to serve projected caseload ☐ ☐ Non-smoking facility ☐ ☐ Americans with Disabilities Act (ADA) compliance
Other (specify by typing into the cells below): ☐ ☐
☐ ☐
b. The State agency conducts studies (provide a link to or copy of the most recent study: Click or tap here to enter text. of the cost-effectiveness of local agency operations that examine:
☐ Location and distribution of local agencies in proportion to new applicants/participants ☐ Clinic procedures to optimize participant access/service (Patient Flow Analysis, etc.) ☐ Staff-to-participant ratios and related staffing analyses
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☐ Comparative analyses of local agency/clinic costs ☐ Other
5. Does the State agency have a formal written agreement or contract with each local agency? (7 CFR 246.6) ☐ Yes (list the contract duration):Click or tap here to enter text. ☐ No
6. Does the State agency have statewide fair hearing procedures for local agency appeals? (7 CFR 246.4(a)(18)) ☐ Yes, attach local agency fair hearing procedures or specify the location in the Procedure Manual and reference below: ☐ No
7. Does the State agency maintain a list of clinic sites that include the following information? If available, please attach and/or reference the location of the listing: Click or tap here to enter text.
☐ Location
☐ Type of site (e.g., hospital, health department, community action program)
☐ Service area ☐ Hours of operation ☐ Days of operation ☐ Health services provided on-site ☐ Social services provided on-site ☐ Participation ☐ Other (specify): Click or tap here to enter text.
C. Local Agency Staffing
☐ Does not apply because the State agency has only one location or no local agency(ies). (PROCEED TO NEXT SECTION)
1. Staffing Standards (7 CFR 246.3(e)) a. Which local agency staffing standards are prescribed by the State agency?
☐ Credentials
☐ Staff levels
☐ Staff-to-participant ratio standards
☐ Time spent on WIC functions
☐ Other (specify): Click or tap here to enter text.
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☐ Functions of CPAs
☐ Paraprofessional requirements
☐ Separation of duties to ensure no conflicts of interest
☐ Other (specify):
☐ Not applicable b. Does the State agency’s ensure local agency(ies) credentials are in line with the Nutrition Services Standards? ☐ Yes ☐ No c. Does the State agency maintain copies of local agency(ies) CPA position descriptions, classified in terms of Nutrition Services Standards, i.e., federal requirements, recommended criteria, best practices? ☐ Yes ☐ No d. Do local agency(ies) follow staffing standards established by unions or local governmental authorities? ☐ Yes ☐ No If yes, how many of the total local agencies are currently authorized by unions or local governmental authorities? Click or tap here to enter text.
2. Local Level Staffing Data a. When/how is data collected and analyzed by the State agency to determine staff-to-participant ratios? (Check all that apply):
☐ For each clinic/local agency ☐ By function
☐ At regular intervals ☐ Program management
☐ Monthly
☐ Food delivery
☐ Quarterly
☐ Certification
☐ Annually
☐ Nutrition education
☐ Breastfeeding promotion and support
☐ Other (specify): Click or tap here to enter text.
b. Are results of analyses from data collected to determine staff-to-participant ratio reported back to local agency(ies)? ☐ No ☐ Yes, in a single report comparing all local agencies ☐ Yes, in a local agency-specific report (no comparative data)
3. Local Agency Breastfeeding Staffing Requirement
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a. List the number of local agency(ies) with a designated staff person to coordinate breastfeeding promotion and support activities. b. Click or tap here to enter text.The State agency maintains approved copies of local agency(ies) Breastfeeding Coordinator and Peer Counselor position descriptions as outlined in the WIC Breastfeeding Support guide? ☐ Yes ☐ No
c. Number of local agencies with breastfeeding peer counselors. Click or tap here to enter text.
D. Plan of Alternate Operating Procedures (Disaster Plan) Per 7 CFR 246.4(a)(30), developing a plan of alternate operating procedures, referred to as a Disaster Plan, is required. This is a new requirement beginning with the FY25 State plan submission that must include policies and procedures for operations when regular operations are disrupted, which may include disasters, emergencies, public health emergencies, and supply chain disruptions that can impede delivery of WIC benefits. This section includes questions to guide State agencies in developing their plan of alternate operations prior to a disaster, emergency, public health emergency, and/or supply chain disruption.
1. Has the State agency developed a WIC disaster plan separate from a broader plan developed by the State agency’s administering Department (e.g., Health Department)? ☐ Yes ☐ No If yes, attach or list the location of the plan: Click or tap here to enter text.
2. Does the State agency have a WIC disaster plan that is part of a broader Health Department or Indian Health Services plan, or have policies that are partnered with other State agency(ies) during disasters ? ☐ If yes, what agency(ies): Click or tap here to enter text. ☐ No List the location and sections of the disaster plan that is not part of the WIC disaster plan: Click or tap here to enter text. 3. Has the State agency shared the disaster plan(s) with its local agency(ies) and clinics? ☐ Yes ☐ No
4. For the purposes of this section, the word “disaster” is used to encompass disaster, emergencies, public health emergencies, supplemental food recalls or supply chain disruptions, unless otherwise specified.
Under the Implementation of the Access to Baby Formula Act of 2022 and Related Provisions Rule, published December 14, 2023, State agencies are required to develop Alternate Operating Procedures – a disaster plan to submit along with their annual State plan. State agencies must develop a plan to ensure continued WIC services to participants during a disaster. To assist
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State agencies in this effort, section a-g is provided as a guide for the types of policies and procedures that may be needed during a disaster. Not all items listed will be applicable to each State agency.
For the FY 2025 State plan submission, State agencies have the option to submit previously approved policies that capture disaster-related operations, including amendment(s) as a result of waivers that sufficiently support efforts to meet relevant disaster plan requirements for FY 2025, where applicable. If existing policies or waiver amendment(s) do not fully meet the requirements outlined in the ABFA rule, State agencies can continue developing these policies or amendments to meet the disaster plan requirement for FY 2026. If no policies or waiver amendment(s) currently exist, a policy must be developed for the FY 2025 submission, where applicable.
a. Coordination and Communication during a disaster.
i. Does State agency have a designated emergency contact for disasters?
☐ Yes ☐ No ☐ Other: Specify: Click or tap here to enter text.
If yes, please list designee’s contact information: Click or tap here to enter text.
ii. Does State agency coordinate with the following organizations to support data-informed approaches when responding to a disaster? (Select all the apply.) ☐ No ☐ State/Local emergency operation centers (EOC) ☐ Relief organizations (such as Red Cross, Southern Baptist, Salvation Army, etc.) ☐ Federal Emergency Management Agency (FEMA) ☐ Other Organizations Click or tap here to enter text. iii. Does the State agency have a communication plan with its local agencies? (7 CFR 246.4a(30)(vii)) ☐ Yes ☐ No If yes, attach or list the location of the plan. Click or tap here to enter text.
iv. Does the State agency have a communication plan with its vendors? (7 CFR 246.4a(30)(vii)) ☐ Yes ☐ No If yes, attach or list the location of the plan. Click or tap here to enter text.
v. Does the State agency have a communication plan with its FNS Regional Office? (7 CFR 246.4A(30)(viii)) ☐ Yes ☐ No If yes, select the information shared with the Regional Office after a disaster?
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☐ Call down roster ☐ Clinic Damage Assessment ☐ Status/Number of Participants impacted ☐ Clinic location ☐ Open Shelters ☐ Feeding Organizations ☐ Clinic closure ☐ Alternate clinic sites ☐ Request for Program assistance (waiver request) ☐ Other operating procedures Click or tap here to enter text.
vi. Does the State agency have a communication plan to notify participants and other stake holders of alternate operations? (7 CFR 246.4a(30)(vii))
☐ Yes ☐ No ☐ Other Click or tap here to enter text.
If yes, attach or list the location of the plan. Click or tap here to enter text.
vii. Does the State agency have a plan to inform receiving State agencies of where they may obtain a verification of certification for displaced participants?
☐ Yes ☐ No ☐ Other: Specify: Click or tap here to enter text. If yes, attach or list the location of the plan. Click or tap here to enter text.
viii. Does the State agency provide participants with instructions for obtaining their verification of certification?
☐ Yes ☐ No
If yes, attach or list the location of the plan. Click or tap here to enter text.
ix. Does the State agency have a plan to determine if an emergency period or supply chain disruption as declared by the Secretary of Agriculture exists? An emergency period is defined as (1) a presidentially declared major disaster as defined under Section 102 of the Robert T. Stafford Disaster Relief and Emergency Assistance Act (Stafford Act, 42 U.S.C. 5121 et seq.), (2) a presidentially declared emergency as defined under the Stafford Act, (3) a public health emergency declared by the Secretary of Health and Human Services under Section 319 of the Public Health Service Act (42 U.S.C. 247d), or (4) a renewal of such a public health emergency.
☐ Yes ☐ No
If yes, attach or list the location of the plan. Click or tap here to enter text.
x. Does the State agency have a plan for how it would determine if a waiver is necessary to continue WIC services?
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☐ Yes ☐ No If yes, attach or list the location of the plan. Click or tap here to enter text.
b. Continuation of Benefits When a disaster strikes, State agencies must continue to serve participants. This section lays out a plan to collect required information from participants. i. The State agency will continue to serve participants during a disaster by: (Select all that apply)
☐ Remote certification for new applicants and recertification for current participants
☐ Physical presence exemption, if applicable
☐ Temporary certification for applicants temporarily displaced
☐ Temporary certification for applicants eligible for Disaster Supplemental Nutrition Assistance Program
(DSNAP) benefits
☐ Expedited certification for displaced participants
☐ Issue VOC (verification of certification) to applicants that must evacuate (7 CFR 246.7(k))
☐ Issue VOC (verification of certification) to evacuees returning to the originating State
☐ Alternate clinic locations (within the disaster area, if possible)
☐ Mobile clinics or satellite clinics (grassroot organizations, etc.)
☐ Provide participants access to program records to relocate
☐ Provide nutrition assessments and referrals to other organizations when clinic operations are disturbed
☐ Other Click or tap here to enter text.
Describe or attach a plan for each method the State agency plans to implement during a disaster: Click or tap here to enter text.
ii. The State agency has alternate procedures to collect the following during program disruptions (Select all that apply)
☐ Anthropometric data (7 CFR 246.7(e)(1)) ☐ Medical documentation (7 CFR 246.10(d)) ☐ Bloodwork data (7 CFR 246.7(e)(1)(i)(B)) ☐ Income documentation (7 CFR 246.7(d)) ☐ Residency documentation (7 CFR 246.7(c)) ☐ Adjunct or Automatic eligibility documentation 7 CFR 246.7(d)(2)(v)(A)) ☐ Verification of certification (VOC) documentation (7 CFR 246.7(k)) ☐ Signature for Rights and Obligations and other required documentation (7 CFR 246.7(i)(10)) ☐ Other Click or tap here to enter text.
Describe or attach a plan for each method the State agency plans to implement during a
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disaster: Click or tap here to enter text.
iii. The State agency allows the certification of participants affected by a disaster to submit for certification: (Select all the apply) (7 CFR 246.7(d)(2)(v)(C))
☐ A signed statement ☐ Letter from the employer ☐ Other Click or tap here to enter text.
iv. How will the State agency collect information from participants when using remote certification? (Select all the apply)
☐ Secure website upload ☐ Mobile device screen share ☐ Mail ☐ Secure email ☐ Video conference ☐ Other Click or tap here to enter text.
Describe or attach a plan for each method the State agency plans to implement during a disaster: Click or tap here to enter text.
v. The State agency has a Memorandum of Understanding/Agreement with WIC-affiliated agencies (such as Medicaid) to collect WIC eligible documentation during a disaster?
☐ Yes ☐ No ☐ Not applicable
c. Benefit Issuance and Redemption.
i. How will the State agency issue Food Instruments (i.e., EBT cards) during a disaster? (Select all that apply)
☐ Clinic pickup ☐ Certified Mail ☐ Other Click or tap here to enter text.
Describe or attach a plan on how the State agency will issue Food Instruments during a disaster: Click or tap here to enter text.
ii. Does the State agency have a reciprocal agreement to accept EBT cards with bordering States?
☐ Yes ☐ No ☐ Other
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iii. Does the State agency have a plan to replace lost, stolen, or damaged Food Instruments during a disaster? 7 CFR 246.4(a)(14)(xix)
☐ Yes ☐ No ☐ Not applicable
iv. Describe or attach a plan on how the State agency will replace Food Instruments during a disaster: Click or tap here to enter text.
Does the State agency keep replacement Food Instruments on hand?
☐ Yes ☐ No ☐ Not applicable
v. Does the State agency have a policy to replace a participant’s supplemental foods if destroyed during a disaster?
☐ Yes ☐ No
Describe or attach the policy on how the State agency will replace destroyed supplemental food(s) for participants: Click or tap here to enter text.
vi. Does the State agency have a direct distribution or home delivery system in place as an alternative to using the retail food delivery system during normal program operations?
☐ Yes ☐ No
If yes, does the direct distribution and home delivery system include provisions reasonable to institute during recalls and/or supplemental food shortages?
☐ Yes ☐ No
Describe or attach the policy on direct distribution or home delivery systems: Click or tap here to enter text.
vii. Does the State agency have a policy to implement direct distribution to participants during disasters?
☐ Yes ☐ No ☐ Not applicable
Does the State agency have a policy to implement direct home food delivery during disasters?
☐ Yes ☐ No ☐ Not applicable
viii. Does the State agency have a policy to implement direct distribution of ready-to-feed, liquid concentrate, or powder infant formula to participants?
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☐ Yes ☐ No ☐ Not applicable
Describe or attach a plan on how the State agency will implement direct distribution of ready-to-feed, liquid concentrate, or powder infant formula: Click or tap here to enter text.
d. Vendor Management Requirements., 246.4(a)(14)(xv).
i. Does the State Agency have a plan to adjust vendor minimum stocking requirements (MSR) for the variety and quantity of supplemental foods during a disaster? (7 CFR 246.12(g)(3)(i)
☐ Yes ☐ No ☐ Not applicable
Describe or attach the policy on how the State agency will implement MSR: Click or tap here to enter text.
ii. Does the State agency have a plan to adjust authorization requirements for new vendor applicants and/or authorized vendors during a disaster?
☐ Yes ☐ No ☐ Not applicable
If yes, which parts of the selection criteria will the State agency adjust?
☐ State agency business integrity requirements
☐ State agency minimum stocking requirements
☐ Competitive price selection criteria and/or maximum allowable reimbursement levels
☐ Other State agency-imposed criteria (please list): Click or tap here to enter text.
iii. Does the State agency have a plan to meet the annual vendor routine monitoring and compliance investigation requirements during a disaster? 7 CFR 246.4(a)(14)(iv)
☐ Yes ☐ No ☐ Not applicable
e. Nutrition Services. (7 CFR 246.4(a)(30)(ii), 246.7(j)(2)(iii), 246.10(d), 246.10(i), 246.10(e) and 246.16a(5).
i. Does the State agency have a designated emergency contact to address the needs of participants with qualifying conditions receiving Food Package III?
☐ Yes ☐ No ☐ Other: Specify: Click or tap here to enter text.
If yes, please list the designee’s contact information: Click or tap here to enter text.
ii. Does the State agency have a plan to support participants within the following groups?
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(Select all the apply.)
☐ Participants in rural areas ☐ Tribal populations ☐ Medically fragile participants (i.e., participants with documented qualifying conditions receiving Food Package III) ☐ Other Click or tap here to enter text.
Describe or attach a plan on how the State agency will support medically fragile participants, participants in rural areas, tribal populations, and other priority populations, as applicable: Click or tap here to enter text.
iii.Does the State agency have a plan to review and update supplemental foods authorized by their program at least annually for reasons including, but not limited to: ensuring continued marketplace availability of authorized foods in package sizes that provide the maximum monthly amount and being responsive to evolving participant needs?
☐ Yes ☐ No
iv. Does the State agency have a plan to make food package adjustments that do not require waivers when the maximum food benefit cannot be offered to participants (includes informing participants, vendors, etc.)?
☐ Yes ☐ No
v. Does the State agency have a plan to support breastfeeding participants during a disaster? Support would include, but not limited to: Supporting participants with breastfeeding initiation, relactation, and breastfeeding challenges as well as assisting with breast pump acquisition. This support may include referrals outside of WIC.
☐ Yes ☐ No
Describe or attach a plan on how the State agency will implement breastfeeding support during a disaster.Click or tap here to enter text.
vi. Does the State agency have a plan for implementing infant formula cost containment contract remedies during an infant formula recall?
☐ Yes ☐ No ☐ Not applicable
Describe or attach a plan on how the State agency will implement infant formula cost containment remedies during an infant formula recall: Click or tap here to enter text.
f. Allowable Cost. (7 CFR 246.14(d)) and (7 CFR 246.14(c)(1)(i))
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i. Does the State agency have a plan to request the necessary health and safety equipment needed during disasters (e.g., Personal Protect Equipment)?
☐ Yes ☐ No ☐ Not applicable
ii. Does the State agency plan to use State/local agency staff to support disaster recovery efforts?
☐ Yes ☐ No ☐ Not applicable
If yes, describe how the staff will be used. Click or tap here to enter text.
iii. Does the State agency have a cost sharing agreement with other agencies to use staff during a disaster?
☐ Yes ☐ No ☐ Not applicable
g. Alternate Procedures. State agencies should consider any policies and procedures necessary to continue Program operations. For instance, certain policies may generate Management Information System (MIS) changes. Planning is key. The State agency’s disaster plan should support any request for Program flexibilities that impact their MIS.
i. Does the State agency have a plan to monitor local agency(ies) during a disaster?
☐ Yes ☐ No ☐ Not applicable
ii. Does the State agency have a plan for MIS recovery?
☐ Yes ☐ No ☐ Not applicable
iii. Does the State agency have a plan for MIS backup filing system?
☐ Yes ☐ No ☐ Not applicable
iv. Does the State agency have a plan to backup computer systems?
☐ Yes ☐ No ☐ Not applicable
v. Does the State agency have a plan to manage alternate procedures in the MIS?
☐ Yes ☐ No ☐ Not applicable ☐ Other (describe): Click or tap here to enter text.
vi. Does the State agency have a plan for a backup power system?
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☐ Yes ☐ No ☐ Not applicable
Describe or attach a plan for each method the State agency plans to implement during a disaster: Click or tap here to enter text.
5. At what frequency will the State agency plan to train staff and test the readiness of their approved disaster plans? State agencies that do not encounter disasters regularly should test their plan at a minimum every two years to learn about any MIS updates. For example: State agencies can test readiness by requesting to participate in State-lead (emergency operating centers) disaster exercises that would include the Health Department or Indian Health Services.
☐ Semi-annually ☐ Annually
☐Every 2 years
☐ Other Click or tap here to enter text.
Please describe or attach how the State agency plans to conduct its readiness testing: Click or tap here to enter text.
6. Does the State agency require local agencies/clinics to have individual disaster plans. ☐ Yes ☐ No
If yes, such plans are reviewed for compliance and consistency with the State agency disaster plan. ☐ Yes ☐ No
ADDITIONAL DETAIL: Organization & Management Appendix and/or Procedure Manual (citation): Click or tap here to enter text.
III (A). INFORMATION SYSTEM
GOAL: Transition to a new Maintenance & Enhancement (M&E) contract of the State Agency Model (Crossroads), the State Agency (SA) will monitor and maintain the business processes and technology for the provision of nutrition services and food benefits to the women, infants and children of WV.
METHODOLOGY: 1. Work with the M&E contractor, as well as state and local agency staff to monitor and test the application to ensure that it is working properly.
2. Provide project management and contract administration throughout the duration of the project.
3. Manage the transition from the current M&E contract to the newly awarded contract.
EVALUATION: The SA will identify and report system issues and enhancements. These will be sent to the Crossroads User Group (XRUG) Product Management Office (PMO) for review and prioritization. Once issues have been coded and implemented, all states in the user group will begin testing.
STATUS: The SA continues participation in XRUG meetings of Release Management, Change Control Board, Designated Governing Board, Technology Advisory Group (TAG), Executive Steering Committee, and monthly USDA Food and Nutrition Service (FNS) touchpoint.
West Virginia continues to contract with BerryDunn on behalf of the XRUG to serve as PMO. A new Statement of Work and Implementation Advance Planning Document Update were submitted to USDA FNS on July 2, 2024 for approval and WISAM funding. The new contract between WV and BerryDunn for service period October 1, 2024 - May 31, 2026 was finalized on June 10, 2024. The SA hosts a bi-weekly touchpoint with BerryDunn as oversight of the PMO.
The Commonwealth of Virginia solicited and procured the Crossroads Maintenance and Enhancement vendor with award on October 1, 2023. West Virginia successfully transitioned from Gainwell Technologies to Voyatek although a supplemental contract necessary to pay for enhancements is still working through the state procurement approval process.
The Voyatek first year release schedule - with three major builds - is on target. The first maintenance release addressed 67 tickets and was adopted by all XRUG states in April. WV currently has Release 2.7 in production. 1 of 3
The XRUG has completed testing of Release 2.8 and will be deploying it to production during 4th quarter of FFY2024. Continued status reports will be provided via WISAM quarterly reports.
This goal is complete and will continue to be part of ongoing operations and IAPDU submissions. The focus of M&E in FFY2025 will be on maintenance and enhancements to meet all federal regulation changes (risk code revisions, PC+ data requirements, Food Delivery Portal data requirements, and new food package rule). If awarded FFY2024 WIC Infrastructure funding, enhancements will be initiated for the participant portal, vendor portal and a data analytics dashboard throughout the Infrastructure grant performance period. Status updates will occur via quarterly FNS-908 reports.
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III (B). INFORMATION SYSTEM
GOAL: Pursue WIC Online Ordering solution of WIC eligible food items.
METHODOLOGY: Identify recommendations/limitations/benefits/impacts for implementing WIC online ordering. Initiate discussion and collect comments / recommendations from the WIC community (FNS, forum, other States) related to successful adoption and implementation of WIC online ordering. Explore key aspects of WIC online ordering and develop high-level business requirements, such as WIC authorized vendor requirements, and transaction security, costs impact. Engage WIC authorized vendors to explore online ordering platforms.
EVALUATION: The State Agency (SA) will evaluate the estimated cost of implementing online ordering and research and review grant opportunities to fund this initiative. Vendors will be polled to assess interest in participating in an online ordering model and willingness to incur any associated costs.
STATUS: WV assessed several demonstrations of online pilot projects via the National WIC Association Technology Conference as well as a state specific presentation by JPMA in partnership with Umoja. WV began working with Rhode Island in April 2024 on an application as a multi-state consortium - Connecticut, Rhode Island, Vermont and WV - for the second round of Center for Nutrition and Health Impact’s WIC Online Ordering grants. Notice was provided in June 2024 that the proposed solution does not meet requirements of online ordering, but the consortium will transition to an online ordering planning grant. WV will continue work with CT, RI and VT - See vendor management goal (E) - for FFY2025. Status updates will be provided there as the Vendor Management Unit takes lead on the initiative. 3 of 3
X (A). MONITORING AND AUDITS
GOAL: Continue to maintain and update as necessary the monitoring policy, tool and findings report to reflect updates to business processes within clinic operations and Crossroads. External and internal monitoring tools will be maintained and updated as necessary for compatibility with Crossroads as well as modernized service delivery models. State Agency (SA) Program Integrity Coordinator will provide training to local agency directors and/or designated staff regarding revised monitoring tools and business processes.
METHODOLOGY: Until such time that the pending change request and tickets are resolved related to the Monitoring and Analysis section within Crossroads, West Virginia will not have the capability to complete monitoring within the Crossroads application. The SA will continue to provide training to Local Agency Directors on revised paper monitoring tools and the working functions of the Monitoring and Analysis section of Crossroads.
The revised monitoring tools are used to increase effectiveness of the monitoring process, both internal and external. Even though the Monitoring and Analysis section of Crossroads is not fully functioning, the web-based aspect of the program still will increase flexibility and provide opportunities to complete major portions of chart reviews prior to onsite visits, thereby reducing disruption of clinic flow created by the monitoring visits.
EVALUATION: The evaluation process will consist of a review of local agency internal monitoring reports, and the number of written monitoring findings and responses. External reports will also be evaluated on an ongoing basis to determine alterations in monitoring processes. Overall evaluation will be more efficient once the Monitoring and Analysis section of CrossRoads is implemented. Once implementation of this system an evaluation of current and future fiscal year monitoring will be accessible in one area to provide an analysis of each Local Agency Monitoring S.W.A.T. (strengths, weaknesses, opportunities, and threats).
STATUS: The Program Integrity Coordinator position was vacant from April 28, 2023 through March 25, 2024. Although a draft internal and external monitoring tool was introduced for Local Agency comment in February 2023, the policy and tool revisions stalled because of this position vacancy as well as focus on service delivery redesign in response to extended waivers through September 2026.
The Program Integrity Coordinator is currently learning the system and will be knowledgeable in all aspects of Internal and External monitoring within the monitoring and analysis process in Crossroads and share this
knowledge with SA and LA staff. Monitoring to catch up FFY2024 will be conducted in FFY2025 with the current full tool within policy and procedure. This will allow the new personnel to revise the tool to accommodate hybrid service delivery as well as Crossroads business processes. Priority will be placed to utilize the Monitoring and Analysis section of Crossroads for efficient tracking and reporting of monitoring, but prior to this transition, the monitoring policy, tool and findings report will be updated to reflect business processes within WV’s service delivery redesign framework supported by federal waivers available through September 30, 2026. External and internal paper monitoring tools will be maintained while the new Program Integrity Coordinator catches up monitoring from FY2024 resulting from State Agency position vacancies. Through this experience Chapter 9 policy updates as well as monitoring tools and report revisions will begin. and updated as necessary for compatibility with Crossroads. State Agency (SA) Program Integrity Coordinator will provide training to local agency directors (LA) and/or designated staff regarding any alterations in business processes. This goal is ongoing for FY 2025 for Chapter 9 policy updates as well as monitoring tools and report revisions.
II. (A). NUTRITION SERVICES
GOAL:
The Local Agency (LA) Breastfeeding Liaisons (BFL) and the State Agency (SA) Breastfeeding Coordinator, will train all local and state staff on Level 1 of the new USDA breastfeeding training. Levels 2–4 will be offered to appropriate staff when Level 1 Training is complete.
METHODOLOGY: 1. SA Breastfeeding Coordinator in collaboration with BFLs, develop an annual training calendar where Local Agency BFLs rotate conducting the Level 1 USDA training on a quarterly basis to ensure Level 1 training is completed by all new employees.
2. Level 2 training will be offered each fiscal year within each LA by the BFL for Breastfeeding Peer Counselors (BFPCs) and Certifying Professional Authorities (CPAs) hired within the last 12 months.
3. Level 3 training will be provided to Local Agency breastfeeding staff
members who are credentialed in lactation, BFLs and CPAs.
4. Level 4 training will be provided to every Designated Breastfeeding
Expert within the Local Agency.
EVALUATION: Level 1 and Level 2 have been rolled out and completed for the State
Agency Staff. All local agencies are on track to complete by the end of
FY2023. Every Local Agency BF Liaison has been training their staff and
Level 2 should be complete by the end of FY2023. All agencies will
report the number of employees trained as well as those that still need
Level 1 in their final FY2023 BF report.
STATUS:
Level 1 USDA Breastfeeding Training continues to be presented in a virtual setting via Google Meet. Level 1 is taught by the Local Agency BF Liaisons and offered on a quarterly basis throughout the state. 29 employees have received Level 1 training in FY2024. Level 1 training methodology is now part of regular operations.
Level 2 training was offered throughout FY2023, goal was achieved and 5 employees have completed the training in FY2024. The Local Agency BF Liaisons continue to conduct Level 2 with new employees within their agency as part of regular training operations.
At mid-year FY2024, Level 3 USDA training has been completed by two BF Liaisons via self-study videos. At this time, the remaining six BF Liaisons have yet to complete the Level 3 training to then begin training their staff at the local level. Vacancy in the State Breastfeeding Coordinator role in the beginning of FY2024 delayed planning for Level 3 1 of 9
training, hence this is an ongoing goal for FFY2025. With the input of the Local Agency Breastfeeding Liaisons, State Agency is exploring partnering with IBCLC, Cathy Carothers at Every Mother Inc to conduct Level 3 in a live virtual setting.
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II. (B). NUTRITION SERVICES
GOAL:
For FY 2024, Nutrition staff will provide nutrition education materials
specific to fruit and vegetable consumption to 95% of participants who
appear on the underutilized report.
METHODOLOGY: Nutrition Education Liaisons will target these participants by utilizing the
eWIC custom underutilized CVB report. They will contact participants via
phone (call or text), email, or mail and provide materials either in-person,
email, or mail. These materials will be used to educate participants and
items listed below will be used to incentivize the participants to increase
their consumption of fruits and vegetables. The participants will be
informed of the incentive items which will increase the consumption of
fruits and vegetables among the participants. At the contact point with the
participant, the nutrition education staff will discover why a participant is
not using CVB benefits and send out materials and incentive items
accordingly. These materials and incentive items will lead to healthier
participants and will increase fruits and vegetable consumption over the
reporting period.
Potential Mailing Materials: Stocking the Pantry- fliers on use of frozen/canned fruits and vegetables) Recipe Cards Nutrition Matters Cards for Fruits and Vegetables Benefit Card- Highlights Specific Benefits
Visual Materials: Videos with instructions for making recipes including recipes using frozen
and canned fruits and vegetables.
Potential Incentive Items: MyPlates Fresh Baby Freezer Pop Makers with Recipe Cards Ice Cube Trays for Perfect Portions of Baby Food Baby Spoons
EVALUATION: Using the eWIC custom underutilized CVB report, each Local Agency
will be examined for families who are using 5% or less of their CVB.
Families will not appear on more than two reports since nutrition staff are
targeting 95% of the families on that report and incentivizing them with
items and materials. Nutrition Education Program Plans are reviewed and comments sent to Local Agency Nutrition Education Liaison (NEL) by August 31, 2024. Mid-Year and Year-End evaluations will be reviewed by the State Agency WIC Coordinator and comments provided to NEL for completion of goals.
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STATUS:
Local Agencies are on track at the mid-year FY2024 reporting with 95% of participants contacted that appeared on the CVB report who were using 5% or less of their CVB. CVB usage reports show an increase in CVB usage from 10/23 at 67.6% to 5/24 72% usage. 6/1/24 CVB can be spent at approved Farmers Markets which will continue to increase CVB usage. This goal continues throughout FY2024. This goal should be completed this year, and will be adopted as regular operations with contact via OneCallNow automated messaging for participants with CVB underutilization.
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II. (C). NUTRITION SERVICES
GOAL: To continue utilizing an operational quality improvement initiative to develop best practice standards in areas of training, communication and workflow processes as identified by an all staff survey and focus groups.
METHODOLOGY: A quality improvement team consisting of State Agency (SA) and Local
Agency (LA) employees will work together to finalize a quality
improvement plan outlining outcomes and strategies to be undertaken in
FFY2024. Strategies will be carried out via sub-committees to improve
training, communication, and workflow in WIC at all levels. The OQII
team will meet in-person quarterly, and sub-committees will meet
virtually.
EVALUATION: The evaluation process will consist of meeting deliverables, objectives, outputs and evaluations by SA employees and LA employees to ensure all strategies are deployed effectively. Evaluation will also be completed using performance measures and monitoring findings as evidenced by internal and external monitoring, Corrective Action Plans, participant complaints, correct WIC-53s, and record documentation. Lastly, surveys and post tests will be conducted for some elements of the quality improvement plan.
STATUS: The operational quality improvement (OQI) team has implemented the products developed in FY2023 throughout FY2024 which includes a training framework for the first two years of employment, workflow process document for each position at the state agency and local agencies, a communication guide including newsletter sharing pilot project updates and innovation program-wide, and service delivery redesign (SDR) framework. Evaluation of OQI efforts in FFY2024 was designed and conducted by a neutral consultant. OQI participants chose to gather feedback on OQI products through focus groups with statewide WIC staff to assess both the knowledge and effectiveness of the tools produced by the workgroups and distributed for implementation statewide. The results of the focus groups will be analyzed and applied, by participants, to OQI planning for FFY2025 at the August 2024 OQI meeting.
The Nutrition Services Unit will continue technical assistance to the SDR workgroup to implement the framework in existing policy and procedure, request additional waivers for modernization, and develop training curriculum.
This is an ongoing goal for FFY2025.
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II. (D). NUTRITION SERVICES
GOAL:
Local Agency Breastfeeding staff will follow up with 90% of all Pacify lactation calls as defined by attempted contact with the participant as indicated by the Pacify weekly report.
METHODOLOGY: Each agency shall evaluate the weekly Pacify reports sent by the State
Breastfeeding Coordinator and follow up with the participants who made
calls to Pacify lactation consultants.
Follow up contacts will be documented on the Pacify weekly report.
EVALUATION: The percentage will be measured by taking the number of calls made to Pacify that received follow up contact divided by the total number of calls made to Pacify during the reporting period. The Local Agency Breastfeeding Liaison will report the number of calls and number of follow ups made on the mid-year and final breastfeeding reports.
STATUS: Each Local Agency successfully completed meeting this goal except for one agency due to staffing. Local Agency Breastfeeding Liaisons reported an 88-100% follow-up call percentage for their Pacify participants. 100% of calls (10 calls) in Wheeling-Ohio agency were not followed up on due to lack of breastfeeding staff and vacancy in the Breastfeeding Liaison role. Each of the 9 Breastfeeding Liaisons continue to receive detailed weekly Pacify reports shared from the State Agency where they follow up with participants to ensure best practice and continuity of care. This goal is complete and has become a part of regular operations.
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II. (E). NUTRITION SERVICES
GOAL:
For FY 2024, nutrition staff will provide and/or offer iron-specific nutrition education materials to 95% of participants 1-2 years of age with a hemoglobin level of 10g/dL or below.
METHODOLOGY: Utilizing the available data on iron, nutrition staff will provide iron-specific materials and potential incentive items to participants. Staff will inform participants that incentive items and materials are available on iron and will utilize these materials and items to target participants 1-2 years of age that appear on the High Risk Report. At contact points with participants, the staff will determine which materials and incentive items will be appropriate for each participant. Incentive items and materials will vary from Local Agency to Local Agency.
Potential Incentive Items: 1: Calcium Cards 2: Iron Foods Handouts 3: Dairy Cups 4: Measuring Cups to Show Portion Sizes for Iron Foods Potential Visual Materials 1: Iron-Rich Videos 2: Vitamin-C Videos
EVALUATION: Utilizing the High Risk Report, 95% of participants age 1-2 will be contacted that have a hemoglobin level of 10g/dL or below. If 95% of participants are contacted and materials or incentive items are provided, the goal will be met. This report will be run every six (6) months to report on who needs materials, not as a way to see who has improved in hemoglobin levels. Nutrition Education Program Plans are reviewed and comments sent to Local Agency Nutrition Education Liaison (NEL) by August 31, 2024. Mid-Year and Year-End evaluations will be reviewed by the State WIC Agency.
STATUS:
Challenges occurred to implement the goal when there a low number of participants ages 1-2 as High Risk with a hemoglobin level of 10g/dL. Local Agencies report that is is difficult to track who have been given incentive items as well as encouraging participants to show up for their follow-up appointments. The Local Agencies are on track at the mid-year FY 2024 providing nutrition education and incentive items for each High Risk 201 risk code between the ages of 1-2 years. This goal should be completed this year.
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II. (F). NUTRITION SERVICES
GOAL:
Parents will be knowledgeable and supported throughout their breastfeeding journey.
OBJECTIVES: 1. Improve participant engagement throughout diverse communication
tailored to meet participant needs.
2. Increase guidance for mothers by ensuring consistent access to breastfeeding resources and breastfeeding support staff across all clinic locations.
3. Strengthen relationships with community partners by increasing
awareness of WIC breastfeeding resources.
METHODOLOGY: A variety of methods and materials will be utilized throughout FY25 to achieve our goal. Methods include increasing consistency of the message of breastfeeding promotion throughout the state, providing participants with a variety of ways to be educated on breastfeeding. By increasing access to breastfeeding resources and support staff in the office setting and community, a parent will feel more supported and encouraged to initiate breastfeeding in the hospital setting and breastfeed longer.
Secret Ingredient Materials, digital Brush Art platform, existing
Breastfeeding Inventory print materials, One Call Now, Pacify app will all
be available to use to promote breastfeeding and better inform participants
of upcoming breastfeeding events in the community.
EVALUATION: 1. Breastfeeding Initiation and Duration Reports → Goal for >65% statewide Initiation Rate. Reports will be run on a quarterly basis, comparing Initiation and Duration Rates to FY2023 and FY2024 data.
2. Breast Pump Issuance Report → Baseline data will be collected for the last quarter of FY2024. Prior to the start of FY2025, breast pump inventory will be updated to reflect current inventory and the addition of the new single use and multi-user breast pumps. This report will be run on a quarterly basis by each local agency, showing the number of pumps issued by type. To support our breastfeeding goal, success will be measured if the rate of breast pump issuance increases by 25% throughout Q1 and Q2 of FY2025.
3. Prior to the start of FY2025, SA Breastfeeding Coordinator will collaborate with LA Breastfeeding Liaisons to create individualized promotional materials in order to support LA staff in tracking community partner engagement and efforts in birthing hospitals. STATUS:
This is a new goal.
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II. (G). NUTRITION SERVICES
GOAL:
Increase nutrition education for WIC participants by offering new client-
centered approaches to access and deliver information.
OBJECTIVES: 1. Add up to 2 new ways to deliver nutrition education based on participant input.
2. Close 2 critical gaps - in internal (staff) and external (participant) systems in delivering new ways of providing Nutrition Education to participants.
METHODOLOGY: Offer client-centered nutrition education approaches. Offering additional options and flexibility towards the way WV WIC offers Nutrition Education will provide ongoing support and follow-up to reinforce learning and behavior change. Local Agency staff will conduct staff training to ensure all staff understand newly implemented Nutrition Education offered to participants. The Local Agency staff will understand the impact/change to scheduling and utilize appropriate documentation methods in Crossroads. Nutritionists/CPAs can utilize current Nutrition Education inventory, Secret Ingredient Materials, digital Brush Art platform and additional participant and family-centered materials. Nutritionists/CPAs will be provided continuing education opportunities in order to stay up-to-date with the latest research, recommendations and best practices.
EVALUATION: 1. Measure change by running Missed and Refused Nutrition Education appointments.
2. Gather feedback from participants around the FY2025 Nutrition Education Annual Plan by conducting a participant satisfaction survey.
3. Gather feedback on the success and obstacles from Nutritionist/CPAs during Nutrition Education Liaison meetings.
STATUS: This is a new goal.
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V. NUTRITION SERVICES AND ADMINISTRATION EXPENDITURES
GOAL:
No goals for FY 2025.
IV.(A). ORGANIZATION AND MANAGEMENT
GOAL:
In early 2023 it became clear from WV WIC data that caseload counts were dropping indicating a lack of connection to and sustained engagement between WV families with young children and WV WIC. As local agency directors and state agency staff discussed the issue it became clear that Outreach (its staff and activities) are the cornerstone of WV WIC. Reaching out to, connecting, and forming relationships with WIC clients is the foundation for bringing nutrition services and health surveillance to WV’s young families. Through the use of outside consultants WV WIC will create an outreach framework that highlights outreach as a cornerstone of the WV WIC program.
METHODOLOGY: Through consultant facilitated meetings, state and local agency teams will continue work on standard operating procedures for key areas of work related to outreach, engage in peer-to-peer learning and information sharing, and increase the overall capacity of WV WIC to more effectively engage in outreach work.
EVALUATION: The WV WIC program will have an outreach training packet used to onboard new outreach coordinators, new standard operating procedures for key areas of work related to outreach, and a new annual reporting tool for the whole WV WIC program.
STATUS:
2023 WIC Infrastructure funding has supported this initiative throughout FY2024 with status updates provided via FNS-908 quarterly reporting.
The WV WIC Outreach Quality Improvement (ORQI) initiative had a quarterly meeting October 16-19, 2023. Sessions developed the basic content needed to develop Local Agency Outreach Liaison job descriptions, an orientation training guidebook, and developing a standard operating procedure for contacting eligible Medicaid recipients identified through a data-sharing report. Likewise action plans were developed for each Local Agency to host a partner meeting to introduce a digital referral process with Google Forms.
The WV WIC Outreach Quality Improvement (ORQI) initiative had a quarterly meeting January 22-25, 2024. Sessions finalized the Local Agency Outreach Liaison job description, drafted version 2 of an orientation training guidebook and defined the top 3 priority areas for development, and shared a picture of achievements, challenges and solutions with hosting partner organization referral sessions with clinic tours. The State Agency presented a PPT and evaluation tools for assessing partner presentations effect on electronic referrals.
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The WV WIC Outreach Quality Improvement (ORQI) initiative had a quarterly meeting April 15 - 18, 2024. Products from this meeting included: Development of FFY2025 Annual Planning Goal and Action Plan templates and process, development of Local Agency Medicaid Outreach Form, evaluation tools, and training PPT. drafting Policy 7.01 - Introduction to Outreach, Staff Activity Policy Guidance on Outreach Activities and Hours, Guide to Partner Relationship Building Tools, Community Partner PPT Presentation, Community Partner Referral Form, Community Partner Training Feedback Form, WIC Community Partner Pre-Meeting Survey, Recommendations to Strengthen the Outreach Liaison Mentoring Process, and Outline of Topics and Timeline for development of the Outreach Liaison Guidebook.
The Outreach Guidebook is being constructed currently. The materials are being gathered to make this take shape. The materials captured by August 26, 2024 will be presented to ORQI in August. The work on this project will continue, with its fruition coming in October ORQI. Although the outreach guidebook and policy revisions are ongoing this goal is complete as the process and team building for continual quality improvement via SA-LA collaborative workgroups is established; the state outreach coordinator will facilitate complete and maintenance of products as part of her functional job description.
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IV.(B) ORGANIZATION AND MANAGEMENT
GOAL:
WIC services have changed through the COVID-19 Health Emergency. It is paramount that WV WIC undergo process changes to stay relevant and connected with West Virginia families. Through the use of outside consultants WV WIC will build capacity at the local agency level to effectively pilot projects and report their effectiveness. The state agency will gain valuable skills to increase their capacity to provide technical assistance to the local agency teams.
METHODOLOGY: Through consultant facilitated meetings, state and local agency teams will continue to develop leadership skills and test various project management styles, engage in peer-to-peer learning and information sharing to increase the overall capacity of WV WIC local agencies to modernize the West Virginia WIC Program. The state agency team will develop leadership, note taking, and facilitation skills to better serve the local agencies in their role as technical assistants.
EVALUATION: Operational Quality Improvement (OQI) is operating under a 3-year plan, October 1, 2022 – September 30, 2025. The group meets quarterly and has four workgroups; service delivery, workforce, communication and training - reference Nutrition Services II (C) for this specific goal. Each Local Agency will engage in at least one modernization (i.e. pilot) initiative for continual quality improvement which creates a cultural shift of a bottom up vs. top-down approach for quality improvement and modernization efforts.
Individual workgroup performance indicators for products will be developed in August 2024. The WV WIC program will implement a new Standard Operating Procedure (SOP) for the initiation of new pilot projects. This tool will promote and streamline the process of starting a new pilot project. It contains an algorithm of how the process should be initiated, researched, planned and presented for OQI approval. Evaluation of each pilot project is defined and conducted by the State Agency Research Coordinator.
STATUS:
Technology for a Better WIC Experience funding has supported this initiative January 1, 2023 through May 31, 2024 with status updates provided via FNS-908 quarterly reporting. Modernization funding began funding the initiative June 1, 2024 and will continue through FFY2025.
The pilot project SOP is in final review and will be presented at the August 2024 OQI meeting for approval. A Local Agency staff meeting pilot project and SOP will also be finalized by the end of the FY.
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The use of a Medicaid List SOP was initiated in February of 2023. The purpose of this outreach activity is to target pregnant mothers and children under 5 that are currently receiving WV Medicaid for WIC services. This is being accomplished by the use of targeted phone calls, emails, text messages, and mailings (based on designated Medicaid preferred method of contact) for pre-certification/application via a Google form or online portal application. This tool and SOP are currently in pilot with all local agencies throughout the state. To date, 21,419 emails have been sent with 376 responses.
Medical Nutrition Therapy for diabetes began piloting in July 2024 through the Monongalia County Health Department in a collaboration and partnership to develop policy and procedures to expand public health services within WIC clinics. Pilot is ongoing and will continue in FY 2025.
Hospital certification and enrollment pilot program is currently under development through the ONS and WVU Medicine. Hospital certifications are active at WVU Medicine Children’s Hospital in Morgantown and United Health Center Hospital in Bridgeport. The goal of this program is to have mom and newborn leave the hospital a WIC participant. A FFY2024 WIC Infrastructure proposal seeks to fund expansion of hospital certifications to six additional facilities over the next three years. It is proposed infrastructure funding support operations for two years in each facility to build caseload for ongoing support of hospital WIC personnel to be permanently within the facility. This personnel is a BFPC who conducts intake and breastfeeding services while a CPA remaining in clinic completes nutrition assessment via Google Meet. WVU Medicine has granted access to the EMR to obtain mom and baby anthropometric measures.
Lead testing was initiated in FY2024 through ONS and the Monongalia County Health Department in Harrison County via a Medicaid Quality Improvement grant. The data collected through this pilot proved 50-70 lead tests were being conducted monthly which is the most within WV in any setting. As such, the program will be expanded in FY2025 to include Monongalia and Marion county WIC clinics through the Monongalia County Health Department, and Ohio County WIC clinic through the Wheeling-Ohio Health Department. MCHD will pilot Medicaid billing for these services within Harrison County while the Medicaid Quality Improvement funding transitions to support Ohio County. This will provide feedback to Medicaid on the current reimbursement rate and the ability to sustain testing within WIC clinics long term. CDC funding was secured for the expansion into Monogalia and Marion County, but Medicaid billing will occur for those eligible to also test a blended funding structure. 4 of 5
A pilot project between Valley Health WIC Program and FamilyCare Health Centers has been awarded funding from The Pallottine Foundation and the Health Plan to implement the FamilyCare Prescribing Better Health Produce Prescription Program. FamilyCare Health Center patients will be receiving $50 preloaded debit cards to purchase fruits and vegetables each month for six months. Eligible maternal and child patients will also receive a “WIC fresh fruits and vegetables prescription form” as a referral for WIC services in Boone, Cabell, Kanawha and Putnam Counties. Additional referral methods were established to create a comprehensive approach that meets the needs of various providers and junctures in a patient experience. FamilyCare Eligibility Specialists will assist all potentially eligible families in applying for WIC through the online participant portal. FamilyCare Social Workers will utilize a Google Form for referral that will go directly to the Valley Health Systems WIC Program.
The use of the Massimo device to collect hemoglobin measurements noninvasively, is currently being studied in the Mid Ohio Valley Health Department Wood County clinic. The device is currently being tested against the traditional method of a finger stick. Data is being collected and analyzed at this point. This will continue into FY 2025.
Annual planning goals, objectives, methodology and evaluation have been developed via a collaborative SA - LA partnership in March and April of 2024 for the following areas: ● Farmers Market Nutrition Program ● Vendor Management ● Nutrition Services ● Breastfeeding ● Outreach
A standard operating procedure will be developed and adopted for the annual planning process.
WV accessibility and utilization rates have been discussed between state and local agencies. The local agencies commented in April 2024. The refinement of the definition and tracking will be discussed again in August 2024.
This will be an ongoing goal for FY2025.
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WIC services last fiscal year 8 Number of local agencies planned to provide WIC services this fiscal year 8 0 When does the State agency accept applications from potential local agencies? <☐> Annually <☐> Biennially <☐> On an on-going basis <☐> Other (specify) On an as needed basis 1 Does the State agency require existing local agencies to reapply and compete with new applicant agencies for authorization? <☐> Yes <☐> No If yes, what is the frequency? <☐> Annually <☐> Biennially 0 ☒Not applicable ☐Ot敨猨数楣祦 汃捩牯琠灡栠牥潴攠瑮牥琠硥匍汥捥 楴湯䌠楲整楲ൡ桔瑓瑡条湥祣甠敳桴潦汬睯湩牣瑩牥慩椠敳敬瑣湩潬慣条湥楣獥椠敮⁷ 敳癲捩牡慥湡⽤牯椠敲楶睥湩灡汰捩瑡潩獮映潲硥獩楴杮猠牥楶散愠敲獡›䌨敨正愠汬 琠慨⁴灡汰⥹不 睥匠牥楶 散䄠敲獡 䔇楸瑳湩 敓癲捩牁 慥 ݳ܇< 111111 111111111 111111111 11122222 2222222 2222222 2222222 2222222 2222222 2222222 2222222 2222222 2222222 2222222 2222222 2 ☐ > <☐> Coordination with other health care providers <☐> ☒ Projected cost of operations/ability to operate with available funds <☐> ☒ Location/participant accessibility <☐> ☒ Financial integrity/solvency <☐> <☐> Relative need in the area <☐> ☒ Range and quality of services <☐> ☒ History of performance in other programs <☐> ☒ Ay to serve projected caseload
<☐> <☐> Non-smoking facility <☐> <☐> Americans with Disabilities Act (ADA) compliance Other (specify by typing into the cells below): <☐> <☐> <☐> <☐> 1 The State agency conducts studies (provide a link to or copy of the most recent study: Wfing Project for Mid-Atlantic Region of the cost-effectiveness of local agency operations that examine: <☐> Location and distribution of local agencies in proportion to new applicants/participants <☐> Clinic procedures to optimize participant access/service (Patient Flow Analysis, etc.) ☒Staff-to-participant ratios and related staffing analyses ☒Comparative analyses of local agency/clinic costs ther 2 Does the State agency have a formal written agreement or contract with each local agency? HYPERLINK "https://www.ecfr.gov/current/title-7/part-246" \l "p-246.6" \h(HYPERLINK "https://www.ecfr.gov/current/title-7/part-246" \l "p-246.6" \h7 CFR 246.6) ☒Yes (list the contracton):October 1 through September 30 <☐> No 3 Does the State agency have statewide fair hearing procedures for local agency appeals? HYPERLINK "https://www.ecfr.gov/current/title-7/part-246" \l "p-246.4(a)(18)" \h(HYPERLINK "https://www.ecfr.gov/current/title-7/part-246" \l "p-246.4(a)(18)7 CFR 246.4(a)(18)) ☒Yes, attach local agency fair hearing procedures or specify the location in the Procedure Manual and reference below: WV P&P 1.17 – Fair Hearing Policy for Local Agencies <☐> No 4 Does the State agency maintain a list of clinic sites that include the following information? If available, please attach and/or reference the location of the listing: https://dhhr.wv.gov/wic – WIC participant sen – Find WIC Clinics <☐> Location <☐> Type of site (e.g., hospital, health department, community action program) ☒Service area ☒Hours of operation ☒Days of operation <☐> Health services provided on-site <☐> Social services provided on-site <☐> Participation <☐> Other (specify): Click or tap here to enter text.
A䩏䩐䩑䩞䩡_x0016_._x001b__x0010_萏Ǡ萑ﺘ葞Ǡ葠࠵ﺘ䌁ᑊ伀Ɋ倀Ɋ儀Ɋ帀Ɋ愀ᑊȀĀ⸀ĀЀĀ̀ ကༀᄁ预廾态预㗾Ĉ._x001b__x0 ocalgency Staffing <☐> Does not apply because the State agency has only one location or no local agency(ies). (PROCEED TO NEXT SECTION) 0 Staffing Standards HYPERLINK "https://www.ecfr.gov/current/title-7/part-246" \l "p-246.3(e)" \h(HYPERLINK "https://www.ecfr.gov/current/title-7/part-246" \l "p-246.3(e)" \h7 CFR 246.3(e)) 0 Which local agency staffing standards are prescribed by the State agency? ☒Credentials <☐> Staff levels <☐> Staff-to-participant ratio standards <☐> Time spent on WIC functions ☒Other (specify): FTE positions-to-participant ratios ☒Functions of CPAs ☒Paraprofessional requirements ☒Separation of duties to ensure no conflicts of interest <☐> Other (specify): <☐> Not applicable 1 Does the State agency’s ensure local agency(ies) credentials are in line with the Nutrition Services Standards? ☒Yes <☐> No Doe
V. NUTRITION SERVICES AND ADMINISTRATION (NSA) EXPENDITURES State Agency: West Virginia for FY 2025. NSA expenditures involve the process of allocating, documenting, and monitoring the distribution of administrative funds to local agencies, including the monitoring of nutrition education costs, and State and local agency direct/indirect costs. During disasters, emergencies, public health emergencies, or a supply chain disruption, including infant formula recalls, the State agency may request to implement existing and allowable regulatory flexibilities or waivers to support the continuation of Program benefits and services. Waivers granted under Access to Baby Formula Act of 2022 (codified at 7 CFR 246.4a(30)) or temporary provision(s) authorized by Congress are not permanent amendments to the State Plan; however, State agencies should consider any historical amendments as the result of waivers granted under prior waiver authority to develop policies and procedures for current and future disasters. A. Funds Allocation-246.4(a)(13); (14)(ix): describe the policies and procedures used to allocate administrative funds to local agencies, including start-up funds, and conversion of food funds to NSA funds. B. Local Agency Budgets/Expenditure Plans-246.4(a)(2): describe the policies and procedures for preparing and submitting local agency budgets and expenditure plans and the services that are entirely supported by WIC Program funds. C. State and Local Agency Access to Funds-246.4(a)(13): describe the procedures and method(s) of distribution/ reimbursement of NSA funds to local agencies. D. Reporting and Reviewing of State and Local Agency Expenditures-246.4(a)(11)(iv); (12); and (13): describe the policies and procedures used to report, monitor, and review State and local agencies’ expenditures, including the documentation of staff time, local agency report forms, on-site reviews of local agencies’ NSA expenditures, and in-kind contributions. E. Nutrition Education Costs-246.4(a)(9)and 246.14(c)(1): describe the plans and procedures used to meet the nutrition education expenditure requirements, including monitoring activities, local agency reports, and assurances that the special nutrition education needs of migrant farmworkers and their families, Indians, and homeless persons are met. F. Indirect Costs-246.4(a)(12) and 246.14(a)(1)(ii): describe the policies and procedures used to document and monitor indirect cost rates and services at the State and local level.
A. Funds Allocation 1. Allocation Process a. The State agency has established and provided written procedures to local agencies describing the process for allocation of NSA funds among local agencies. ☒Yes ☐No ☐Not applicable, State agency does not have separate local agencies. (Proceed to A. 2. Conversion of Food Funds to NSA Funds) b. Local agencies were involved in developing these procedures via: ☐Task force/committee of selected local agencies ☐Comment on proposals made available to all local agencies ☒Other (describe): Committee of State and Local Agencies developed the allocation methodology c. The State agency allocates NSA funds to local agencies through the use of: ☐A negotiated budget ☐Flat cost per participant Statewide ☒Formula (variable) ☐Other method (describe): N/A d. The allocation procedure takes the following factors into account (check all that apply): ☐Staffing needs ☒Number of participants ☐Population density ☐Cost-containment initiatives ☐Availability of administrative support from other sources ☐Other (specify): N/A e. The State agency methodology for funds allocations to local agencies includes a mechanism for reallocation. ☒Yes ☐Monthly ☐Quarterly ☐Semiannually ☐No ☐Other (specify): N/A ADDITIONAL DETAIL: NSA Expenditures Appendix and/or Procedure Manual (citation): N/A 2. Conversion of Food Funds to NSA Funds a. The State agency converts food funds to NSA funds: ☐Based on a plan submitted to FNS to reduce average food costs per participant and to increase participation above the FNS-projected level for the State agency.
☐The State agency achieves, through acceptable measures, increases in participation in excess of the FNS-projected level for the State agency. ☐Describe measures used to increase participation: ☒Not applicable ADDITIONAL DETAIL: NSA Expenditures Appendix and/or Procedure Manual (citation): N/A 3. The State’s Fiscal Year runs from July 1 to June 30 ADDITIONAL DETAIL: NSA Expenditures Appendix and/or Procedure Manual (citation): N/A B. Local Agency Budgets/Expenditures Plans 1. Local Agency Budgets/Expenditure Plans ☐Not applicable, State agency does not have separate local agencies. (Proceed to C. State and Local Agency Access to Funds.) a. The State agency requires its local agencies to prepare and submit administrative budgets. ☒Yes ☐No If yes, the State agency requires that local agency budgets include the same cost categories as those used for State-level budget preparation. ☒Yes ☐No b. Local agencies' budgets are broken out by (check all that apply): ☒Line items ☐Accounting ☒Maintenance and repair ☐ADP services ☒Materials and supplies ☐Breastfeeding aids ☒Memberships, subscriptions, and professional activities ☒Capital expenditures ☒Printing and reproduction ☐Clinic/lab services ☒Training and education ☐Communications ☐Transportation ☒Employee salaries ☒Travel ☒Employee fringe benefits ☒Other (specify): Contractual, Indirect, Utilities ☒Lease or rental of space ☒Breastfeeding promotion/support (e.g., breastfeeding aids) ☒Functions ☒Client services 3
☒General administration/ ☐Other (specify): N/A Program management ☐Food Delivery ☐Certification ☒Nutrition education ☐Other (specify): N/A c. The State agency has an established formal process for local agencies to follow when requesting amendments or modifications to their budgets. ☒Yes ☐No d. To prepare the federally required WIC administrative budget, the State agency: ☒Uses local agency budgets or prior year expenditures ☐Uses a state agency information system to collect and compile expenditure and cost data ☐Extracts or consolidates data reported under other State or local agency systems to group costs under the federal line items and functions ☐Other (describe): N/A ADDITIONAL DETAIL: SA/LA Spending Plan Appendix and/or Procedure Manual (citation): N/A C. State and Local Agency Access to Funds 1. The State Agency manages its NSA Grant on a/an: ☐Cash basis ☒Accrual basis ☐Other (specify): N/A ADDITIONAL DETAIL: NSA Expenditures Appendix and/or Procedure Manual (citation): N/A 2. Reimbursement/Provision of Funds to Local Agencies a. The State agency provides local agencies with funds in advance. ☒Yes (state conditions): Quarterly advance payments only paid when monthly and quarterly expenditure reports are submitted showing funds are being spent consistently ☐No ☐Not Applicable (Proceed to next section.) If yes, advances must be reconciled to incoming claims. Local agency claims are submitted: 4
☒Monthly ☐Quarterly b. In order to qualify for payment, an expenditure must be (check all that apply): ☒At or below the level of its approved budget line item ☒Supported by appropriate documentation (e.g., check or receipt) ☒A reasonable and necessary expense for WIC ☐Other N/A c. If an expenditure exceeds the budget provided for that particular line item, the State agency requires the local agency to (check all that apply): ☐Submit a supplemental request ☒Provide a justification for exceeding the budget line item ☐Make an offsetting adjustment to another line item in its budget ☒Request approval of a budget modification ☒Other (explain): Sufficient funds must remain in the grant agreement’s overall budget as well as each category d. Local agencies receive payment via: ☒Electronic funds transfer ☐State treasury check/warrant ☐Other (specify): N/A ADDITIONAL DETAIL: NSA Expenditures Appendix and/or Procedure Manual (citation): P&P 6.12 – Reporting and Project-Monthly Reporting; 6.14 – Payment to the Local Agency D. Reporting and Reviewing of State and Local Agency Expenditures 1.Documentation of Staff Time a. How does the State agency determine the percentage of staff time devoted to WIC tasks to document allowable staff costs under the WIC Program (check all that apply): At SA At LA ☒ ☐ 100 percent reporting ☐ ☐ Random moment sampling ☐ ☒ Periodic time studies: ☐ ☐ 1 week/month ☐ ☒ 1 month/quarter 5
☐ ☐ Other (specify): N/A b. The State agency last evaluated its time documentation protocol on (specify date). 5/1/2022 If available, please attach a copy of the protocol to this section or cite Procedure Manual reference. ADDITIONAL DETAIL: NSA Expenditures Appendix and/or Procedure Manual (citation): P&P 6.09 2. Please indicate below the services that are entirely supported by WIC funds: ☒Anthropometric measurements ☒Nutrition counseling/education ☒Breastfeeding promotion/support ☐Immunization status assessments ☐Referrals to health and/or social services ☒Hematological assessments ☐Other (specify): N/A ADDITIONAL DETAIL: SA/LA Spending Plan Appendix and/or Procedure Manual (citation): P&P 6.06 – Expenditures – Nutrition Education/Breastfeeding Promotion and Support; 6.08 – Expenditure – Client Services 3. Local Agency Report Forms a. The State agency specifies standard forms and/or procedures for local agencies to use in reporting monthly local-level expenditures. ☒Yes ☐No ☐Not Applicable (Proceed to next section) ADDITIONAL DETAIL: NSA Expenditures Appendix and/or Procedure Manual (citation): P&P 6.12 – Reporting and Projection- Monthly Reporting; 6.14 – Payment to the Local Agency 4. On-Site Review of Local Agencies' Administrative Expenditures a. The State agency conducts on-site reviews of local agency administrative expenditures: ☐Annually ☒Every two years ☐Every three years ☐Other (specify): N/A The review is conducted by: ☐WIC State agency staff ☒State Department of Health fiscal or audit staff 6
☐CPA or audit firm ☐Other (specify): N/A b. The State agency utilizes a standard format/guide to review local agencies' NSA expenditures. ☒Yes ☐No If yes, the standard review guide includes the following procedures (check all that apply): ☒Verification of at least one monthly billing/claim/expenditure report against source ☒Documents ☒Tracking written approval of procurements ☒Requesting records of ordering, receipt, billing, and payment ☒Determination that costs were necessary, reasonable, and appropriate ☒Determination that costs were properly allocated among WIC and other programs ☒Determination that personnel costs charged to WIC were appropriate ☒Determination that local agencies' indirect costs were appropriately charged ☐Other (specify): N/A c. If available, please attach a copy of the State agency's NSA expenditure review guide. d. The State agency notifies local agencies of findings and establishes claims for unallowable costs, as appropriate. ☒Yes ☐No ADDITIONAL DETAIL: NSA Expenditures Appendix and/or Procedure Manual (citation): N/A 5. The State agency requires local agencies to document the sources and values of in-kind contributions. ☐Yes ☐No ADDITIONAL DETAIL: NSA Expenditures Appendix and/or Procedure Manual (citation): N/A E. Nutrition Education Costs 1. The State agency documents that it meets its nutrition education and breastfeeding promotion expenditure requirements per 7 CFR 246.14(c)(1) via: 7
☐Activity reports ☐Time studies ☒Itemizing expenditures ☐Other (specify): N/A ADDITIONAL DETAIL: NSA Expenditures Appendix and/or Procedure Manual (citation): P&P 6.12 – Reporting and Projection – Monthly Reporting 2. The State agency monitors expenditures for the following activities related to breastfeeding promotion and support at the State and/or local level (check all that apply): At SA At LA Breastfeeding promotion coordinator’s salary ☒ ☒ Written educational materials ☒ ☐ Participant education/counseling ☐ ☒ Staff training ☒ ☒ Breastfeeding promotion activities ☐ ☒ Direct support costs ☒ ☐ Breastfeeding aids and equipment (e.g., breast ☒ ☐ pumps purchased with NSA funds) Other ☐ ☐ (If other, specify): N/A ADDITIONAL DETAIL: NSA Expenditures Appendix and/or Procedure Manual (citation): P&P 6.06 – Expenditure – Nutrition Education/Breastfeeding Promotion and Support; the WIC accountant also monitors expenditures as the local agency invoices come in via the State Accounting System. 3. In the event that the State agency uses funds from other sources in meeting minimum expenditure requirements for nutrition education (NE) and breastfeeding promotion and support (BFPS), please provide below the source of these funds, the amount, and the method the State agency will use to document the use of these NE and BFPS funds. (Federal WIC food funds used to purchase/rent breast pumps, and expenditures from breastfeeding peer counseling funds, cannot be counted toward the nutrition education and breastfeeding expenditure requirement.) 8
☒Does not apply. (Proceed to E. 4. Local agencies report nutrition education and breastfeeding promotion and support costs.) Source Amount N/A N/A N/A N/A N/A N/A Method(s): ☐Activity reports ☐Time studies ☐Itemizing expenditures ☐Other (specify): N/A ADDITIONAL DETAIL: NSA Expenditures Appendix and/or Procedure Manual (citation): N/A 4. Local agencies report nutrition education and breastfeeding promotion and support costs: ☐Does not apply ☒When they report routine NSA costs ☐Through a different system (specify): N/A ADDITIONAL DETAIL: NSA Expenditures Appendix and/or Procedure Manual (citation): N/A F. State and Local Agency Indirect Costs 1. Indirect Cost Rate and Services a. Please list below indirect cost/cost allocation agreements in which the State agency is included: N/A b. The State agency's indirect cost rate(s) is 33.70% and is based on: ☒Salaries ☐Direct costs for administration☐Both ☒Other (specify): Salaries and wages only, excluding all fringe benefits c. If applicable, cite the effective date of the State agency’s executed cost allocation plan for indirect cost: N/A If applicable, cite the expiration date of the State agency’s most recent executed indirect cost 9
allocation plan: N/A d. The State agency receives the following types of services under the indirect cost rate agreement(s): ☒Budgeting/accounting ☒Personnel/payroll ☒ADP ☐Space usage/maintenance ☒Communication/phone/mail ☐Central supply ☒Legal services ☐Procurement/contracting ☐Printing/publication ☒Audit services ☒Equipment usage/maintenance ☐Other (specify): N/A e. The State agency allows local agencies to report indirect costs. ☒Yes ☐No ☐Not Applicable ADDITIONAL DETAIL: NSA Expenditures Appendix and/or Procedure Manual (citation): N/A 2. Review of Indirect Cost Documentation a. The State agency and local agencies ensure that services received and paid for through indirect costs benefit WIC, and are not also charged directly to WIC by comparing direct charges by line item to a listing of services paid by funds collected through the application of the indirect cost rate: ☐Done for State agency level indirect costs (frequency): N/A ☒Done for local agency level indirect costs (frequency): Annually ☐Not done at either level. b. State and local agency WIC management have access to and review the following documents as applicable to ensure that indirect cost services are not also charged directly to WIC (check all that apply): At SA At LA Indirect cost agreements/plans ☒ ☐ The accounting mechanism used to ensure the ☐ ☐ propriety of indirect cost charges A copy of the cost allocation plan ☐ ☐ A list of all services paid from indirect costs ☐ ☒ Other documentation related to the establishment ☐ ☐ and charging of indirect costs 10
Not applicable ☐ ☐ c. When the State agency reviews the local agencies' indirect cost rate agreements, the review includes (check all that apply): ☐Required submission of indirect cost agreement by the local agency to the State agency ☐Assessment of how the rate or method is applied (correct time period, percentage, and base) ☐Verification that the State agency had previously approved the local agency to negotiate such an agreement ☒Post-review or audit to ensure the rate was applied correctly ☐Other documentation related to the establishment and charging of indirect costs (list): N/A ☐Not applicable ADDITIONAL DETAIL: NSA Expenditures Appendix and/or Procedure Manual (citation): Appendix V. A Indirect Cost Rate Agreement 2023 11
VI. FOOD FUNDS MANAGEMENT (Please indicate) State Agency: West Virginia. for FY: 2025. Food funds management involves monitoring cost containment measures and procedures related to infant formula and other authorized food items, the monitoring and management of State agency funding sources, and the accurate reporting of participation figures. During disasters, emergencies, public health emergencies, or a supply chain disruption, including infant formula recalls, the State agency may request to implement existing and allowable regulatory flexibilities or waivers to support the continuation of Program benefits and services. Waivers granted under Access to Baby Formula Act of 2022 (codified at 7 CFR 246.4a(30)) or temporary provision(s) authorized by Congress are not permanent amendments to the State Plan; however, State agencies should consider any historical amendments as the result of waivers granted under prior waiver authority to develop policies and procedures for current and future disasters. A. Cost Containment Measures - 246.4(a)(14)(xi), 246.4(a)(14)(xvii), 246.16a(a): describe the policies and procedures used to implement cost containment measures as they relate to infant formula contracts, their approval and the processing of infant formula and/ or other rebates, and food package cost containment practices. B. Funds Monitoring/798 Reporting - 246.4(a)(2); (a)(12); and (a)(14): describe the State agency's funding sources, how food obligations are calculated to allow for inflation, rebate cash management, and monthly closeout monitoring activities. C. Participation Reporting - 246.4(a)(11): describe the methods used to accurately document and monitor participation at the State and local level, and methods for monitoring changes in participation by priority.
VI. FOOD FUNDS MANAGEMENT A. Cost Containment Measures 1. The State agency seeks FNS approval related to infant formula cost containment measures (check one): ☐For a waiver of the requirement for a single-supplier competitive system. State agency must complete a cost comparison projecting food cost savings in the single-supplier competitive system based on the lowest monthly net price or highest monthly rebate [as required in Section 246.16a(d)(2)(i) through (d)(2)(iii) and savings under an alternative cost containment system, Section 246.16a(d)(2)(B)] ☐To issue an infant formula bid solicitation that evaluates bids by highest rebate. A State agency must demonstrate to FNS’ satisfaction that the weighted average retail prices for different brands of infant formula in the State vary by 5% or less [as required in Section 246.16a(c)(5)(iii)]. ☒Not applicable Please attach in the Appendix supporting documentation for requests for FNS approval. ADDITIONAL DETAIL: Food Funds Management Appendix and/or Procedure Manual (citation): N/A. 2. Cost Containment Contracts for Infant Formula a. The State agency acquires infant formula through the following food delivery systems: i. Non-exempt infant formula (check all that apply): ☐Home food delivery system ☐Direct distribution food delivery system ☒Retail food delivery system ☐Other (specify): N/A. ii. Exempt infant formula (check all that apply): ☐Home food delivery system ☒Direct distribution ☒Retail food delivery system ☐Other (specify): N/A. iii. WIC-eligible nutritionals (check all that apply): ☐Home food delivery system ☒Direct distribution system ☒Retail food delivery system ☐Other (specify): N/A. 2
VI. FOOD FUNDS MANAGEMENT b. The State agency has a rebate contract/agreement for infant formula. ☒Yes ☐No If no, check which applies: ☐Granted waiver ☐ITO with participation under 1,000 as of April (Proceed to question A.4. Cost Containment for Other Foods) c. Current fiscal year rebates and current net price per unit paid (note the price should reflect current prices rather than original contract prices and rebate amounts): My rebate price sheet is available and attached as Appendix VI A Abbott Rebate Contract Pricing 7-1-2024 (Proceed to A. 3. Infant Formula Issuance.) Primary Contract Infant Formula Product/Unit Size Manufacturer Rebate/Unit Net price/Unit % WS Discount Liquid Concentrate Milk-Based Abbott Soy-based* Abbott Powder Milk-based Abbott Abbott Soy-based* Abbott Abbott Ready to Feed Milk-Based Abbott Abbott Soy-based* Abbott Abbott Exempt Formula (If applicable) *If separate contracts for milk- and soy-based infant formula. 3
VI. FOOD FUNDS MANAGEMENT 3. Infant Formula Issuance. a. Does the State agency issue the Primary Contract Infant Formula as the first choice of issuance (by physical form), with all other infant formulas issued as an alternative? (Section 246.16a(c)(8) & 246.10(e)(1)(iii)) ☒Yes ☐No b. The percent of total infant participants receiving each type of formula is estimated at: *Contract (infant formula authorized and rebated through infant formula cost containment contract/s awarded by the State agency) 76.08% *Non-contract (infant formula that is not rebated through an infant formula cost containment contract awarded by the State agency.) Exempt infant formula (non-contract infant formula that is issued through Food Package III) 23.92% Non-exempt infant formula (non-contract infant formula that is issued through Food Packages I & II)0% *Contract and Non-contract categories should total to 100%. Exempt and Non-Exempt subcategories should total to 100%. ADDITIONAL DETAIL: Food Funds Management Appendix and/or Procedure Manual (citation): N/A. 5. Cost Containment for Other Foods a. Rebates are also obtained on other WIC foods. ☐Yes (specify foods and attach contract in Appendix): N/A. ☒No b. The State agency intends to pursue rebates on other authorized foods. ☐Yes (specify): N/A. ☒No c. To contain food costs, the State agency has limited authorized foods/container sizes/types, etc. ☒Yes (If yes, note such limitations on the following table) ☐No ADDITIONAL DETAIL: Food Funds Management Appendix and/or Procedure Manual (citation): N/A. 4
VI. FOOD FUNDS MANAGEMENT Specific brands are designated Disallowed Only certain container sizes are allowed Allowabl e types are limited Other Exempt formula for women, infants & children X Infant cereal X Infant Fruit/Veg/Meat X Whole fresh fluid milk X Lowfat fresh fluid milk X Skim fresh fluid milk X Fresh milks (e.g., Lactaid, cultured buttermilk, goat milk) (specify): Click or tap here to enter text. X Shelf-stable milk (e.g., evaporated milk, UHT, whole/ low fat/nonfat dry milk) X Cheese X X Yogurt X X X Soy-based beverage X X X Tofu Fresh eggs X X Dried egg mix Hot cereal X X Cold cereal X X Other whole grains X X X Peanut butter X X Dry beans/peas X X Canned Fish X X Canned beans/peas X X 5
VI. FOOD FUNDS MANAGEMENT B. Funds Monitoring/798 Reporting 1. The State agency has procedures to assure that the requirements are met regarding the nonprocurement of food in bulk lots, supplies, equipment, and other services from entities that have been debarred or suspended. ☒Yes ☐No ADDITIONAL DETAIL: Food Funds Management Appendix and/or Procedure Manual (citation): N/A. 2. Food Cost Obligations a. The State agency calculates food obligations based on the following data (check one): ☒Number of expected participants and average food cost per participant ☐Number of expected participants by category (e.g., pregnant woman, infant, etc.) and average food cost per participant category ☐Number of expected redemptions by food instrument type and cash-value voucher type and average value per food instrument type and cash-value voucher type ☐Other (specify): N/A. b. The State agency estimates the impact of inflation on food costs through the use of the following inflation escalators: ☒Inflation factor used in Federal funding formula ☐State-generated estimates of inflation based on State market basket of foods ☐Best guess by food item based on economic reports or other sources ☐Other (specify): N/A. c. The State agency Management Information System automatically produces a monthly obligation amount ☒Yes ☐No, data are pulled from various sources and an estimated amount is calculated manually or with a PC spreadsheet ☐Other (specify): N/A. 6
VI. FOOD FUNDS MANAGEMENT d. The State agency system (in-house or contracted) provides the following data on electronic benefit transactions at specific (daily, weekly, monthly, as needed) frequencies (check all that apply and provide frequency): Frequency Data N/A ☒Electronic benefits paid for issue month N/A ☒Electronic benefits outstanding for issue month N/A ☒Electronic benefits that have expired N/A ☒Electronic benefits that are void/unclaimed ADDITIONAL DETAIL: Food Funds Management Appendix and/or Procedure Manual (citation): N/A. 3. Rebate Cash Management a. The State agency has a billing system in place that ensures rebate invoices for all authorized food, including infant formula, under competitive bidding, provide a reasonable estimate, or actual count of the number of units purchased by participants during WIC transactions (Section 246.16a(k)). ☒Actual count of units purchased ☐Estimate of units purchased (attach methodology) ☐Other (describe): N/A. b. The State agency uses a food instrument that enables it to identify the type and brand of infant formula redeemed. ☒Yes, for all formula types, brands, and physical forms ☐Yes, for exempt infant formulas ☐No c. The invoice to the formula manufacturer is issued by: ☐The WIC unit ☐The State agency fiscal unit ☒Other (specify): Bureau for Public Health, Office of Nutrition Services d. Monthly invoices are submitted with supporting data. ☒Yes ☐No ADDITIONAL DETAIL: Food Funds Management Appendix and/or Procedure Manual (citation): N/A. 7
VI. FOOD FUNDS MANAGEMENT 4. Closeout of Report Month Outlays a. The State agency allows the food vendor (and farmer if any) the following number of days to submit food instruments and cash-value benefits for payment (provide the number of days): 31 days from the participant’s first valid date b. The State agency is generally able to close out a report month completely within: ☒90 days ☐120 days ☐Other (specify number of days): N/A. ADDITIONAL DETAIL: Food Funds Management Appendix and/or Procedure Manual (citation): N/A. 5. Indicate the method used to reimburse vendors (and farmers if any) for redeemed food instruments and cash- value vouchers or other services and specify the entity responsible for making payment: State WIC State FM Other (Specify) ☐ ☐ By check directly to vendor or farmer ☐ ☐ By check directly to vendor’s or farmer’s bank ☒ ☒ By electronic transfer to vendor's or farmer’s bank ☐ ☐ Other (specify): N/A. ADDITIONAL DETAIL: Food Funds Management Appendix and/or Procedure Manual (citation): N/A. C. Participation Reporting 1. Participation Counting a. The State agency counts an enrollee who received at least one food instrument/food package (or who received no food instrument/food package, but was either a fully-breastfed infant of a participating breastfeeding woman or a woman partially breastfeeding a participating 6 to 12 month old infant) as a participant during: ☐The calendar month ☒The computer system cycle month ☐Other (specify): N/A. 8
VI. FOOD FUNDS MANAGEMENT b. The State agency receives participation counts from: ☒The State agency computer system based on the number of persons issued food or food instruments (manual and automated food instruments), the number of fully-breastfed infants who receive no food or food instruments, but are breastfed by participating breastfeeding women, and the number of women who receive no food or food instruments, but are partially breastfeeding a participating 6 to 12 month old infant. ☐Counts reported from local agencies based on issuance records ☐Other (specify): N/A. c. If State funds are present, the State agency differentiates between Federal-supported and State-supported participants by: ☐Special code on food instrument ☐Special areas of State designated as State-supported areas ☐Pro rata allocation based on proportion of Federal to State funds spent ☐Other (specify): N/A. ☒N/A State funds do not support participation d. When local agencies are chronically late in furnishing food instrument and/or certification data needed for participation counts, the State agency: ☐Sends warnings ☐Applies financial sanctions ☐Requires manual reporting ☒Other (specify): N/A – Issuance data is sent via real time from Crossroads to the EBT Processor (FIS/CDP) ADDITIONAL DETAIL: Food Funds Management Appendix and/or Procedure Manual (citation): N/A. 2. Participation by Priority a. Priority level is a critical data field in the State agency's computer system. ☒Yes ☐No b. The State computer system automatically assigns priority level based on the enrollee's nutritional risk condition. ☒Yes ☐No 9
VI. FOOD FUNDS MANAGEMENT c. The State agency’s computer system revises the priority level determination when a participant changes category (e.g., infant becomes child and receives a child’s food package). ☒Yes ☐No d. The State agency has an “unknown” priority category for VOC transfers where priority is unknown. ☒Yes ☐No 3. Participation by Local Agency The State agency's computer system supports its requirement to report participation data by local agency to measure breastfeeding performance. ☒Yes ☐No ☐N/A ADDITIONAL DETAIL: Food Funds Management Appendix and/or Procedure Manual (citation): N/A. 10
VII. CASELOAD MANAGEMENT (Please indicate) State Agency: West Virginia for FY: 2025 Caseload management involves identifying the target population and special populations within it, implementing strategies to enroll the potential population, and utilizing caseload effectively to reach the desired populations. Describe the procedures in place to implement these strategies. During disasters, emergencies, public health emergencies, or a supply chain disruption, including infant formula recalls, the State agency may request to implement existing and allowable regulatory flexibilities or waivers to support the continuation of Program benefits and services. Waivers granted under Access to Baby Formula Act of 2022 (codified at 7 CFR 246.4a(30)) or temporary provision(s) authorized by Congress are not permanent amendments to the State Plan; however, State agencies should consider any historical amendments as the result of waivers granted under prior waiver authority to develop policies and procedures for current and future disasters. A. No-Show Rate – 7 CFR 246.4(a)(11)(i): describe the procedures used by the State agency to monitor potential and current participants’ utilization of program services. B. Allocation of Caseload – 7 CFR 246.4(a)(5)(i) and (13): describe how the State agency assigns and manages local agency caseload allocations. C. Caseload Monitoring – 7 CFR 246.4(a)(5)(i): describe the information and procedures used by the State agency to monitor caseload. D. Benefit Targeting – 7 CFR 246.4(a)(5)(i); (6), (7), (19), (20), (21), and (22): describe the plans and procedures for ensuring that WIC benefits reach the highest risk participants and persons in special need such as migrants, homeless, and institutionalized persons; pregnant women in their early months of pregnancy; and applicants who are employed or who reside in rural areas. E. Outreach Policies and Procedures – 7 CFR 246.4(a)(5)(i),(ii); (6), (7), (19), and (20): describe the types of outreach materials used, where these materials are directed, special agreements with other service organizations and how special populations are addressed. Also, provide data on unserved and underserved areas. F. Caseload Management Strategies – 7 CFR 246.16(c)(2)(ii), 7 CFR 246.4(a)(11)(i); 246.7(f)(1),(2); 246.7(h)(3)(i): describe the policies and procedures used to manage caseload during a funding shortage, lapse in appropriations, or other WIC funding circumstances. 2
A. No-Show Rate 1. Policies and Procedures for Missed Certification Appointments and Food Instrument/Cash Value Voucher Pick-Up (No-Shows) a. The State agency has specific policies and procedures to ensure follow-up of no-shows for (check all that apply): ☒Initial certification for any potential participant ☒Subsequent certifications for high-risk participants ☒Subsequent certification for current participants ☒Food instrument/cash value voucher pick-up ☐Food instrument/cash value voucher/cash value benefit non-redemption ☐State agency has no specific policies and procedures for no-show follow-up b. The local agency or State agency, when the State agency has no separate local agencies, attempts to contact each pregnant woman who misses her first appointment to apply for participation in the Program to reschedule the appointment. Such procedures include (check all that apply): ☒At the time of initial contact, the local agency obtains the pregnant woman's mailing and/or email address and telephone number ☒If the applicant misses her first certification appointment, an attempt is made to contact her by: ☒Telephone ☒Mail ☒Email ☒Text ☐Mobile App ☒If contact is established, she is offered one additional certification appointment. ☒If she cannot be reached, the local agency follows-up with a request for the applicant to contact the local agency for a second appointment by sending her a: ☐Postcard ☒Letter ☐Email ☐Text ☒A second appointment is provided upon request from the applicant. ☐Other Click or tap here to enter text. ADDITIONAL DETAIL: Caseload Management Appendix and/or Procedure Manual (citation): P&P 1.13 2
2. Monitoring No-Show Rates a. The State agency has (check all that apply): ☒Standards defining acceptable no-show rates ☒Policies and procedures designed to assist local agencies to improve no-show rates; Please attach ☐Sanctions that may be applied to local agencies that have chronically unacceptable no-show rates; Please attach ☒Provides regular feedback to local agencies concerning no-show rates ☒Reports to address appropriate follow-up of no-shows ☐No specific policies or procedures concerning local agency no-show rates b. As a matter of standard procedure, the State agency monitors no-show rates through (check all that apply): ☐State agency does not monitor local agency no-show rates ☒Local agency reviews ☒Automated reports ☒Local agency reports on no-show rates ☐Other (specify): Click or tap here to enter text. ADDITIONAL DETAIL: Caseload Management Appendix and/or Procedure Manual (citation): P&P 1.13 B. Allocation of Caseload ☐DOES NOT APPLY (EXPLAIN WHY AND PROCEED TO NEXT SECTION) Click or tap here to enter text. 1. The State agency considers the following factors in its initial allocation of caseload to local agencies in a program year (check all that apply): ☐Percent of target population served by local agency's service area ☐Analysis of no-show, void, non-redemption rates by local agencies ☐Participation by priority and category ☐Special population pockets ☐Waiting lists ☐Staffing/ability of local agencies to serve caseload ☒Prior year caseload ☐Food package costs per person ☐Special projects ☒Other (identify): Weighed average of previous three FYs caseload ADDITIONAL DETAIL: Caseload Management Appendix and/or Procedure Manual (citation): 3
Appendix VII (C)-WIC Estimates v2024 032624.xlsx and Appendix VII (D)-WV WIC Eligible Population Methodology and recommendations 2024.docx 2. The State agency has a written procedure for allocation of caseload to local agencies. ☐Yes ☒No If yes, attach written procedure in the Caseload Management Appendix or specify location in the Procedure Manual below. If no, what guidelines does the State agency use for caseload allocation? (Describe in Caseload Management Appendix) ADDITIONAL DETAIL: Caseload Management Appendix and/or Procedure Manual (citation): Appendix VII (A) Caseload Allocation Methodology 3. The State agency has a procedure in place to ensure that current/prior year caseload levels are maintained. ☐Yes ☒No If yes, attach procedure in the Caseload Management Appendix. Click or tap here to enter text. 4. If it appears that during the course of the program year all funds will be spent, the State agency may reallocate caseload on the basis of the following factors (check all that apply): ☒The State agency does not reallocate caseload mid year ☐Same basis as for initial allocation of caseload ☐Local agency participation levels ☐Local agency high priority participation ☐Waiting lists ☒Other (specify): SA will award additional funds for those LAs that exceed their assigned caseload if funding permits; SA will make requests for additional funding via reallocation requests 5. If it appears that during the course of the program year all funds will not be spent, the State agency may reallocate caseload on the basis of the following factors (check all that apply): ☒The State agency does not reallocate caseload mid-year ☐Same basis as for initial allocation of caseload ☐Local agency participation levels 4
☐Local agency high priority participation ☐Waiting lists ☐Successful special projects ☒Other (specify): The SA will work with LA to complete budget revisions, and USDA approval, to redirect funds for infrastructure needs (i.e. purchase of vehicles, renovations or other needs not typically met within operational budget). ADDITIONAL DETAIL: Caseload Management Appendix and/or Procedure Manual (citation): Click or tap here to enter text. 6. The State agency has written procedures for local agencies to follow in situations of overspending: ☐Yes ☒No If a written procedure is available, provide in the Caseload Management Appendix or specify location in the Procedure Manual below. ADDITIONAL DETAIL: Caseload Management Appendix and/or Procedure Manual (citation): When grant agreements are established by the Central Finance Unit for WIC Local Agencies, the funding is defined based on participation over the last three fiscal years and the grantee agrees to this initial budget via a Letter of Intent. Should an invoice be submitted that is more than the LAs remaining budget, the LA will only be paid what is left in the grant agreement. Any additional funding must be processed via a change order to the grant. The WV state accounting system (wvOASIS) will not allow an invoice to be paid for more than an encumberance. C. Caseload Monitoring 1. The State agency's caseload monitoring process includes the review of the following data (check all that apply): ☒Participation levels/rates ☒High-risk participant levels/rates ☒No-show rates ☐Food costs per participant ☐Food costs by area ☐Other (specify): Click or tap here to enter text. ADDITIONAL DETAIL: Caseload Management Appendix and/or Procedure Manual (citation): P&P 1.13 – Appointment Show Rate and P&P 1.09 Waiting List Management 2. The State agency uses the following methods to monitor the below task (check all that apply): ☐Manual reports submitted by local agencies ☐MIS-generated reports (If utilized please attach a description of each report and how they are 5
used) ☐On-site reviews ☒Other (specify): Appendix VII (A) and Appendix VII (E)- UnduplicatedFY2023_with_family.xlsx ADDITIONAL DETAIL: Caseload Management Appendix and/or Procedure Manual (citation): Appendix VII (A) 3. Local agency caseload utilization, by any method, is reviewed by the State agency at least: ☒Monthly ☒Quarterly ☒Other (specify): Annually ☐Not applicable ADDITIONAL DETAIL: Caseload Management Appendix and/or Procedure Manual (citation): Click or tap here to enter text. D. Benefit Targeting 1. Development and Monitoring of State Agency Targeting Plans a. The State agency has a plan to inform the following classes of individuals of the availability of Program benefits (check all that apply): ☒Pregnant women, with special emphasis on pregnant women in the early months of pregnancy ☒High-risk postpartum women (e.g., teenagers) ☒Parents/Caregivers of Priority I & II infants ☒Migrants ☒Homeless persons/families ☒Incarcerated pregnant women ☒Institutionalized persons ☐Other (specify): Click or tap here to enter text. ADDITIONAL DETAIL: Caseload Management Appendix and/or Procedure Manual (citation): P&P 7.06, 7.07, 7.08, 7.09 b. The local agency or State agency, when the State agency has no separate local agencies, contacts the following organizations to provide WIC Program information to eligible infants and children: ☒Foster care agencies ☒Protective service agencies ☒Child welfare authorities ☐Other (specify): Click or tap here to enter text. 6
c. The State agency ensures that benefits are targeted to those at greatest risk by limiting the use of regression as a nutrition risk criterion to only once after a certification period. ☒Yes ☐No d. In addition to, or in lieu of, State-developed plans, the State agency encourages/permits local agencies to develop their own targeting plans. ☐Yes ☒No ☐Not Applicable e. If yes, the State agency assures the appropriateness/quality of local agency targeting plans by: ☒Requiring local agencies to submit plans for State agency approval ☒Review plans during local agency reviews ☐Other (specify): Click or tap here to enter text. f. The State agency monitors benefit targeting through (check all that apply): ☒Automated reports developed by State agency ☐Manual reports submitted by local agencies ☒Local agency reviews ☐Other (specify): Click or tap here to enter text. ADDITIONAL DETAIL: Caseload Management Appendix and/or Procedure Manual (citation): P&P 7.10 – Outreach Targeting Plan and Evaluation E. Outreach Policies and Procedures 1. Outreach Policies, Procedures and Materials a. To administer outreach activities, the State agency (check all that apply): ☒Issues a standard set of outreach materials for use by all local agencies ☒Requires local agencies to develop outreach plans ☒Reviews outreach plans developed by local agencies ☒Reviews and approves any outreach materials developed by local agencies ☒Utilizes broadcast media for outreach activities ☐Other (specify): Click or tap here to enter text. b. Availability of Program benefits is publicly announced at least annually via: State Agency Local Agency ☒ ☒Newspapers ☐ ☐Radio ☒ ☒Posters ☒ ☐Letters ☒ ☒Brochures/pamphlets 7
☐ ☐Television ☒ ☒Social Media (Twitter, Facebook, etc.) ☒ ☒Other (specify): Community Events c. Outreach materials are available in the following languages (check all that apply): ☒English ☒Spanish ☐Vietnamese ☐Tribal Language(s) ☐Other (specify): Click or tap here to enter text. d. Outreach materials are distributed to (check all that apply): ☒Health and medical organizations ☒Hospitals and clinics ☒Welfare and unemployment offices or social service agencies ☒Migrant farmworker organizations ☐Indian and tribal organizations ☒Homeless organizations ☒Faith-based and community organizations in low-income areas ☒Shelters for victims of domestic violence ☒Food Banks ☒Head Start Centers ☐Other (specify): Click or tap here to enter text. ADDITIONAL DETAIL: Caseload Management Appendix and/or Procedure Manual (citation): P&P 7.02 Publicizing WIC; P&P 7.03 Building an Outreach Network; P&P 7.04 Inform Organization in the Network About the WIC Program, P&P 7.05 Coordination with Community Resources When an ITO State agency operates as both the State and local agency "All" should be checked. 2. Accessibility to Special Populations a. The State agency requires [all, some, none] local agencies to implement the following to meet the special needs of employed applicants/participants. All Some None ☐ ☒ ☐ Early morning/evening clinic hours by appointment ☐ ☒ ☐ Early morning/evening clinic hours, walk-in basis ☐ ☐ ☒ Weekend hours, by appointment ☐ ☐ ☒ Weekend hours, walk-in basis ☐ ☐ ☒ Priority appointment scheduling during regular clinic operations 8
☐ ☒ ☐ Food instrument/cash value voucher mailing procedures specifically designed for working participants ☐ ☒ ☐ Expedited clinic procedures for working participants ☐ ☒ ☐ Evening/weekend nutrition education classes ☒ ☐ ☐ Other (specify): walk-in appointments during outlined operating hours b. The State agency requires/authorizes [all, some, none] local agencies to implement the following to meet the special needs of rural participants (check all that apply): All Some None ☐ ☒ ☐ Special clinic hours to accommodate travel time to clinic sites ☐ ☒ ☐ Use of mobile clinics to rural areas ☐ ☒ ☐ Food instrument/cash value voucher mailing procedures Specifically designed for rural participants ☐ ☒ ☐ Special appointment/scheduling procedures for rural participants who do not have access to public transportation ☐ ☒ ☐ Special food instrument/cash value voucher issuance cycles for rural participants (check one): ☐2 months issuance, ☐3 months issuance ☐ ☐ ☐ Other (specify): Click or tap here to enter text. c. The State agency requires/authorizes [all, some, none] local agencies to implement the following to meet the special needs of migrant families (check all that apply): All Some None ☐ ☒ ☐ Formal coordination with rural/migrant health centers ☐ ☒ ☐ Special outreach activities aimed at migrants ☐ ☒ ☐ Special clinic hours/locations to service migrant populations ☐ ☒ ☐ Expedited appointment procedures to accommodate migrant families ☐ ☒ ☐ Special food instrument/cash value voucher issuance cycles for migrant families (check one): ☐2 months issuance; ☐3 months issuance ☐ ☒ ☐ Other (specify): mobile clinics d. The State agency has in place formal agreements with one or more contiguous States to facilitate service continuity to migrants (exclusive of normal verification of certification procedures): ☐Yes (If yes, please identify the State agencies ☒No with whom formal agreements exist): Click or tap here to enter text. 9
e. The State agency requires [all, some, none] local agencies to implement the following proceedings to facilitate service to homeless families/individuals (check all that apply): All Some None ☒ ☐ Provide homeless applicants with a list of shelters/facilities that fulfill WIC Program requirements ☒ ☐ ☐ Undertake regular and ongoing outreach to homeless individuals ☒ ☐ ☐ Routinely monitors facilities serving homeless participants to ensure WIC foods are not subsumed into communal food service ☐ ☐ ☒ Implement formal agreement with other service providers to facilitate referrals of homeless families/individuals ☒ ☐ ☐ Secure a written statement from the facility attesting to compliance with the requisite conditions for WIC services in a homeless facility ☒ ☐ ☐ Establish, to the extent practicable, plans to ensure that the three conditions in 7 CFR 246.7(m)(1)(i) regarding homeless facilities are met ☐ ☐ ☐ Other (specify): Click or tap here to enter text.
ADDITIONAL DETAIL: Caseload Management Appendix and/or Procedure Manual (citation): Click or tap here to enter text. 3. Unserved Geographical Areas a. How does the State agency prioritize areas defined as underserved geographic areas in descending order? NA b. Please list unserved geographic areas or attach a list to appendix: Click or tap here to enter text. ☒No current unserved areas (check if applicable) ADDITIONAL DETAIL: Caseload Management Appendix and/or Procedure Manual (citation): Click or tap here to enter text. 4. Underserved Geographic Areas a. The State agency has a list on file of served and/or underserved geographic areas including the number of newly potential applicants, the priority level currently being served, and 10
participation. ☒Yes ☐No b. The names and addresses of all local agencies found in the last FNS-648 Report, reflect all local agencies currently in operation. ☐Yes ☒No, an update list is provided in the Appendix VII (B)WIC Local Agency Directory 2024.xlsx ☐N/A, State agency has no local agencies ADDITIONAL DETAIL: Caseload Management Appendix and/or Procedure Manual (citation): Appendix VII (B) 5. The State agency has a plan to: ☒Inform potential local agencies of the Program and the availability of technical assistance in implementation. ☒Describes how State agencies will take all reasonable actions to identify potential local agencies. ☐Encourage potential and existing local agencies to implement or expand operations in the neediest one-third of all areas unserved or partially served. ☐The State agency does not have local agencies and does not plan to have local agencies. Explanation of how underserved and/or partially served areas are addressed is below. ADDITIONAL DETAIL: Caseload Management Appendix and/or Procedure Manual (citation) AND/OR State agency/ITO explanation of how the State agency without local agencies addresses underserved or partially served areas: Click or tap here to enter text. F. Caseload Management Strategies. For FY 2025, Section F. 1 is required. Sections F. 2-5 are optional and allow State agencies to anticipate any potential impacts due to funding shortages or lapse in funding. State agencies should review the below strategies and consider any necessary policy changes, where appropriate. 1. Waiting List Management and Procedures a. The State agency has specific policies/procedures for the establishment and maintenance of waiting lists, which are used by all local agencies. ☒Yes ☐No b. Waiting list procedures are uniform throughout the State agency. ☒Yes ☐No, but State agency approves all exceptions ☐No, local variation allowed without State agency approval 11
c. The State agency routinely monitors waiting lists. ☐Yes ☐No ☒No, for the current Fiscal Year, the State agency does not have a waiting list. d. The State agency requires/allows subprioritization of waiting lists by (check all that apply): ☐No subprioritization permitted ☐Income ☒Nutrition risk ☒Age ☐Point system ☐Special target populations (specify): Click or tap here to enter text. ☒Other (specify): Category and Priority e. The State agency requires pre-screening for certification of individuals prior to placement on waiting lists. ☒Yes ☐No, only categorical eligibility established ☐No, only categorical and income eligibility established ☐No, local agency variation ☐Other (specify): Click or tap here to enter text. f. Waiting lists are maintained: ☐Manually ☒Automated system linked to State agency's central system ☐Automated system, stand alone at some/all local agencies g. Telephone requests for placement on the waiting list are accepted. ☒Yes ☐No h. The State agency requires all local agencies to maintain waiting lists (telephone and/or pre-certification) with the following information (check all that apply): ☒Name ☒Address ☒Phone number(s) ☒Date placed on waiting list ☒Category ☒Priority ☒Nutritional risk ☐Income eligibility status ☐Method of application ☒Date applicant notified of placement on the waiting list ☐Other (specify): Click or tap here to enter text. 12
i. The State agency requires local agencies to provide information on other food assistance programs to applicants who are placed on a waiting list. If the State agency has no local agencies, it provides the information. ☒Yes ☐No ADDITIONAL DETAIL: Caseload Management Appendix and/or Procedure Manual (citation): P&P 1.09 Waitlist Management 2. Allowable Cost Saving Strategies (Optional) a. Does the State agency have policies and procedures to control cost when funding is insufficient relative to projected costs? ☒Yes ☐No b. Does the State agency use any of the following policies and procedures? (select all that apply): ☒Modified approved food list ☒Least expensive brands (LEB) ☒Economical container size and packaging ☐Other, please specify: Click or tap here to enter text. c. During funding shortfalls/to control costs, the State agency requires local agencies to certify participants for the minimum period specified in regulations. 7 CFR 246.7(g)(1) ☒Yes ☐No If yes, please describe or attach applicable policies and procedures. Reduce certification period for all age children from one year to six months. d. During funding shortfalls/to control costs, the State agency requires local agencies to shorten certifications on a case-by-case basis. 7 CFR 246.7(g)(2) ☐Yes ☒No If yes, please describe the case-by-case basis scenario or attach applicable policies and procedures. Click or tap here to enter text. e. The State agency uses targeted outreach to serve participants most in need to control cost. 7 CFR 246.4(a)(7) and 7 CFR 246.6(f). ☐Yes ☒No If yes, please describe the process used to determine which group of participants are most in need or attach applicable policies and procedures. Click or tap here to enter text. 3. Mid-Certification Benefit Discontinuation During Funding Shortfalls (Optional) 13
a. The State agency has specific policies/procedures for establishing and implementing mid-certification benefit discontinuation due to funding shortfalls, which are used by all local agencies. ☐Yes ☒No If yes, please describe the process used to determine how mid certification benefits will be discontinued or attach applicable policies and procedures. Click or tap here to enter text. b. If a State agency experiences a funding shortfall where it is unable to maintain its current level of participation for the remainder of the fiscal year and has explored all other alternative actions, the State agency will instruct local agencies to begin mid-certification benefit discontinuation by: (Select all that apply) ☐Mid-certification disqualification of program participants ☒Withholding of benefits for program participants c. The mid-certification benefit discontinuation action must affect the least possible number of participants and be directed first at those where their nutritional and health status is at least risk. When implementing mid-certification benefit discontinuation due to funding shortfalls, State agencies will select participants by: (Select all that apply) ☐Selecting participants in reverse order from the nutritional risk priority system. ☐Selecting participants who were certified due to possible regression in nutritional status, especially if original eligibility was based on a lower priority condition. ☒Selecting participants who have only one month left in their certification periods. ☐Selecting participants at higher income ranges. ☐Other: specify: Click or tap here to enter text. d. Prior to implementing mid-certification benefit discontinuation due to funding shortfalls, the State agency will notify FNS. ☒Yes ☐No e. Prior to implementing mid-certification benefit discontinuation due to funding shortfalls, the State agency will provide FNS the following information: ☒A summary description of the alternative policies and procedures explored or used prior to implementing any adverse action. ☒An explanation of how the planned action is intended to meet the criteria of affecting the least number of people and also the lowest priority persons to bring caseload in line with available resources. ☐Other: specify: Click or tap here to enter text. 14
4. During funding shortfalls, the State agency authorizes local agencies to disqualify participants in the middle of a certification period for failure to pick up food instruments. (Optional) ☒Yes ☐No ☐N/A, the State agency already authorizes local agency to disqualify participants for failure to pick up food instruments/CVV during normal operations. If yes, please indicate the number of months before a participant is disqualified or attach applicable policies and procedures. 60 days from last date to spend (2 months) 5. Competitive Vendor Selection Strategies. (Optional) a. During funding shortfalls/to control costs, does the State agency have procedures to adjust their vendor cost containment policies, including their competitive price selection criteria and/or maximum allowable reimbursement levels? ☒Yes ☐No b. During funding shortfalls/to control costs, does the State agency have procedures to adjust their vendor authorization policies (outside of cost containment), including application periods, selection criteria, and limiting criteria? ☒Yes ☐No c. If the State agency answered “yes” to either a or b: During funding shortfalls/To control costs, does the State agency reassesses vendors using the updated vendor authorization policies and selection criteria, including cost containment? ☒Yes ☐No d. During funding shortfalls/to control costs, does the State agency have procedures to assess the effectiveness of their above-50-percent vendor population to ensure continued oversight of cost neutrality assessment? ☐Yes ☒No WV Does not authorize above-50-percent vendors 15
VIII. CERTIFICATION, ELIGIBILITY & COORDINATION OF SERVICES (Please indicate) State Agency: West Virginia. for FY 2025 The review of certification, eligibility and coordination of services involves the process of determining and documenting participant eligibility (income eligibility as well as nutritional risk determination, standards, and criteria), and the coordination of certification activities with other health services. During disasters, emergencies, public health emergencies, or a supply chain disruption, including infant formula recalls, the State agency may request to implement existing and allowable regulatory flexibilities or waivers to support the continuation of Program benefits and services. Waivers granted under Access to Baby Formula Act of 2022 (codified at 7 CFR 246.4a(30)) or temporary provision(s) authorized by Congress are not permanent amendments to the State Plan; however, State agencies should consider any historical amendments as the result of waivers granted under prior waiver authority to develop policies and procedures for current and future disasters. A. Eligibility Determination and Documentation - 7 CFR 246.7(c)(1); 2(1); 246.7(d)(1); (2)(v)(B)): describe the policies and procedures for determining and documenting eligibility including the application process, residency requirements, identity requirements, documented physical presence or valid exception; proof of categorical eligibility, income limits, income eligibility documentation, determination of special populations and a definition of and policy toward the economic unit. B. Nutrition Risk Determination, Documentation, and Priority Assignment - 7 CFR 246.4(a)(11)(i): describe the policies and procedures for determining and documenting nutritional risk and priority assignments. Include a copy of the nutritional risk criteria the State agency plans to use with the appropriate documentation. C. Health Care Agreements, Referrals, and Coordination - 7 CFR 246.4(a)(6); (7); (8) and (19): describe the procedures for coordinating agreements and services with other health care providers at the State and local agency level including procedures to ensure that benefits are provided to persons with special needs. D. Processing Standards - 7 CFR 246.4(a)(11)(i); 246.7(f)(2): describe the State agency's processing procedures to ensure that the required standards and timelines are met. E. Certification Periods - 7 CFR 246.4(a)(11)(i); 246.7(g): describe the policies and procedures used to establish certification periods for participants and the autonomy (if applicable) granted to local agencies in determining eligibility time periods.
F. Transfer of Certification - 7 CFR 246.4(a)(6); (11)(i); and 246.7(k): describe the State agency's procedures for the transfer of certification and VOC cards ensuring that vital participant and program information is included. G. Dual Participation, Participant Rights and Responsibilities, Fair Hearing Procedures, and Sanction System - 7CFR 246.4(a)(11)(i) (16); (17) and (18); 246.7(h); 246.7(i)(10); 246.7(j); 246.7(I): describe the procedures used to detect and prevent dual participation at the State and local level, the procedures for ensuring participants are notified of their rights and responsibilities, and the procedures regarding participant fair hearings and sanction system. 2
A. Eligibility, Determination, and Documentation 1. Application Process a. The State agency requires all local agencies to use a standardized application process for all persons applying for the WIC Program ☒Yes ☐No b. The State agency shares ☒Statewide or ☐at local agency (check one), a common income application or certification form with (check all that apply): ☒No other benefit programs ☐Medicaid ☐TANF ☐SNAP ☐Maternal and Child Health (MCH) ☐Other reduced-price health care program(s) ☐Other (specify): N/A. ADDITIONAL DETAIL: Certification and Eligibility Appendix and/or Procedure Manual (citation): Policy and Procedure 2.01 Certification of Participants; 2.06 Income Eligibility Requirements 2. Residency, Identity and Physical Presence Requirements a. The State agency requires documentation of residency ☒Yes ☒Signed statement that documentation of residency information is not available and why (e.g., homeless, theft, fire) ☐No (Specify why, e.g., ITOs and Alaska natives who are exempt from this requirement): N/A. b. The State agency has reciprocal agreements concerning residency with other State agencies ☐Yes; list States: N/A. ☒No Describe any reciprocal agreements: N/A. c. The State agency has special residency policies and procedures for how the following special categories should be treated (check all that apply): ☒Homeless applicants ☐Institutionalized applicants 3
☒Migrants ☐Indian Tribal Organizations ☐None ☐Other (specify): N/A. d. The State agency allows the following as proof of identity; please select all that apply. ☒Driver’s license ☒Passport ☒State issued identification card ☒Employer issued identity card ☒Documentation from participation in a means-tested program. ☒Other (please list all that are accepted) Policy and Procedure 2.04 Residency Requirements; 2.17 Attachment #2 e. The State agency requires physical presence of the applicant or a valid exception to be documented: ☒Yes except for the following condition(s): 7 CFR 246.7(o)(2) ☒Applicant or parent/caretaker is an individual with disabilities which prevent him/her from being physically present at the WIC clinic (e.g., medical equipment, bedrest or serious illness exacerbated by coming into clinic). ☒Applicant is an infant or child receiving documented ongoing health care from any health care provider, including the local agency; being physically present would pose an unreasonable barrier; and the infant or child was present at his/her initial WIC certification. ☐Applicant is an infant under 8 weeks of age who cannot be present at the time of certification (for a reason determined appropriate by the local agency) and for whom all necessary certification information is provided. ☒Applicant is an infant or child who was present at his/her initial certification; was present at certification within the one-year period of the most recent determination; and is under the care of one or more working parent, or under the care of primary working caretakers whose status presents a barrier to bringing the infant or child into the WIC clinic. 3. The State agency requires applicants to submit proof of categorical eligibility for (check all that apply): ☐All pregnant women ☒Pregnant women not visibly pregnant ☐Postpartum women ☐Children ☐Infants ☐Other (specify): N/A. 4. Income Limits for Eligibility a. The State agency gross income limit for income eligibility is at or below 185% of the federal poverty income guidelines 4
☒Yes, with no local agency exceptions ☐Yes, with local agency variation ☐No, with no local agency exceptions (specify State maximum percent of poverty: N/A. ☐No, with local agency variation (specify State maximum percent of poverty: N/A. ADDITIONAL DETAIL: Certification and Eligibility Appendix and/or Procedure Manual (citation): Policy and Procedure 2.06 Attachment #1 Income Eligibility Requirements b. The State agency implements income eligibility guidelines concurrently with Medicaid ☒Yes ☐No ADDITIONAL DETAIL: Please attach a copy of the income guidelines in the Appendix or the appropriate citation in the Procedure Manual. Certification and Eligibility Appendix and/or Procedure Manual (citation): Policy and Procedure 2.06 Attachment #1 Income Eligibility Requirements c. The State agency requires documentation of an applicant's, or certain family members' eligibility to receive benefits in the following means-tested programs that confer adjunctive income eligibility for WIC, as set forth in 7 CFR 246.7(d)(2)(vi): Poverty Level ☒TANF (specify State "percent of poverty") 150 % ☒SNAP 150 % ☒Medicaid (specify State "percent of poverty" for each) 150-185 % ☒Pregnant women and infants 150-185 % ☒Children 150 % ☒Other categorically eligible women 150% d. The State agency uses documented eligibility for participation in other means-tested programs to establish automatic WIC income eligibility (check all that apply, and the poverty levels used for each): Poverty Level ☐Free or Reduced-Price School Meals N/A. ☐Supplemental Security Income (SSI) N/A. ☒Other State-provided health insurance (specify State "percent of poverty" maximum 150-185% 5
☐Food Distribution Program on Indian Reservations (FDPIR) N/A. ☐Other (specify): N/A. e. Individuals are required to document that they or a family member are certified as eligible to receive TANF, Medicaid, or SNAP benefits or, under the State option, certified as eligible to receive benefits in State- administered programs by providing: ☒Program ID card (only if it includes dates of eligibility) or notice of current eligibility ☐Documentation of participation in State-administered programs (and such programs require documentation of income and have income guidelines at or below WIC's income guideline of 185% of poverty). (Program[s]: N/A. ADDITIONAL DETAIL: Certification and Eligibility Appendix and/or Procedure Manual (citation): Policy and Procedure 2.06 Attachment #1 Income Eligibility Requirements 5. Income Eligibility Documentation a. For WIC applicants whose income eligibility is not based on adjunctive or automatic income eligibility in another means-tested program, the State agency requires (check all that apply): ☒Documentation of income information ☒Signed statement that documentation of income information is not available and why ☒Notation in the participant record if the applicant declares no income and why ☐Other (specify): N/A. b. Exceptions to income documentation are made for the following: 7 CFR 246.7(d)(2)(v)(C) ☒The necessary information is not available ☒The income documentation presents an unreasonable barrier to participation as determined by the State agency ☒Those applicants with no income ☒Those applicants who work for cash ☐Other (specify):N/A. c. If the applicant does not supply the necessary documentation at the certification appointment, local agencies are generally instructed to do the following: ☐Certification process is terminated, and no food instruments/cash-value vouchers are provided; appointment rescheduled. ☒Temporary certification (not to exceed 30 days) for applicants that have one qualifying 6
nutrition risk and are able to present at least two of the three required documents (identification, residency, and income) during a certification appointment is completed and food instruments are provided. However, if applicant does not provide documentation within 30 days, certification expires, and a new eligibility determination must be conducted. ☐Other (specify): N/A. d. The State agency requires ☒State-wide, or ☐at local agency discretion (check one), the verification of applicant income information, if determined necessary ☒No ☐Yes (check all sources required, as appropriate): ☐Employer ☐Public assistance offices ☐State employment offices (wage match, unemployment) ☐Social Security Administration ☐School districts/offices ☐Collateral contacts ☐Other (specify): N/A. e. The State agency has specific policies that define actions to be taken at a mid-certification appointment if a participant’s income eligibility changes. ☒Yes; Please specify: Policy and Procedure 2.06 Income Eligibility Requirements. ☐No f. The State agency allows documentation of alternate income procedures for Indian or Indian Health Service (IHS) operated local agencies. ☐Yes ☐No ☒Not Applicable g. The State agency has a specific policy that addresses income from benefits provided by a State-administered programs. ☒Yes ☐No h. The State agency has a specific policy to ensure that certain types of income, such as combat pay or Family Subsistence Supplemental Allowance (FSSA) payments for households that include service members, are excluded from consideration in the WIC income eligibility determination, as provided by law and regulation. ☒Yes ☐No ADDITIONAL DETAIL: Certification and Eligibility Appendix and/or Procedure Manual (citation): Policy and Procedure 2.06 and 2.06 Attachment #3 Income Eligibility Requirements 7
6. In determining an applicant’s income eligibility for WIC, the State agency excludes basic allowance for housing received by military services personnel residing off military installations and in privatized housing, whether on- or off-base. ☒Yes, State-wide ☐No ADDITIONAL DETAIL: Certification and Eligibility Appendix and/or Procedure Manual (citation): Policy and Procedure 2.06 and 2.06 Attachment #3 Income Eligibility Requirements 7. The State agency excludes cost-of-living allowances for military personnel on duty outside of the contiguous 48 States (OCONUS COLA) from applicant income for purposes of WIC income determination. ☒Yes, State-wide ☐No 8. In determining an applicant’s income eligibility for WIC, the State agency excludes payments given to deployed military service members. These payments are in accordance with Chapter 5 of Title 37 of the U.S.C. ☒Yes, State-wide ☐No ADDITIONAL DETAIL: Certification and Eligibility Appendix and/or Procedure Manual (citation): Policy and Procedure 2.06 and 2.06 Attachment #3 Income Eligibility Requirements 9. In determining an applicant’s income eligibility for WIC, the State agency calculates multiple income sources received by an applicant’s household at different frequencies in accordance with WIC Policy Memo 2011-7 and compares the sum to the established WIC IEGs. ☒Yes, State-wide ☐No ADDITIONAL DETAIL: Certification and Eligibility Appendix and/or Procedure Manual (citation): Policy and Procedure 2.06 Income Eligibility Requirements 10. The State agency defines the economic unit in accordance with WIC Policy Memo 2013-3. ☒Yes ☐No (if no, why not): Click or tap here to enter text. Provide the definition of an economic unit used by the State agency in the Appendix or the appropriate citation in the Procedure Manual. ADDITIONAL DETAIL: Certification and Eligibility Appendix and/or Procedure Manual (citation): Policy and Procedure 2.06 Income Eligibility Requirements 8
11. The State agency has specific policies or lists examples concerning the determination of the economic unit for (check all that apply): ☒Foster children ☐Divorced/legally separated parents; step parents ☐Absentee spouse (military hardship tours, etc.) ☐Cohabitation ☐Institutionalized applicants (including incarcerated applicants) ☐Homeless applicants ☐Minors ("emancipated" minors) ☐Separate economic units under the same roof ☐Striker/unemployed ☐Students away at school ☐Self-employed applicants ☒Other (specify): Policy and Procedure 2.06 Income Eligibility Requirements ADDITIONAL DETAIL: Certification and Eligibility Appendix and/or Procedure Manual (citation): Policy and Procedure 2.06 Income Eligibility Requirements 12. Mid-Certification Disqualification a. The State agency ensures that local agencies are required to stipulate that an individual is not automatically disqualified mid-certification since she/he no longer participates in one or more of the Programs for which they were originally determined adjunctively/automatically income eligible. ☒Yes ☐No b. WIC regulations specify that when income eligibility is reassessed mid-certification, State/local agencies are required to reevaluate the Programs for which the individual could be determined adjunctively/automatically income eligible. If the individual cannot qualify based on eligibility for one of these Programs, eligibility must be determined based on WIC income guidelines and disqualification made only after all options are exhausted. The State agency ensures its policy and procedures comply with this requirement: ☒Yes ☐No B. Nutrition Risk Determination, Documentation and Priority Assignment 9
1. Nutrition Risk Determination and Documentation a. Professionals authorized by the State agency as Competent Professional Authorities (CPAs) to determine nutritional risk include (check all that apply): Can certify for: Qualification Priorities I-III All Priorities RD or Masters Level Nutritionist ☒ ☒ Bachelor's Level Nutritionist ☒ ☒ Physician ☒ ☒ Physician Assistant ☒ ☒ Registered Nurse ☒ ☒ Licensed Practical Nurse ☒ ☒ Home Economist ☒ ☒ Paraprofessional ☒ ☒ Other (Specify): Click or tap here to enter text. b. The State agency authorizes local agencies to (check all that apply): ☒Conduct ☒Anthropometric and ☒Hematological measurements ☒Use medical referral data for ☒Anthropometric and ☒Hematological measurements ☒Use data from a state Health Information Exchange (including access to medical referral data via a participant/physician portal) ☐Use data from a trusted partner trained in taking accurate measurements. Please list or attach partners the state agency accepts data from (list doesn’t need to be all-inclusive): c. The State agency uses only FNS-approved nutrition risk criteria, as referenced in Policy Memorandum #2011-5, WIC Nutrition Risk Criteria, and transmittal memorandum (dated December 17, 2020) that list the revised risk criteria requiring implementation by 10/1/2022, published on the FNS PartnerWeb, to document nutrition risk. (Note: A more recent transmittal memorandum was issued on November 17, 2022, however, the revised risk criteria included in this memorandum are not scheduled to be implemented until October 1, 2024) ☒Yes ☐No Please append a list of the nutrition risk criteria used by the State agency in its entirety to this State Agency Plan. d. The State agency modifies nutrition risk criteria such that criteria definitions are more 10
restrictive than nationally established definitions. ☐Yes (list criteria): Click or tap here to enter text. ☒No e. Hematological risk determination: CFR 246.7(e)1(i)(A) The State agency requires (check one of the following): ☐Bloodwork data to be collected at the time of certification (Statewide). ☒Bloodwork data to be collected within 90 days of certification, so long as the participant is determined to have at least one qualifying nutritional risk at the time of certification (Statewide), and the State has implemented procedures to ensure receipt of data. ☐A shorter (less than 90 days) timeframe for collection of data past certification. Please specify the shorter timeframe Click or tap here to enter text. The State agency ensures that hematological assessment data are current and reflective of participant status, to include a bloodwork periodicity schedule that conforms to the requirements as described in 7 CFR 246.7(e)(1)(ii)(B). ☒Yes ☐No The State agency allows local agencies the option of obtaining bloodwork on children ages 2-5 annually if prior certification results were normal. ☒Yes ☐No f. Anthropometric risk determination: The State agency allows (check one): ☒Anthropometric data for certification to be no older than 60 days (Statewide) ☐A shorter (less than 60 days) limit on age of anthropometric data or certification g. Nutrition assessment: (i) Local agencies are required to perform a complete nutrition assessment (as described in the Value Enhanced Nutrition Assessment [VENA] Guidance) for all participants. ☒Yes ☐No (explain): Click or tap here to enter text. (ii) Local agencies are required to perform a mid-certification nutrition assessment (as described in the Guidance for Providing Quality Nutrition Services during Extended Certification Periods) for all participants with and extended certification period. ☒Yes ☐Not Applicable: (The State agency does not utilize the extended certification option for any participant category) 11
(iii)The State agency policy requires that nutrition assessment intake information be collected on a State agency mandated form or Management Information System (MIS). ☒ Yes ☐No If yes, attach mandated forms (or MIS screen shots) or specify location in the procedure manual and reference below. If no, the State agency assures quality of nutrition assessment by: ☐Requiring local agencies to submit forms for approval ☐Annually monitoring the locally developed forms during local agency review ☐Other (specify): Click or tap here to enter text. (iv) Dietary assessment is based on professionally recognized guidelines (e.g., Dietary Guidelines for Americans, My Plate Food Guide, American Academy of Pediatrics) ☒Yes (specify): Dietary Guidelines for Americans, MyPlate Food Guide, AAP ☐No (explain): Click or tap here to enter text. ADDITIONAL DETAIL: Certification and Eligibility Appendix and/or Procedure Manual (cite): P&P 2.11, 2.12, 2.13, and 11.02; Appendix VIII (A) Risk Codes; Appendix VIII (B) CATD Woman, Child and Infant (each form reflects the screens in Crossroads needed to complete certification) 2. Documentation a. The State agency requires documentation in the applicant’s case file for all nutrition risk criteria used to establish WIC eligibility (check one) (as described in FNS Policy Memorandum #2008-4, WIC Nutrition Services Documentation): ☐Yes, supported by a written "exceptions" policy (e.g., policies to direct clinic staff in situations in which documentation is unavailable) ☒Yes, with CPA discretion when to waive documentation requirement (no written policy) ☐No (explain): Click or tap here to enter text. b. As a matter of policy, the State agency requires the documentation of nutritional risk criteria on a participant's certification form in the following manner: ☒All identified risk criteria are recorded ☐A set number of criteria Click or tap here to enter text. is recorded (maximum number is 10 criteria) ☐Local agency personnel decide how many and which criteria are 12
recorded ☐Other (specify): Click or tap here to enter text. 3. Priority Assignments a. Participants certified for regression ☒Remain in the same priority in which they were previously assigned ☐Are assigned to Priority VII, regardless of their initial priority at first certification ☐Other (specify): Click or tap here to enter text. b. The State agency requires verification for all nutrition risk criteria that require a physician’s diagnosis. ☒Yes ☐No ADDITIONAL DETAIL: Certification and Eligibility Appendix and/or Procedure Manual (cite): P&P 2.11 Nutrition Risk Criteria c. Participants may be certified for regression (check all that apply): ☐A single six-month period ☒One time following a certification period ☐No policy, local agency discretion d. High risk postpartum women are assigned to the following priority: ☒Priority III ☐Priority IV ☐Priority V ☐Priority VI e. Participants certified solely due to homelessness/migrancy are assigned to the following priority: IV V VI VII Pregnant Women ☒ ☐ Breastfeeding Women ☒ ☐ Postpartum Women ☒ ☐ Infants ☒ ☐ Children ☒ ☐ f. Attach a copy of any nutrition risk criteria that will be added, modified, or deleted during the coming fiscal year. For each criterion, indicate: Applicable participant category Applicable priority level(s) 13
Whether a physician’s diagnosis is required SA code number which conforms to list of codes provided by USDA for Participant Characteristics data collection ADDITIONAL DETAIL: Certification and Eligibility Appendix and/or Procedure Manual (citation): P&P 2.11 Nutrition Risk Criteria C. Health Care Agreements, Referrals, and Coordination 1. State Agency Referral Agreements and Coordination of Services a. The State agency has written formal agreements that permit the sharing of participant information with the following programs/providers (indicate whether information is shared manually (M) or through ADP (A) by placing either an M or A in front of the appropriate service): Click or tap here to enter text. SNAP Click or tap here to enter text. Rural/migrant health centers Click or tap here to enter text. TANF A Hospitals M Medicaid M Childhood immunization Click or tap here to enter text. SSI A Immunization registries M EPSDT Click or tap here to enter text. Well-child programs M MCH programs A Child protective services M Family planning Click or tap here to enter text. IHS facilities A Private physicians M Children with special health care needs program(s) ☒Other (specify): WV Health Information Exchange (A) and Head Start (M) b. Formal agreements for coordination of services include: ☒Responsibilities of each party ☒Assurance that information is used only for program eligibility and/or outreach ☒Assurance that information will remain confidential and not be shared with a third party c. The State agency requires local agencies to coordinate services with, and/or develop referral systems for, the following (check all that apply): ☒SNAP ☒Children with special health care needs ☒TANF ☒Schools ☐SSI ☒Expanded Food and Nutrition Education 14
Program (EFNEP) ☒Medicaid ☒Other food assistance program (TEFAP, FDPIR, CSFP, etc.) ☐CHIP ☒Breastfeeding promotion ☐IHS facilities ☒Child protective services ☐MCH (clinics/facilities) ☒Head Start ☒Early and Periodic Screening, Diagnostic and Treatment (EPSDT) ☒Early Head Start ☒Family planning ☐Healthy Start ☒Prenatal care ☒Substance abuse program ☒Postnatal care ☐Child abuse counseling ☒Immunization ☒Foster care agencies ☐Dental services ☒Homeless facilities ☒Private physicians ☒Mental health services ☒Hospitals ☒Rural/migrant health centers ☒Well-child programs ☒Lead Screening ☒Other (specify): Domestic Violence Shelters ADDITIONAL DETAIL: Certification and Eligibility Appendix and/or Procedure Manual (citation): Policy and Procedure 10.02 Coordination of Program Services 2. Local Agency Referral Procedures a. The State agency ensures that local agencies make available to all adults applying or re-applying for the WIC Program for themselves or on behalf of others the following types of information: ☒State Medicaid Program, including presumptive eligibility determinations, where available ☒Child support services ☒SNAP ☒Substance abuse counseling/treatment programs ☒TANF, including presumptive eligibility determinations, where available ☒Other State-funded medical insurance programs (specify): CHIP ☒Other nutrition services (specify): Food Banks ☒EPSDT Program ☒Children’s Health Insurance programs (s) ☐Other (specify): Click or tap here to enter text. 15
b. The referral methods used by local agencies to other health and social service programs include (check all that apply, and indicate whether the method selected is the primary method of referral): Primary ☒State agency-developed referral forms ☐ ☒Local agency-developed referral form ☐ ☒Telephone call to referring agency ☒ ☒Verbal referral to participants ☒ ☒Automated client/participant information exchange ☐ ☒Written literature on referral programs ☒ ☐Follow-ups by staff to monitor ☐ ☒Maintain a list of local resources for drug and other harmful substance abuse ☐ ☐Counseling ☐ ☐Other (specify): Click or tap here to enter text. ☐ c. Methods used by other health and social service programs to refer clients to the WIC Program include (check all that apply, and indicate whether the method selected is the primary method of referral): Primary ☒WIC Program referral form ☐ ☒Health/social program referral form ☐ ☒Telephone call ☐ ☒Verbal referral ☐ ☒Automated client/participant information exchange ☐ ☒Written literature on the WIC Program ☐ ☐Other (specify): Click or tap here to enter text. d. The State agency has a system in place to monitor the extent to which WIC participants are using other health or social services (check all that apply): 16
☒Yes (check): ☒Medicaid ☒TANF ☒MCH ☒SNAP ☐Yes, other (specify): Click or tap here to enter text. ☐No e. The State agency requires local agencies to monitor referrals to determine the extent of health or social services utilization in addition to State monitoring systems. ☐Yes ☒No ADDITIONAL DETAIL: Certification and Eligibility Appendix and/or Procedure Manual (citation): P&P 7.05, 10.01, 10.02, 10.03, 10.04 f. To facilitate referrals to the Medicaid Program, the State agency provides each local agency a chart showing the maximum income limits, according to family size, applicable to pregnant women, infants, and children up to age 5 under the Medicaid Program. ☒Yes ☐No g. The State agency assures that each local agency operating the Program within a hospital, and/or that has a cooperative arrangement with a hospital, advises potentially eligible individuals that receive inpatient or outpatient prenatal, maternity, or postpartum services, or that accompany a child under the age of 5 who receives well-child services, of the availability of Program services. ☒Yes ☐No h. The State agency ensures that, to the extent possible, local agencies provide an opportunity for individuals who may be eligible to be certified within the hospital for participation in WIC. ☒Yes ☐No i. The State agency ensures that when WIC is at maximum caseload, local agencies make referrals to: ☒Food banks ☒Food pantries ☒Soup kitchens or other emergency meal providers ☒SNAP ☒The Emergency Food Assistance Program (TEFAP) ☐Food Distribution Program on Indian Reservations (FDPIR)☐Other (specify): Click or tap here to enter text. 17
j. The State agency ensures that when WIC is at maximum caseload, local agencies notify the State agency of any waiting lists established. ☒Yes ☐No k. The State agency ensures that when WIC is at maximum caseload, the State agency notifies FNS of any waiting lists established. ☒Yes ☐No l. The State agency ensures that when the WIC participant's family has immediate needs for food beyond what WIC might provide, local agencies make referrals to: ☒Food banks ☒Food pantries ☒Soup kitchens ☒SNAP ☒The Emergency Food Assistance Program (TEFAP) ☐Food Distribution Program on Indian Reservations (FDPIR) ☐Other (specify): Click or tap here to enter text. m. Immunization Screening and Referral The State agency assures that each local agency is meeting the requirements of WIC Policy Memorandum #2001-7, August 30, 2001: Immunization Screening and Referral, as follows: ☒Screening children under the age of two using a documented immunization history: ☒Using the minimum screening protocol; or ☐Using a more comprehensive means, (specify): Click or tap here to enter text. ☒Using another program or entity to screen and refer WIC children using a documented immunization history; (specify):WV Health Information Exchange or WV Immunization Registry ☐Implementing the minimum screening protocol is unnecessary because immunization coverage rates of WIC children by 24 months are 90% or greater; or ☐The State agency has been unable to formalize a coordination agreement with the State Immunization Program. Provide explanation of extenuating circumstances: Click or tap here to enter text. 18
The State agency's policy and procedure manual has been updated to include the above immunization screening and referral protocol. ☒Yes ☐No D. Processing Standards 1. Notification Standards a. The State agency defines special nutritional risk applicants who are to be notified of their eligibility within 10 days of the date of the first request (at the local agency) for program benefits as the following (check all that apply): ☒Pregnant women eligible as Priority I ☒High-risk infants (optional) ☒Migrant farmworkers/family members ☐Homeless (optional) ☐Optional; please specify: Click or tap here to enter text. b. The State agency requires local agencies to follow special policies and procedures to ensure timely certification of: ☒Rural applicants ☐Employed applicants ☐No special policies/procedures c. The State agency's policy allows it to authorize an extension of the notification period up to 15 days for special nutritional risk applicants when local agencies provide a written request with justification. ☐Yes ☒No d. Policies and procedures are in place to assure all other applicants are notified of eligibility within 20 days of first request (at the local agency) for Program benefits. ☒Yes ☐No ADDITIONAL DETAIL: Certification and Eligibility Appendix and/or Procedure Manual (citation): P&P 2.05 2. Processing Standards a. Processing standards begin when the applicant (check all that apply): ☒Calls the local agency to request benefits ☒Visits the local agency in person ☒Makes a written request for benefits ☒Makes a request for benefits via an application portal 19
b. The State agency requires the local agency to have a monitoring system in place to ensure processing standards are being met for all categories of applicants. ☒Yes ☐No ADDITIONAL DETAIL: Certification and Eligibility Appendix and/or Procedure Manual (citation): P&P 2.05 E. Certification Periods 1. Certification Period Standards a. (i) The State agency authorizes local agencies to certify infants under six months of age for a period extending up to the first birthday provided the quality and accessibility of health care services are not diminished: ☒Yes, at all local agencies ☐Yes, at selected local agencies ☐No (ii) The State agency authorizes local agencies to certify children for a period of up to one year provided that participant children receive required health and nutrition services: ☒Yes, at all local agencies ☐Yes, at selected local agencies ☐No (iii) The State agency authorizes local agencies to certify breastfeeding mothers for a period extending up to the infant's first birthday or until breastfeeding is discontinued (whichever comes first), if there is no decrease in health and nutrition services that the participant would otherwise receive during a shorter certification period: ☒Yes, at all local agencies ☐Yes, at selected local agencies ☐No (iv) The State agency ensures that health care and nutrition services are not diminished for participants certified for longer than six months: ☐No ☒Yes (describe): Participants are scheduled for mid-certification follow-up appointments for anthropometrics measures and nutrition education at six months. b. Extended certification is an option for the following (check all that apply): ☒Priority I infants ☒Priority II infants ☒Priority IV infants ☒Priority III Children ☒Priority V Children ☒Priority I Breastfeeding Women ☒Priority IV Breastfeeding Women 20
c. The State agency authorizes local agencies to shorten or extend the certification period up to 30 days in certain circumstances. ☐Yes (If yes, provide citation indicating circumstances): ☒No Click or tap here to enter text. ADDITIONAL DETAIL: Certification and Eligibility Appendix and/or Procedure Manual (citation): P&P 2.08 and 2.16 2. The State agency authorizes local agencies to disqualify an individual in the middle of a certification period for the following reasons (check all that apply): ☒Participant volunteers the information that they are over income ☒Participant abuse ☒Family member found income ineligible at recertification ☒Failure to pick up food instruments/cash-value vouchers for 2 consecutive issuances ☐Other (specify): Click or tap here to enter text. ADDITIONAL DETAIL: Certification and Eligibility Appendix and/or Procedure Manual (citation): P&P 2.09 F. Transfer of Certification 1. Procedures for Transfer of Certification and Verification of Certification (VOC) a. The State agency has procedures in place that are used by all local agencies for transfers of certification within the State agency (intra-State), between State agencies (inter-State), and to the WIC Overseas Program (WICO): Intra-State Inter-State WIC Overseas ☒ ☒ ☒ Yes ☐ ☐ ☐ No b. A participant ID card/folder/documentation is provided which also serves as a VOC: ☐Yes ☒No c. The State agency requires all local agencies to use a standardized VOC: ☒Yes ☐No d. VOCs are issued to the following (check all that apply): ☒All participants ☐Migrants 21
☐ Homeless ☐Participants relocating during certification period ☐Persons affiliated with the military who are transferred overseas ☐Other (specify): Click or tap here to enter text. ADDITIONAL DETAIL: Certification and Eligibility Appendix and/or Procedure Manual (citation): P&P 2.14 2. The State agency requires all local agencies to include the following information on the VOC (check all that apply): ☒Name of participant ☒Date certification performed ☒Date income eligibility last determined ☒Nutritional risk condition of the participant ☒Date certification period expires ☒Signature/printed or typed name of certifying local agency official ☒Name/address/phone number of certifying local agency ☒Identification number or some other means of accountability ☐Other (specify): Click or tap here to enter text. 3. The State agency requires all local agencies to accept as valid all VOCs from both the domestic WIC Program and the WIC Overseas Program that contain the following essential elements: ☒Participant name ☒Name and address of the certifying agency ☒Date the current certification period expires 4. The State agency honors the one-year certification period for transferring participants (infants, children, and breastfeeding women) even if it certifies participants every six months. ☒Yes ☐No ADDITIONAL DETAIL: Certification and Eligibility Appendix and/or Procedure Manual (citation): 22
P&P 2.14 G. Dual Participation, Rights and Responsibilities, Fair Hearings, Sanctions 1. Dual Participation a. The State agency has written procedures to prevent and detect dual participation within each local agency and between local agencies: ☒Yes (Please attach any descriptions of policy in Appendix or cite appropriate section(s) of the Procedure Manual): P&P 1.11 ☐No b. The State agency has a written agreement with the Indian State agency(ies) or other geographic State agencies in proximity for the detection and prevention of dual participation (attach a copy of each applicable agreement or provide a citation of where a copy is located): ☒Yes ☐No ☐Not applicable c. The State agency has established procedures to handle participants found in violation due to dual participation: ☒Yes (Please attach any descriptions of policy in Appendix or cite appropriate section(s) of the Procedure Manual): P&P 1.11 ☐No ADDITIONAL DETAIL: Certification and Eligibility Appendix and/or Procedure Manual (citation): Appendix VIII D, E and F 2. Participant Rights and Responsibilities a. The State agency has uniform notification procedures that are used by all local agencies statewide: ☒Yes ☐No b. The State agency requires all local agencies to inform applicant/participant of his/her rights and responsibilities in written form, and must be read by or to the applicant, parent, or caretaker: ☒Yes ☐No c. The State agency has implemented a policy of disqualifying participants for not picking up food instruments: ☒Yes ☐No ☐Not applicable If yes, the policy is communicated to participants in the participant rights and responsibilities materials: 23
☒Yes ☐No ☐Not applicable d. The State agency has implemented a policy to specifically inform participants that they are not allowed to sell WIC food benefits, including online: ☒Yes ☐No; explain: Click or tap here to enter text. e. The State agency has policies and procedures to identify attempted sales of WIC food benefits in their WIC State Plan: ☒Yes ☐No; explain: Click or tap here to enter text. ADDITIONAL DETAIL: Certification and Eligibility Appendix and/or Procedure Manual (citation): P&P 1.06 and 2.10 f. The State agency has developed special notification policies and procedures for the following: ☒Applicant/participant who cannot read ☒Applicant/participant who speaks in a language other than English ☐Homeless ☐Migrants ☒Persons with disabilities ☐Other (specify): Click or tap here to enter text. g. The State agency requires all local agencies to provide notification of participant rights and responsibilities in the following situations: ☒Eligibility at each certification ☒Ineligibility at initial certification ☒Mid-certification disqualification ☒Expiration of a certification period ☒Waiting list status ☐Other (specify): Click or tap here to enter text. ADDITIONAL DETAIL: Certification and Eligibility Appendix and/or Procedure Manual (citation): P&P 2.10 3. Fair Hearing and Sanction System 24
a. The State has a law or regulation governing participant appeals: ☒Yes ☐No b. The State agency has established statewide fair hearing procedures: ☒Yes; attach fair hearing procedures for participants or specify the location in the Procedure Manual and reference in additional detail section below. ☐No c. State or local agency actions against participants include (check all that apply): ☒Reclaiming the value of improperly received benefits ☒Disqualification from the Program for up to one year ☒Suspension from the Program mid-certification ☐Other (specify): Click or tap here to enter text. d. Appeal hearings are held at: ☐WIC State agency parent agency ☒Other State agency or hearing board (specify): WV Office of Inspector General Board of Review☒ ☐Local WIC agency ☐Other (specify): Click or tap here to enter text. e. Statewide fair hearing procedures include (check all that apply): ☒Request for hearing ☒Local agency responsibilities ☒Denial or dismissal of request ☒Continuation of benefits ☒Rules of procedure ☒Responsibilities of hearing official ☒Fair hearing decision ☐Other (specify): Click or tap here to enter text. ☒Judicial review f. State agency procedures require written notification for (check all that apply): ☒Appeal rights ☒Request for hearing ☒Denial or dismissal of request ☒Notice of hearing ☒Termination within certification period ☒Fair hearing decision ☒Judicial review ☐Other (specify): Click or tap here to enter text. 25
g. The State agency has established timeframes to govern each step of the hearing process: ☒Yes ☐No h. The State agency requires all local agencies to document any notification/correspondence in the participant's file: ☒Yes ☐No i. The State agency has a written sanction policy for participants: ☒Yes (If yes, provide appropriate citation below) ☐No j. The State agency has established procedures which determine the type and levels of sanctions to be applied against participants: ☒Yes ☐No ADDITIONAL DETAIL: Certification and Eligibility Appendix and/or Procedure Manual (citation): P&P 1.06 and 1.07 26
West Virginia WIC Policy & Procedure 9.01 Date: 04/23/2012 9.01 State Agency Review of Local Agency Program POLICY: The State Agency will evaluate and review each Local Agency to assure compliance with Federal, State and local regulations, policies and guidelines. PROCEDURE: A. Frequency of Local Agency Program Review The State Agency will perform the review of each Local Agency a minimum of one (1) time every two (2) fiscal years, and more frequently if deemed needed by the State Agency, at the State Agency’s discretion. B. Functional Areas of the Local Agency Review Financial management systems will be monitored separately per Policy and Procedure 6.17. Compliance with administrative and operations regulations will be monitored separately from compliance with clinical and nutrition related regulations policy and procedure. Reviews will consist of a scheduled interview with the Local Agency Director, to include a review of past performance, computer reports, current operation, and a review of any documents at the Local Agency Headquarters. In addition, monitoring reviews will consist of unannounced on-site visits to selected clinic sites (20% of sites under the Local Agency) to review any documents and files that may be stored there, observe procedures and the physical site, and interview employees on the site-level application of procedures and policy. The following Operational areas will be reviewed: ● Evaluation of Management ● Security ● Eligibility and Certification ● Facility Evaluation ● Caseload Management ● Outreach ● Civil Rights Compliance ● Food Delivery Accountability Systems The following Clinical and Nutrition areas will be reviewed: ● Eligibility and Certification ● Nutrition Education and Breastfeeding Promotion and Support ● Individual and Group Nutrition Education 1 of 5
West Virginia WIC Policy & Procedure 9.01 Date: 04/23/2012 9.01 State Agency Review of Local Agency Program ● Food Package Tailoring ● Farmers’ Market Nutrition Program ● Participant Services C. Written Notification 1. The State Agency will send written notification to the Local Agency Director a minimum of thirty (30) days in advance of a review to assure that appropriate personnel and records are available. If at all possible, nutrition and operations functional area reviews will occur at the same time. 2. Written notification will include a description of records or files that the Local Agency must have available for review. This may take the form of the monitoring tool(s) but additional documentation may be requested in the written notification. Written notification will include the name of the clinic(s) to be reviewed but will not include an announcement of the clinic on-site review dates, or the individual participant records that will be reviewed. D. On-Site Review of Local Agency Headquarters The State Agency will conduct a mandatory entrance interview with the Local Agency Director at the beginning of each Local Agency Review to discuss the upcoming clinic site reviews and any issues which the Local Agency may wish to share. The monitor will review documents that may be stored at the Local Agency Headquarters if not otherwise accessible, and discuss performance indicators and/or statistical reports at a Local Agency level with the Director. 1. The State Agency will use both 9.01 Attachment #1 for the nutrition portion of the review with the Local Agency Director and 9.01 Attachment #2 for the operations portion of the review with the Local Agency Director. E. On-Site Review of WIC Clinics 1. The State Agency will designate the WIC clinic(s) for the on-site review. 2. The number of WIC clinics to be reviewed will be twenty (20) percent of the total Local Agency WIC clinics. 3. The date of the on-site review of clinics will be unannounced, but within the timeline specified in the Crossroads tracking system as to when the review must be completed. 2 of 5
West Virginia WIC Policy & Procedure 9.01 Date: 04/23/2012 9.01 State Agency Review of Local Agency Program 4. The review will consist of observation of the physical site, personnel interviews, and observation of interviews or other direct observation of employees, review of documents, and review of individual participant files. 5. The number of individual participant records that will be examined will be based on the clinic being classified as large, medium, or small. The size classification will be determined based on the clinic’s active caseload in the most recent closed month. A clinic will be classified as large if the caseload is 1,500 and above; a clinic will be classified as medium if the caseload is between 501 and 1,499; and a clinic will be classified as small if the caseload is 500 and below. a. For clinics that are classified as large, a total of fifty (50) participant records will be monitored; including a random sample of ten (10) records for each WIC condition (pregnant, breastfeeding, postpartum, child, and infant). The random sample should include both low and high risk participants. b. For clinics that are classified as medium, a total of thirty (30) participant records will be monitored; including a random sample of six (6) records for each WIC condition. The random sample should include both low and high risk participants. c. For clinics that are classified as small, a total of twenty (20) participant records will be monitored; including a random sample of four (4) records for each WIC condition. The random sample should include both low and high risk participants. d. d. Special Formula Documentation will be monitored based on clinic size; with fourteen (14) records to be reviewed in clinics that are classified as large, ten (10) records to be reviewed in clinics that are classified as medium, and four (4) records to be reviewed in clinics that are classified as small. e. Five (5) termed records will be monitored for proper notification of terminations and denials for the past six (6) months which require advance written notice to the participant; regardless of clinic size classification. 3 of 5
West Virginia WIC Policy & Procedure 9.01 Date: 04/23/2012 9.01 State Agency Review of Local Agency Program f. When observing certifications and sub-certifications for on-site monitoring, one of each WIC condition (pregnant, breastfeeding, postpartum, infant, and child) should be observed if possible. When observing a participant from each WIC condition is not possible; a minimum of one (1) woman, regardless of WIC condition (pregnant, postpartum, or breastfeeding), one (1) infant, and one (1) child must be observed. These categories or samples may be changed as new risk categories arise, or as the State Agency deems warranted in specific situations. F. Exit Interview The Local Agency Director has the option to have an exit interview with the State Agency Monitor to discuss preliminary review findings. The interview may be in person or by telephone. G. Local Agency External Review Form 1. The State Agency will use the State Agency’s Nutrition and Operations Monitoring Forms (see Attachment #3 and #4, 9.01). H. Local Agency Review Report The State Agency Monitor will submit a written report to the Local Agency Director within thirty (30) days of the last day all clinics in the Local Agency review are visited. The report will address the findings of the review. I. Action Plan 1. The Local Agency Director will submit a plan of corrective action to the State Agency within thirty (30) days of the receipt of the review report. The plan must include proposed corrective actions and target dates to correct the findings. 2. The State Agency must monitor local agency implementation of corrective action plans. Documentation of the corrective action plans must be on file, to include items such as procedure manual revisions, meeting agendas with sign-in sheets, memorandums issued to staff, verification proposed training occurred, etc. Once verification of the corrective action plan implementation is received, the State Agency will notify the Local Agency in writing of the approval or disapproval of the corrective action plan within fifteen days of verification of implementation. 4 of 5
West Virginia WIC Policy & Procedure 9.01 Date: 04/23/2012 9.01 State Agency Review of Local Agency Program J. Follow-up Review The State Agency Monitor will examine the Local Agency compliance with the action plan during a follow-up review of the Local Agency should the State Agency determine that a follow-up review is necessary. REFERENCES: 1. Federal Regulations 246.19, Management Evaluation and Reviews. ATTACHMENTS: 1. Local Agency Monitoring-Entrance Interview Questions Nutrition Services 2. Local Agency Monitoring-Entrance Interview Questions Operations 3. Nutrition Monitoring Form Internal and External Monitoring Clinic Observation 4. Operations Monitoring Form Internal and External Monitoring Clinic Observation 5 of 5
Attachment #1, 9.01 Local Agency Monitoring-Entrance Interview Questions Nutrition Services Responsibility 1. Training file is complete and contains all required Training or Continuing Education Activities Forms (Attachment #1, 1.19): 2. An ongoing record of training hours is being maintained for each CPA. This should be recorded on the Competent Professional Authority Continuing Education Hours Form (Attachment #2, 1.19) or on either Training Tracking Report (Attachment #3 or #4, 1.19): 3. Inservices that are required by the State Nutrition Education Coordinator are provided to all CPAs: 4. Affidavits are signed/dated and notarized (Attachment #2, 11.02) for each CPA: 5. Monitor has verified (can be done at State Agency Office) that the Annual Nutrition Education Plan, Annual Nutrition Education Progress Report, Annual Breastfeeding Plan, and Annual Breastfeeding Progress Report have been submitted to the State Agency within specified timeframe and have been approved: Loving Support 1. Annual assessment is conducted to determine each of the following: a. The needs of your target audience b. Where gaps exist in breastfeeding services and resources within your local agency and the community that can be addressed through peer counseling c. Where improvements in your program are needed
2. There are opportunities for peer counselors to observe and shadow experienced lactation experts and experienced peer counselors. 3. The work of peer counselors is monitored through spot checks, chart reviews or contact forms. 4. Newly trained peer counselors are routinely observed during contacts with mothers to provide guidance and affirmation. 5. Routine meetings are scheduled to discuss case studies with your peer counselors. 6. There is adequate supervision of peer counselors by staff with advanced lactation training. 7. Peer counselors routinely contact mothers, at a minimum, monthly during pregnancy and weekly 2 weeks prior to a woman’s expected delivery date. 8. Peer counselors routinely contact mothers, at a minimum, every 2-3 days in the first week after delivery and within 24 hours if the mother reports problems with breastfeeding and weekly throughout rest of the first month. 9. Peer counselors routinely contact mothers after a woman’s first month postpartum, at a minimum, monthly, as long as things are going well. 10. Peer counselors routinely contact mothers after a woman’s first month postpartum, at a minimum, 1-2 weeks before the mother plans to return to work or school and 1-2 days after she returns to work or school. 11. The clinic environment is supportive of breastfeeding by visibly endorsing breastfeeding as the preferred method of infant feeding. 12. There are policies that support a clinic environment where participants feel comfortable breastfeeding. 13. All staff are trained to support the goal of exclusive breastfeeding with WIC participants using the FNS-developed competency-based breastfeeding curriculum, Using Loving Support to
Grow and Glow in WIC, or Loving Support Through Peer Counseling. 14. New clinic staff orientation includes breastfeeding policies and procedures especially related to supporting exclusive breastfeeding. 15. Ongoing training is provided to all WIC staff using the FNS-developed competency-based breastfeeding curriculum, Using Loving Support to Grow and Glow in WIC, WIC Learning Online course, WIC Breastfeeding Basics, or similar State-developed training based on Using Loving Support to Grow and Glow in WIC or Loving Support Through Peer Counseling. 16. There is ongoing continuing education on breastfeeding for all staff through regularly scheduled staff trainings and other educational opportunities. 17. There are policies that ensure all participant breastfeeding concerns are addressed according to established time frames. Revised 01/17
Attachment #3, 9.01 Nutrition Monitoring Forms Internal and External Monitoring Clinic Observation Staffing & Organization 1. If a participant is late for a nutrition education appointment, how is that handled? 2. If a participant misses a nutrition education appointment, how is that handled? 3. Nutrition education attendance is documented in the computer. 4. Refusal to participate in nutrition education is documented and does not cause denial of WIC benefits. Health Check 1. Are parents/guardians of children on Medicaid questioned about their child’s medical provider? 2. Is a referral form completed if the child does not have a medical provider 3. Are referrals to Head Start offered to parents/guardians of children age 3 or older? 1
Attachment #3, 9.01 Prescribing Food Packages and Formula Stock 1. Who in the clinic performs certifications, enters risk codes, and determines and prescribes food packages? 2. Who in the clinic accepts WIC-53 forms? 3. When there is no CPA on site, how are WIC-53 and food package changes handled? 4. Infant formula stock in date? 5. The return formula tracking log, Policy 3.06. B, Attachment #1 is maintained and up to date. Calibrating Scales 1. Are scales being calibrated according to policy 2.12? 2. Is there a calibration log being maintained according to policy 2.12? Blood Work 1. Lancets/lancet stock in clinic are retractable and follow criteria for lancets outlined in Hematology: A Training and Reference Manual 2
Attachment #3, 9.01 for West Virginia WIC Clinics (Second Edition, 2001) 2. In the case of an accidental needlestick/exposure involving infectious materials; employees know where to locate guidelines for emergency procedures in the Hematology: A Training and Reference Manual for West Virginia WIC Clinics (Second Edition, 2001) 3. Tuberculocidal disinfectant available in hematological testing area. 4. Sharps box is within easy reach of the employee, not too full. 5. Cuvettes are stored in dry conditions, at room temperature and not out of date. Observing Anthropometric Techniques For Children 2 Years and Older or Adult (Height and Weight) WIC Condition: P ID: N ID: B ID: C >2 yrs. ID: Capturing Height: 1. Participant is measured in stocking feet with nothing on the head which interferes with height measurement. 2. Heels, buttocks, and shoulder blades touch the board surface. 3. Legs are straight, shoulders relaxed, and feet slightly apart. 4. Eyes are looking straight ahead. 3
Attachment #3, 9.01 5. Sliding headpiece touches crown of head when height is read. 6. Height is recorded correctly in Crossroads. Capturing Weight: 7. Participant is wearing light indoor clothing, NO SHOES. 8. Participant is correctly positioned on the scale. 9. Scale is read when participant is on it. 10. Weight is recorded correctly in Crossroads. Observing Anthropometric Techniques For Participants Younger than 2 Years (Length and Weight) WIC Condition: I <1 year ID: C <2 years ID: Capturing Length: 1. The recumbent board is covered with paper. 4
Attachment #3, 9.01 2. Assistant holds crown of head up against the stationary headpiece on recumbent board. 3. There are no hair ornaments on the participant’s head. 4. Participant is not wearing shoes. 5. Body is in a straight position: knees are not bent and feet are not spread wide apart. 6. Clear view of foot piece touching soles of the feet at both heels when the length is captured. 7. Length is recorded correctly in Crossroads. Capturing Weight: 8. Paper is on scale. 9. Participant is nude or in a single layer/diaper is dry. 10. Participant is positioned correctly on the scale. 11. Weight is recorded correctly in Crossroads. 5
Attachment #3, 9.01 Observing Blood Work Techniques WIC Condition: P ID: N ID: B ID: I >9 mos. ID: C ID: 1. Hands are washed or disinfected. 2. Employee is wearing gloves. 3. Worker assembles the following supplies: Cuvette, alcohol wipe, dry gauze or absorbent material, disposable retractable lancet 4. Employee explains the procedure to the participant and/or parent/guardian. 5. Employee ensures puncture site is warm. 6. Employee cleanses site with alcohol. 7. Employee allows alcohol to dry or wipes dry. 8. Employee sticks finger on the side of the extremity. 9. The lancet is discarded immediately into the sharp’s container. 10. Minimal squeezing to produce blood drops; the first three drops of blood wiped away with dry absorbent material. 6
Attachment #3, 9.01 11. The pointed end of the cuvette is placed in 4th blood drop and filled. Cuvette does not touch blood drop more than once. 12. Outer edges of cuvette are wiped clean of blood and placed in the HemoCue within 5 min of being filled. 13. Used gauze, filled cuvettes are disposed of according to medical waste regulations. 14. Surfaces disinfected; hands washed/or disinfected. Observing Nutrition Counseling WIC Condition: P ID: N ID: B ID: I ID: C 1-2 yrs. ID: C >2 yrs. ID: 1. VENA principles are used during counseling. 2. Appropriate risk codes assigned and explained. 3. Applicable referrals have been correctly documented. 4. Applicable, WIC-53 food packages have been prescribed correctly. 5. Substance-abuse materials are being given to participants. 6. Postpartum participants are screened for depression and referred if necessary. 7
Attachment #3, 9.01 7. For Prenatal participants: Breastfeeding is promoted, information offered. 8. Appropriate food package is prescribed. 9. Assists participant in setting a goal for behavior change. 10. Care plan completed same day as visit. 11. WIC personnel verbally instruct the parent/guardian or caretaker during cert/sub-cert appointment of the correct use of food benefits, the WIC-Approved Food List (FD-09) and the eWIC benefit card Notes: Nutrition Services—Breastfeeding 1. All pregnant women are scheduled for a breastfeeding nutrition education contact. 2. Adequate print and audiovisual materials in the clinic. 3. Office supplies are free of formula product names. 8
Attachment #3, 9.01 4. Monitor will review the Breastfeeding Peer Counselor documentation contact in Breastfeeding Care Plan in Crossroads. 5. Loan agreements for electric breast pumps are maintained in Crossroads. Observing Nutrition Education Contacts Group Nutrition Education Contact/One-on-One Nutrition Education Contact Name/Title: Evaluator: Date: 9
Attachment #3, 9.01 1. Prepared for nutrition education contact/or one-on-one contact 2. Introduces self 3. Provides an explanation for the NE contact/or one-on-one contact 4. Conveys warmth/empathy 5. Uses reflective listening 6. VENA being used: asks participant(s) if they have any questions/concerns; discussion is based on participant’s needs 7. Uses appropriate language level 8. Culturally-sensitive to participant(s) 9. Uses participant(s) name(s) when possible 10. Maintains eye contact and appropriate body language 11. Uses open-ended questions to encourage participant discussion 12. Requests permission to offer information/suggestions to participant(s); offers concrete suggestions for behavior change 13. Printed materials, audiovisuals, and teaching props are used in nutrition education contact when appropriate to enhance presentation; handouts are available and offered to the participant(s) 10
Attachment #3, 9.01 14. Information provided is tailored to the participant(s) needs/concerns 15. Summarizes what was discussed during contact and encourages behavior change Observing Nutrition Education Contacts: Breastfeeding One-on-One Breastfeeding Education Contact Name/Title: Evaluator: Date: 1. Introduces self 2. Provides an explanation for the nutrition education contact 3. Breastfeeding is promoted by offering breastfeeding materials and information; peer counselor ID card is given if likely to breastfeed 4. Conveys warmth/empathy 5. Uses reflective listening 6. VENA being used: asks participant if they have any questions/concerns about breastfeeding 7. Uses appropriate language level 8. Culturally-sensitive to participant 9. Uses participant’s name 11
Attachment #3, 9.01 10. Maintains eye contact and appropriate body language 11. Uses open-ended questions to encourage discussion 12. Requests permission to offer information/suggestions to participant 13. Printed materials, audiovisuals, and teaching props are used when appropriate to enhance education; handouts are available and offered to participant 14. Information provided is tailored to the participant’s needs/concerns 15. Summarizes what was discussed Observing Nutrition Education Contacts: Breastfeeding Group Breastfeeding Contact Name/Title: Evaluator: Date: 1. Introduces self 2. Participants are screened for likelihood of breastfeeding and peer counselor ID cards are given to those likely to breastfeed 3. VENA being used: asks participant(s) if they have any questions/concerns 12
Attachment #3, 9.01 4. The following topics may be offered for discussion, but not limited to these topics: ● Misconceptions, questions, or concerns with breastfeeding ● How the breast makes milk ● Benefits for mother & infant ● Clothing to wear for discretion ● Nipple assessment and care ● Proper positioning ● Latching on/letting go ● Letdown reflex ● Engorgement and prevention ● Nursing schedule ● How to tell if baby is getting enough milk ● Social Support Services ● Addressing hospital policies on breastfeeding ● Ways to obtain incentive items offered if applicable 13
Attachment #3, 9.01 Monitoring Individual Participant Records (Records monitored in Crossroads) WIC Condition and ID number: 1. Risk codes are correct 2. Appropriate food package prescribed by a CPA 3. Individual care plan completed correctly according to Policy 5.06 and relevant to participant’s assigned risk codes (Policy 5.05 & 5.06 Attachment #1) 4. High Risk Care Plans address reasons participant is high risk (Policy 5.06) 5. Nutrition Education or High Risk appointment is scheduled 6. Referral completed (if necessary) and documented 7. Correct documentation and plotting on growth chart or prenatal weight gain grid. 14
Attachment #3, 9.01 Special Formula Documentation (Records monitored in Crossroads) WIC Condition And ID number: 1. WIC-53 is correctly documented in Crossroads. 2. WIC-53 is filled out correctly with physician’s diagnosis, prescribed formula, number of months formula is prescribed 3. Formula prescribed is allowable medical condition per Policy 4.07 4. Reason for Ready-to-Feed (RTF) formula issuance is included in a care plan 5. RTF formula is issued correctly 6. A care plan has been documented by a CPA 7. Correct duration for the special formula is documented 15
Attachment #3, 9.01 8. Correct and current diagnosis is documented 9. Is staff verifying that warehouse orders have been successfully received by CAP? Revised 1/17 16
Attachment #4, 9.01 1 of 9
Operations Monitoring Forms Internal and External Monitoring
Clinic Observation
Certification and Eligibility – Observation of Intake Process
Categories of Participants Observed: (Use tally marks to show how many participants were seen.) P B N I C
During clinic observation, are rights and responsibilities verbally explained and Participant Agreement electronically signed? Is the signature legible and belonging to the proper parent/guardian or caretaker of the family?
Is correct documentation used to verify income, identification and residency?
Is racial and/or ethnic data collected and properly documented in the computer?
Are applicants who receive SNAP, AFDC, and/or Medicaid certified as adjunctively eligible?
Is applicant/participant physically present during certification?
Are infants and children screened for immunization status?
Are referrals to other agencies appropriate and properly documented during clinic observation?
The following documents are scanned into the participant’s record if applicable:
Attachment #4, 9.01 2 of 9
a) Custody papers b) VOC for transfers into West Virginia (WV) c) Photo Release Form d) Prescription Formula Form (WIC-53) e) Sanction Letters
Are VOC cards accepted if certification period is valid, or previous clinic contacted to verify that a valid certification period is in effect?
Is Voter Registration offered at each certification, sub-certification appointment and when an address change is reported? Is the proper form completed for documentation?
Is every effort made to coordinate appointments within a family if the family has multiple WIC participants?
Is EBT card use and responsibility explained to parent/guardian or caretaker prior to card issuance?
Is each participant provided a current list of WIC vendors and a current food list?
Are women certified without proof of pregnancy and given 60 days to provide documentation of pregnancy, if pregnancy cannot be visually verified?
Civil Rights
Clerk and/or supervisor: describe the procedure for handling a civil rights complaint.
Staff demonstrate ability to locate approved Civil Rights Complaint Form on WIC website.
Attachment #4, 9.01 3 of 9 How are other types of complaints handled?
Describe the procedure when a non-English speaking participant is enrolled or otherwise contacts your clinic?
What do you do to ensure ease of access to the clinic for persons with disabilities?
Describe any alternate method(s) of providing services when your clinic site is not accessible to persons with disabilities.
Clinic Accountability
Documentation which is required to be accessible:
Clerk demonstrates ability to access: Yes No Comments Crossroads User Manual within the Application
Policy and Procedure Manual (may be electronic)
Vendor Manual (may be electronic)
Quarterly Vendor Listing (may be electronic)
Motor Voter Declination forms
Are all required public notices present and prominently displayed during clinic observation?
a) Emergency Escape Plan b) “And Justice for All”, USDA Form AD-475A (Revised 3/98) c) USDA Hotline poster d) “Don’t Fall for the Trap” WV fraud poster e) No Smoking Policy
Is the Food List explained at an initial certification or if changes to the Food List have occurred?
Attachment #4, 9.01 4 of 9
Is EBT equipment kept secure?
Who in the clinic approves WIC-53 forms?
When there is not a Competent Professional Authority (CPA) onsite, how are WIC-53 and food package changes handled?
Are comment forms readily available to participants in the waiting room or prominent location?
Facility Evaluation
Is WIC in its own building or does the clinic share space with other entities? If shared, what other entities share the facility?
Is participant confidentiality protected by providing private areas for breastfeeding, intake, medical history and nutrition counseling?
Are WIC offices separated by lockable doors? Who has keys to the clinic? Who is responsible for locking WIC office?
Is the building clean, safe, and does it have adequate space?
Are participant areas safe for children?
If laptops are used in the clinic, where are they stored when not in use? Do they ever leave the clinic, and if so, for what reasons?
Attachment #4, 9.01 5 of 9
Is there a detailed inventory of all equipment maintained? Where is it kept and who is responsible for updating it?
How are computers protected against the busy hands of toddlers in the WIC offices?
Is clinic equipped with smoke detectors, fire extinguishers, fire alarms, and/or sprinkler system? Has staff been trained on proper use of this equipment?
Are current inspection tags visible on extinguisher units? Who is responsible for verifying their operability?
Food Delivery/Food Benefit Issuance Accountability
Yes No Comments EBT cards are stored in a secure area when not in use (per Policy 3.02)
Unissued EBT cards are not left unattended at any time (per Policy 3.02)
Access to EBT card storage cabinets/drawers is limited to designated staff members
Benefits are not issued and the Benefit Shopping List not printed in advance of appointments.
Review of Termed or Ineligible records
Family Identification number 1 2 3 4 5
Attachment #4, 9.01 6 of 9 WIC Condition Written Notice to Participant
Minimum 15 day Notice Provided
Reason for Termination Stated
Notification signed by participant if applicable
Notification of right to request a fair hearing if applicable
Fair hearing requests handled per established policies and procedures
Sanction letters scanned into system for currently sanctioned participants (on Income Screen)
Notes:
Attachment #4, 9.01 7 of 9 Clinic Chart Review
The ____________ clinic has a current caseload of _________, and is classified as (small, medium, or large). Per policy, a random sample of _______ records was reviewed in the Crossroads system. Note: Make copies of this page as needed to review the required number of charts based on established clinic size.
Family ID Number WIC Condition (P-N-B-I-C)
Custody papers scanned into Crossroads, if applicable
Proper documentation of VOC transfers into the state
Photo release forms signed/scanned into Crossroads, if applicable
Parent/Guardian or Caretaker signature captured for certification/subsequent certification
When WIC staff sign (name may be printed) for food instrument issuance, proper radio button selected and reason for signing noted
If CTads were used for certification, a hard copy Participant Agreement signed and scanned into Crossroads
All applicable screens fully completed for all participants, whether required for certification or not, at each certification or sub-certification
Review of Scanned Custody Papers for Foster Children
Attachment #4, 9.01 8 of 9
Per Policy 2.07.B.3.a. and b., Certification of Foster Children, foster parents must physically take guardianship papers to the WIC clinic and those must be scanned into the participant’s record. In cases where siblings are both listed on one custody document, that information must be scanned into each child’s record. Records for foster children to be reviewed will be drawn from the Crossroads Clinic Report, Detail Report of Infants and Children in foster Care. The number of charts to be reviewed will be based on the size of the clinic under review. Clinics classified as large, over 1,500 caseload, will have fifty (50) records reviewed; clinics classified as medium, 501 – 1,499 caseload, will have thirty (30) records reviewed, and clinics classified as small, less than 500 caseload, will have twenty (20) records reviewed.
Family ID#
Child’s Name
Foster Care Status Properly Documented
Custody or Guardianship Papers Properly Scanned into Chart
Description of Findings, if any
Family ID#
Child’s Name
Foster Care Status Properly Documented
Custody or Guardianship Papers Properly Scanned into Chart
Description of Findings, if any
Attachment #4, 9.01 9 of 9
Farmers’ Market Nutrition Program Monitoring
Are eWIC cards with FMNP QR codes stored under double lock and key? Observed or per staff?
Is clinic personnel reviewing first/last dates to spend with participants, parent/guardians and caretakers?
Is nutrition education being provided and, if so, how?
Has the participant, parent/guardian or caretaker signed into the Farm Market Direct portal to ensure access prior to spending benefits?
Are clinic staff maintaining the card replacement log to capture the number of FMNP participants needing new cards?
X. MONITORING AND AUDITS State Agency: West Virginia for FY 2025 Monitoring and Audits involves State agency efforts to review local agency/clinic activities on an ongoing and timely basis, and to track all audits involving WIC Program activity. During disasters, emergencies, public health emergencies, or a supply chain disruption, including infant formula recalls, the State agency may request to implement existing and allowable regulatory flexibilities or waivers to support the continuation of Program benefits and services. Waivers granted under Access to Baby Formula Act of 2022 (codified at 7 CFR 246.4a(30)) or temporary provision(s) authorized by Congress are not permanent amendments to the State Plan; however, State agencies should consider any historical amendments as the result of waivers granted under prior waiver authority to develop policies and procedures for current and future disasters. A. Monitoring-246.19(b): requires State agencies to establish a management evaluation system. B. Audits-Subpart F to 2 CFR Part 200, as applicable: describe State agency audit responsibilities.
X. MONITORING AND AUDITS A. Monitoring 1. Local Agency/Clinic Monitoring Activity (to be updated each year). Skip this section if the State agency has no local agency(ies) a. Local agencies/clinics monitored: (If State agency has one local agency, specify the date it was last monitored. 8. Number of local agencies (for FFY2024) 3. Number of local agencies monitored last annual period 6. Number of clinics monitored last annual period 5. Number of local agencies to be monitored this current annual period 8. Number of clinics to be monitored this current annual period Specify the last annual period, from: 10/01/2023 to 9/30/2024. (month/day/year – month/day/year; must be applied consistently) Specify current annual period, from: 10/01/2024 to 9/30/2025 (month/day/year – month/day/year; must be applied consistently) b. Number of local agencies/clinics required to submit Corrective Action Plans (CAPs) to address deficiencies identified during monitoring last year: 0 c. The State agency uses a tracking device, such as a chart or spreadsheet, which summarizes the reviews of all local agencies. ☒Yes ☐No If the State agency uses a tracking device, it shows (check all that apply): ☒Date of most recent review for each local agency/clinic ☒Number of clinics reviewed in most recent review for each local agency/clinic ☒Listing of findings for most recent review of each local agency/clinic ☒Date of State agency notice of findings in most recent review for each local agency/clinic ☒Date of local agency/clinic corrective action plan in most recent review for each local agency and/or clinics ☒Outcome of corrective action plan ☒Whether the review was conducted virtually or onsite 2
X. MONITORING AND AUDITS d. In preparing to conduct a local agency review, the State agency reviews data reports on: ☐No-shows by category ☒Administrative costs claimed ☒Financial reports ☒Priorities served ☒Caseload ☐Racial/ethnicity ☒Staff/participant ratios ☒Participant nutrition surveillance data for participants in that local agency/clinic ☒Other (specify): Processing Standards, High risk follow up Report, RTF issuance, WV WIC 53 Expiration, Computer Security ADDITIONAL DETAIL: Monitoring & Audits Appendix and/or Procedure Manual (citation): P&P 9.01 and 9.01 Attachments 1-4 2. Local Agency/Clinic Monitoring Procedures a. The State agency uses an established protocol when it monitors local agencies/clinics. ☒Yes ☐No If yes, please provide the citation of where it can be found in the appendix or procedure manual:Appendix-A-9.01 State Agency Review of Local Agency Program Updates; X Appendix-B-9.01 Attachment #1 Nutrition Entrance Interview Questions; X Appendix-C-9.01 Attachment #2 Operations Entrance Interview; X Appendix-D-9.01 Attachment #3 Nutrition Monitoring Forms Clinic Observation; X Appendix-E-9.01 Attachment #4 Operations Clinic Monitoring Checkoff Sheet This monitoring protocol includes: ☒Advance notification of monitoring visit ☒Determination of timeframes for conducting the review ☒Designation of local agency/clinic staff to assist State agency staff during review ☒Discussion of review findings on-site with local agency/clinic ☒Specified time frame for providing written review report ☒Specified time frame for local agency/clinic submission of corrective action plan, not to exceed 60 days from receipt of State agency’s report ☒Instructions or guidance for preparation of corrective action plan (e.g., inclusion of implementation time frames) ☒Evaluation of adequacy of corrective action ☒Follow-up with local agency/clinic to ensure corrective action measures are implemented ☒Written notification of closure of the review 3
X. MONITORING AND AUDITS ☐Other (specify): N/A. b. Monitoring of local agencies/clinics is conducted by (check all that apply): ☒State WIC staff ☐District or regional staff ☐Other health programs ☒Other (specify): BPH Central Finance Unit Monitoring and Audit Staff c. Specialists in the following areas monitor the areas of their expertise: ☒Certification and eligibility determination ☒Caseload management ☒Nutrition service ☒Breastfeeding promotion and support ☒Targeting and outreach policies ☒Financial management of administrative funds ☒Food delivery system ☐Vendor management ☒Civil rights ☐Information Systems security ☐Other (specify): N/A. 4
X. MONITORING AND AUDITS If the State agency uses reviewers to monitor areas in which they do not have expertise and/or prior knowledge, describe how the State agency trains or equips its reviewers to conduct the review: The State agency uses a standard local agency/clinic review form. ☒Yes ☐No If yes, please provide the citation of where it can be found in the appendix or procedure manual: X Appendix-A-9.01 State Agency Review of Local Agency Program Updates; X Appendix-B-9.01 Attachment #1 Nutrition Entrance Interview Questions; X Appendix-C-9.01 Attachment #2 Operations Entrance Interview; X Appendix-D-9.01 Attachment #3 Nutrition Monitoring Forms Clinic Observation; X Appendix-E-9.01 Attachment #4 Operations Clinic Monitoring Checkoff Sheet If yes, the review form covers the following areas: ☒An assessment of local agency/clinic management ☒An assessment of patient flow ☒Certification case file reviews, including procedures for determining adjunctive income eligibility ☒Caseload management ☒Training of local agency and clinic staff ☒Nutrition education ☒Breastfeeding promotion and support ☒Targeting and outreach policies ☒Financial management of administrative funds ☒Validation of staff time spent on WIC ☒Food instrument accountability ☐Vendor training and monitoring (If these functions are delegated to a local agency/clinic) ☒Civil rights compliance ☒Other (specify): Staff observation, chart reviews The State agency has developed procedures for local agencies/clinics to use when they evaluate: ☒Their own operations ☒Subsidiary/satellite operations (e.g., county health department clinic) ☐Subcontractors (e.g., community action program, hospital) ☒Homeless facilities/institutions ☐Other (specify): N/A. If you selected any of the options above, please provide the citation of where it can be found in the appendix or procedure manual and answer the following questions: Appendix-A-9.01 State Agency Review of Local Agency Program Updates; X Appendix-B-9.01 Attachment #1 Nutrition Entrance Interview Questions; X Appendix-C-9.01 Attachment #2 Operations Entrance Interview; X Appendix-D-9.01 Attachment #3 Nutrition Monitoring Forms Clinic Observation; X Appendix-E-9.01 Attachment #4 Operations Clinic Monitoring Checkoff Sheet 5
X. MONITORING AND AUDITS Do these procedures include a monitoring tool? ☒Yes ☐No Are all local agencies/clinics required to follow these procedures? ☒Yes ☐No (specify basis for exemptions): ADDITIONAL DETAIL: Monitoring & Audits Appendix and/or Procedure Manual (citation): X Appendix-B-9.01 Attachment #1 Nutrition Entrance Interview Questions; X Appendix-C-9.01 Attachment #2 Operations Entrance Interview; X Appendix-D-9.01 Attachment #3 Nutrition Monitoring Forms Clinic Observation; X Appendix-E-9.01 Attachment #4 Operations Clinic Monitoring Checkoff Sheet 6
X. MONITORING AND AUDITS 3. Use of Local Agency/Clinic Review Data a. The State agency analyzes the results of local agency/clinic monitoring visits to determine whether deficient areas are common among its local agencies/clinics. ☒Yes ☐No b. The State agency utilizes local agency/clinic review data to (check all that apply): ☒Identify outstanding operational approaches that could be shared with other local agencies/clinic ☒Track individual local agency/clinic performance ☒Compare administrative costs/expenses among local agencies/clinics ☒Compare staffing and organization among local agencies/clinics ☒Other (specify): Identify operating procedures that vary due to some LA’s are run by the private sector ADDITIONAL DETAIL: Monitoring & Audits Appendix and/or Procedure Manual (citation): 9.01 State Agency Review of Local Agency Program B. Audits Do not include management evaluations or other reviews conducted by FNS regional offices or by WIC State agencies. This section concerns the audits conducted under Subpart F to 2 CFR Part 200 and audits conducted by USDA’s OIG, per 7 CFR 246.20 (a, b). 1. Audits (Federal, State, and Local) a. Number of audits conducted during FY2023 : 8 b. Entities audited (includes both Auditor(s) Period of Status/disposition of audit at this State and local agencies) Audit time (management decision, final action, etc. Entities audited (includes both State and Local Agencies) Auditor(s) Period of Audit Status/ disposition of audit at this time (management decision, final action, etc.) WV Department of Health and Human Resources/Bureau for Public Ernst & Young 6/30/2023 Complete 7
X. MONITORING AND AUDITS Health/Office of Nutrition Services LLP Clay County Board of Health (Central) David L. Howell, CPA 06/30/2023 Complete Mid-Ohio Valley Board of Health Perry & Associates, CPA, A.C. 06/30/2023 Complete Monongalia County Health Department Ferrari& Associates, PLLC 06/30/2023 Complete Randolph Elkins Board of Health David L. Howell, CPA 06/30/2023 Complete Shenandoah Valley Medical System, Inc. SEK & Co., LLC 04/01/2023 - 03/31/2024 Audit Occurring Valley Health Systems, Inc. Hayflich, CPAs 05/31/2023 Complete West Virginia Emergency Medical Services, Technical Support Network, Inc. (TSN) Herman & Cormany CPA, A.C. 06/30/2023 Complete Wheeling-Ohio County Board of Health Ferrari & Associates, PLLC. 06/30/2023 Complete
If additional audits were conducted, please provide separately. c. Entities not audited and reason (e.g., local office is not a subrecipient local agency, non-federal entity did not expend $750,000 or more in Federal funds during the fiscal year, etc.) Entities not audited (includes Reason Entity Not Audited both State and local agencies) N/A – Not applicable All eight Local WIC Agencies and the State Agency were audited for FY ending June 30, 2023. ADDITIONAL DETAIL: Monitoring & Audits Appendix and/or Procedure Manual (citation): Click or tap here to enter text. 2. Audit Management Decision a. Methods used by the State agency to ensure that corrective action is taken on audit findings include (check all that apply): ☒State agency has a copy of the corrective action plan on file. ☒State agency tracks audits to determine if the same problems are recurring from year to year. ☒Local agency must file periodic reports. ☒State agency contacts local agency by phone or in writing periodically. 8
X. MONITORING AND AUDITS ☒State agency visits local agency. ☐Other (specify): Click or tap here to enter text. b. State agency actions taken to ensure that all claim amounts are recovered include (check all that apply): ☐Local agency files periodic reports. ☒State agency contacts local agency by phone or in writing. ☒State agency monitors receipt of a check in the amount of an audit claim. ☒State agency establishes and employs billing/offsetting of account procedures. ☐Other (specify): Click or tap here to enter text. c. State agency accounting procedures for claim amounts recovered: ☒Recovered claim amounts from prior fiscal years are returned to FNS. ☒Recovered claim amounts are reallocated if collected within the same fiscal year. ☐Claim amounts are verified with local agency. ☐Other (specify): Click or tap here to enter text. ADDITIONAL DETAIL: Monitoring & Audits Appendix and/or Procedure Manual (citation): Click or tap here to enter text. 3. Availability of Audit Reports a. The State agency receives and maintains for at least three years copies of all organization-wide audits involving the WIC Program and maintains a listing of those audits. ☐Yes ☒No, copies are retained by: WV Office of Shared Administration – Office of Internal Control and Policy Development Division of Compliance and Monitoring. All audits are scanned and made available on the WV State Auditor’s Office website b. Procedures used for maintaining files to reflect the trail from the receipt of the audit to final action include: ☒Detailed breakdown of each audit finding is tracked separately. ☐Individuals are assigned to monitor each audit. ☒One individual is assigned to monitor all 9
X. MONITORING AND AUDITS audits. ☐Other (specify): Click or tap here to enter text. c. The State agency maintains a listing of all planned audits for the coming Fiscal Year. ☒Yes ☐No (Indicate recent FYs which included WIC in the single audit report): On the State of WV A-133 Audit, WIC was not considered a major program in SFY 2023 ending 6/30/2023 but it was pulled and considered a major program for SFY 2024 ending 6/30/2024. d. The State agency ensures WIC participation in the single audit and other audits by (check all that apply): ☐Developing a tracking system that monitors the status of each audit ☒Establishing a contact person for each audit ☒Including this audit requirement in the local agency contract ☐Other (specify): Click or tap here to enter text. ADDITIONAL DETAIL: Monitoring & Audits Appendix and/or Procedure Manual (citation): P&P 6.17, 6.18, 6.19 10
West Virginia WIC Policy & Procedure 1.08 1.08 Civil Rights Effective Date: 7/19/22 POLICY: The Local Agency will adhere to requirements set forth in FNS Instruction 113-1, dated 11/8/2005, which incorporates USDA policies and prohibitions against discrimination, by authority of Title VI of the Civil Rights Act of 1964, Americans with Disabilities Act, Title IX of the Education Amendment of 1972, Section 504 of the Rehabilitation Act of 1973, the Age Discrimination Act of 1975, The Personal Responsibility and Work Opportunity Reconciliation Act of 1996, The Civil Rights Restoration Act of 1987, The Food Stamp Act of 1977, Enforcement of Title VI of the Civil Rights Act of 1964 (65 F.R. 50123) and USDA Regulations. DEFINITIONS: Complaint (see FNS 113-1, page 4, item H): Any verbal or written allegation of discrimination which indicates that the WIC Program) is administered or operated in such a manner that results in disparity of treatment or services being provided to persons or groups of persons because of their race, color, national origin, age, sex (including gender identity and sexual orientation), disability or retaliation. Discrimination (see FNS 113-1, page 4, item M): The act of distinguishing one person or a group of persons from others, either intentionally, by neglect, or by the effect of actions or lack of actions based upon race, color, national origin, age, sex (including gender identity and sexual orientation), disability or retaliation. Grassroots Organization (see FNS 113-1, page 5, item P): An organization at the local level that interacts directly with potential eligibles or participants, such as an advocacy organization, community action program, civic organization, migrant group, religious organization, neighborhood council, or other similar group. Person with a Disability: a physical or mental impairment which substantially limits one or more of an individual’s life activities, or having a record of such an impairment, or is regarded as having such an impairment. PROCEDURE: A. Civil Rights Coordinator/504 Coordinator 1. The Local Agency Director will appoint an individual to act as the Local Agency Civil Rights Coordinator/504 Coordinator. a. The Coordinator’s name will be submitted in writing to the State Agency Director. The State Agency Director will be notified of personnel changes and/or vacancies in this appointment. b. The Local Agency Civil Rights Coordinator/504 Coordinator will: i. Maintain the Civil Rights File; ii. Provide civil rights training; iii. Handle all civil rights complaints ; iv. Disseminate information requested by personnel and/or public; and v. Perform other liaison functions as needed B. Civil Rights File 1 of 8
West Virginia WIC Policy & Procedure 1.08 1.08 Civil Rights Effective Date: 7/19/22 1. A Civil Rights File maintained at the Local Agency will contain the following documents: a. FNS Instruction 113-1, dated 11/08/2005; b. Grassroots Organization Directory; and c. Local Agency 504 Evaluation (see Attachment #1 1.08). 2. A copy of each complaint and decision received will be maintained on file for at least three (3) years plus the current year. C. Public Notification and Outreach 1. Nondiscrimination Statement: The following nondiscrimination statement must be included, in full, on all materials regarding the WIC Program that are produced for public information, public education, or public distribution. In accordance with federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, this institution is prohibited from discriminating on the basis of race, color, national origin, sex (including gender identity and sexual orientation), disability, age, or reprisal or retaliation for prior civil rights activity. Program information may be made available in languages other than English. Persons with disabilities who require alternative means of communication to obtain program information (e.g., Braille, large print, audiotape, American Sign Language), should contact the responsible state or local agency that administers the program or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339. To file a program discrimination complaint, a Complainant should complete a Form AD-3027, USDA Program Discrimination Complaint Form which can be obtained online at: https://www.usda.gov/sites/default/files/documents/USDA-OASCR%20P-Complaint-Form-0508- 0002-508-11-28-17Fax2Mail.pdf, from any USDA office, by calling (866) 632-9992, or by writing a letter addressed to USDA. The letter must contain the complainant’s name, address, telephone number, and a written description of the alleged discriminatory action in sufficient detail to inform the Assistant Secretary for Civil Rights (ASCR) about the nature and date of an alleged civil rights violation. The completed AD-3027 form or letter must be submitted to USDA by: 1. mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250-9410; or 2. fax: (833) 256-1665 or (202) 690-7442; or 3. email: program.intake@usda.gov This institution is an equal opportunity provider. a. When space prohibits use of the lengthy statement, the following statement may be used, in print size no smaller than the text: 2 of 8
West Virginia WIC Policy & Procedure 1.08 1.08 Civil Rights Effective Date: 7/19/22 “This institution is an equal opportunity provider.” b. Radio and television advertising must contain the statement, but in cases where time constraints are imposed, the statement may be reduced to the following: “This institution is an equal opportunity provider.” 2. And Justice For All Poster a. At least one (1) And Justice For All poster will be visibly posted in each Local Agency WIC clinic in an area that is frequented by applicants/participants. 3. Limited English Proficiency/Interpretation Services a. Limited English Proficiency (LEP) are persons whose proficiency in speaking, reading, writing, or understanding English, as a result of national origin, is such that it would deny or limit their meaningful access to WIC services if language assistance were not provided. b. The State Agency will at a minimum yearly assess the language needs of West Virginia WIC participants and determine appropriate measures to meet the language needs of LEP participants. Decisions about the extent of language assistance provided will consider the following factors: i. The types and number of languages spoken ii. The size of the LEP population iii. Clinic size iv. Staffing and other available resources v. The frequency in which local agencies encounter LEP persons. c. It is the responsibility of the WIC Program to provide interpreters for WIC Services. Applicants and clients must be informed of the right to request an interpreter at no charge to them. However, WIC will only pay for interpreters who are scheduled by the WIC staff. i. Interpreters will be provided by the Local Agency upon request with 5 days prior notice. ii. Interpreters will wait no more than 30 minutes after the scheduled appointment time. iii. Failure to show up within 30 minutes for an appointment in which an interpreter is scheduled may result in not having an interpreter scheduled for future appointments if this happens three (3) times. iv. Bilingual WIC staff who are trained and competent in the skill of interpreting are considered acceptable interpreters. v. A family member or friend is not considered an acceptable interpreter unless the applicant/participant specifically requests that person to interpret; use of another WIC participant, a volunteer or any other 3 of 8
West Virginia WIC Policy & Procedure 1.08 1.08 Civil Rights Effective Date: 7/19/22 non-professional as interpreter is not permitted due to confidentiality issues, unless this is requested by the applicant/participant. vi. WIC staff may access telephone interpreter services through the State of West Virginia contracted telephone interpreter service, if this is acceptable to the participant. vii. WIC Services will not be denied when an interpreter is not available. d. Document the participant’s preferred read and spoken language on the Family Demographics Screen. If Language Read and/or Language Spoken is not English or Spanish, use the “yellow sticky note” to document the preferred language. 4. Non-English or Limited English-Speaking Persons a. Where a significant portion of the population of the local WIC service area is composed of non-English or limited English speaking persons who speak the same language, the Local Agency will ensure that all required WIC Program information is provided to such persons in the appropriate language orally and in writing. i. Bilingual personnel or interpreters will be available to serve these persons. ii. Written forms and other materials will be provided for such persons. iii. All rights and responsibilities listed on the Participant Agreement (WIC-05) will be read to those applicants in the appropriate language. 5. Underrepresented Populations a. Agencies or organizations in the Local Agency geographic area which specifically serve racial/ethnic groups or other protected groups underrepresented in the general population will be identified by the Local Agency. The Outreach Coordinator will be responsible for adding such agencies or organizations to the Community Network Agencies list (see Attachment #1, 7.03) to ensure that equal efforts are made to inform underrepresented populations of WIC services and benefits D. Data Collection 1. Racial/ethnic data must be collected by the Local Agency during WIC Program certification through self-reported identification. a. Applicants/participants will be asked to self-identify their racial/ethnic group only after it has been explained, and they understand that the collection of this information is strictly for statistical reporting requirements and has no effect on the determination of their eligibility to participate in the Program. b. Racial/ethnic data will be reported in the Crossroads Participant Demographics Screen. c. The State WIC Agency will produce a racial/ethnic report for each Local Agency. 4 of 8
West Virginia WIC Policy & Procedure 1.08 1.08 Civil Rights Effective Date: 7/19/22 E. Compliance Reviews 1. The Local Agency will be monitored on civil rights during the State Agency Local Agency Program Review and Local Agency Internal Review. See Policy 9.01 State Agency Review of Local Agency Program, Attachments 2 and 4. a. The Civil Rights Notebook will be examined to see that it contains the appropriate documents. b. The Monitor will look for appropriate use of the FNS-approved nondiscrimination statement and the posting of the And Justice For All poster. c. The Monitor will inquire about methods used to collect racial/ethnic data. d. The Monitor will ask several questions to assess if there are any operational procedures which have either deliberately or unknowingly resulted in discrimination. e. The Local Agency will address deficiencies found during the monitoring and write a plan for corrective action. F. Civil Rights Training 1. The Local Agency Civil Rights Coordinator will: a. Provide civil rights training to all new WIC personnel; b. Provide annual civil rights training to all Local Agency staff. Annual training will be due in the same calendar month each year. Training may be as a group or by individual. All persons must complete training between the first and last day of the calendar month. Training may occur earlier (less than 12 months from the last training) but will be due again no later than the same calendar month in the next year (See Policy 1.19, WIC Staff Training); and c. Use the training curriculum provided by the State Agency or obtain prior approval on other Civil Rights Training curriculum. 2. Civil rights training will include, but not limited to, the following: a. Collecting and using racial/ethnic data b. Effective public notification systems c. Complaint procedures d. Compliance Review Techniques e. Resolution of noncompliance f. Requirements for reasonable accommodation of persons with disabilities g. Requirement for language assistance h. Conflict resolution, and i. Customer Service G. Civil Rights Complaints 5 of 8
West Virginia WIC Policy & Procedure 1.08 1.08 Civil Rights Effective Date: 7/19/22 1. The Local Agency will accept written and verbal complaints of discrimination lodged against the State Agency, Local Agency, and WIC clinic or retail store. Such complaints may be filed by State Agency and Local Agency employees and potential employees, program applicants, participants, caretakers or anyone who observes discrimination in the delivery of Program benefits. 2. The Local Agency will use the following procedures for accepting civil rights complaints. a. The State Agency/Local Agency must accept all civil rights complaints filed within one-hundred eighty (180) days of the alleged discriminatory action. b. Civil rights complaints must be accepted whether written, verbal, identified or anonymous. c. Verbal or phoned complaints or allegations in which the complainant refuses or is not inclined to put in writing will be written by the WIC personnel taking the complaint. d. WIC personnel taking the verbal complaint will attempt to obtain the following information: i. Name, address and phone number of the complainant or other means of contacting the complainant; ii. The specific name and location of service delivery site; iii. Nature of the action that led the complainant to feel that discrimination was a factor; iv. Basis on which complainant feels discrimination exists (race, sex [including gender identity and sexual orientation], age, color, national origin, disability, or retaliation); v. Names, titles and business address of person(s) who may have knowledge of discriminatory action; and vi. Dates during which the alleged discriminatory actions occurred, or if continuing, the duration of such actions. 3. If the complainant wishes to file a written Civil Rights program complaint of discrimination, they can complete the USDA Program Discrimination Complaint Form, found online at http://www.ascr.usda.gov/complaint_filing_cust.html, or at any USDA office, or they can call (866) 632-9992 to request the form. They can also write a letter containing all of the information requested in the form. They should send their completed complaint form or letter by mail to U.S. Department of Agriculture, Director, Office of Adjudication, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, by fax (202) 690-7442 or email at program.intake@usda.gov. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339; or (800) 845-6136 (Spanish). 6 of 8
West Virginia WIC Policy & Procedure 1.08 1.08 Civil Rights Effective Date: 7/19/22 4. Documentation of Civil Rights complaints at the Local Agency will be maintained by the Local Agency Director as part of the Civil Rights Notebook. See Policy 9.01 State Agency Review of Local Agency Program, Attachments 2 and 4. 5. Copies of each civil rights complaint will also be sent to the following within 5 calendar days upon receipt of the complaint: Civil Rights Coordinator Food and Nutrition Service Mid-Atlantic Region Mercer Corporate Park 300 Corporation Boulevard Robbinsville, NJ 08691-1598 Director, State WIC Program 350 Capitol Street, Room 519 Charleston, WV 25301-3717 6. Contact the State Agency immediately with any questions. H. Applicants/Participants with Disabilities 1. The Local Agency will make provisions to screen for applicants with disabilities and provide all WIC services to all participants with disabilities. 2. A self-evaluation of Program accessibility will be conducted for each Local Agency WIC clinic using the Local Agency 504 Evaluation (see Attachment #1). a. The self-evaluation will be maintained in the Local Agency Civil Rights File. b. A copy will be sent to the State Agency. c. Once evaluated, there is no requirement for a re-evaluation unless the facilities are changed to increase or decrease the provision of service to applicants/participants with disabilities as stated in the self-evaluation currently on file. d. New WIC clinics will be evaluated as they are opened. 3. If a WIC clinic is not accessible to a person with a disability, a written Local Agency policy will be developed that describes how services will be provided to the person with a disability. a. These alternate services may include, but are not limited to: i. Service at other sites; ii. Service in other accessible locations within the same WIC clinic; or iii. Home visits. 7 of 8
West Virginia WIC Policy & Procedure 1.08 1.08 Civil Rights Effective Date: 7/19/22 b. In choosing among available methods, give priority to those methods that offer programs and activities to qualified people with disabilities in the most integrated setting appropriate to obtain the full benefits of the WIC Program. c. The policy should be flexible to cover all types of disabilities and allow reasonable accommodations, for example: i. Provision of interpreters for applicants/participants who are deaf; ii. Readers or braille for applicants/participants who are visually impaired; iii. Other special learning equipment. REFERENCES: 1. Federal Regulations: 7 CFR Part 15 b Section 504 of the Rehabilitation Act of 1973.FNS Instruction 113-1, dated 11/08/2005, Civil Rights Compliance and Enforcement – Nutrition Programs and Activities 2. SFP 95-123, People with Disabilities 3. SFP 96-009, Use of the USDA’s Nondiscrimination Statement 4. SFP 97-136, USDA’s Nondiscrimination Statement 5. DR 4300-3, 1999 Equal Opportunity Public Notification Policy 6. FNS Memo, dated 05/24/2013, USDA Nondiscrimination Statement Update ATTACHMENTS: 1. Local Agency 504 Evaluation 8 of 8
Attachment #1 1.08 (06/95) LOCAL AGENCY 504 EVALUATION Section I - Agency Identification Name and Address of Local Agency: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ Name and Address of WIC Clinic: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ Date evaluation conducted: ____________________________________________________________________________ Name/title of person(s) conducting evaluation: ____________________________________________________________________________ Name/address of person(s) with a disability or organizations assisting in evaluation: ____________________________________________________________________________ ____________________________________________________________________________ Section II - Program Accessibility Are all services accessible to people with disabilities? ____________________________________________________________________________ In selecting alternative plans to make programs more accessible, has priority been given to methods that allow people with disabilities to participate in Program activities in the most integrated setting appropriate? ____________________________________________________________________________ Was the evaluation conducted with the assistance of people with disabilities or organizations representing people with disabilities? 1 of 5
Attachment #1 1.08 (06/95) ____________________________________________________________________________ Is there a procedure for informing persons, including those with impaired vision or hearing, about the existence and location of accessible programs and activities? ____________________________________________________________________________ Are there procedures to insure that qualified people with disabilities are not denied benefits or services solely on the basis of disability? ____________________________________________________________________________ Are there procedures to ensure that separate services or benefits to people with disabilities are allowed only when the separate services or benefits are necessary to provide a given person with a disability with an equal level of effectiveness as that provided to others? ____________________________________________________________________________ Are notice provisions sufficient to ensure that people with impaired sensory or speaking skill receive effective communication? ____________________________________________________________________________ Have local policies been reviewed to ensure that none of them would discriminate against the person with a disability? ____________________________________________________________________________ Are any local policies developed that deal with the provision of services to the person with a disability? (If yes, please attach copies). ____________________________________________________________________________ Section III - Building Accessibility Checklist The below listed items are very detailed and some may not apply to this WIC clinic. Evaluate the WIC clinic as to its accessibility to people with disabilities for them to receive Program services. Building Site Yes No N/A Does the grading of the building site allow the approaches to the building to be substantially level? Is there parking within 200 feet of the building entrance? Is any of the parking reserved for the person with a disability? Are any parking spaces open on one side to allow easy access for wheelchairs and for people who use braces to get in and out of the automobile? Are parking spaces on level ground? 2 of 5
Attachment #1 1.08 (06/95) Are there ramps or level spaces to allow people to enter the building without crossing a curb? Walk Ways Yes No N/A Are walks at least 48 inches wide? Is the gradient not greater than a 1 foot rise in 20 feet (5%)? Are walks without interruption (steps or abrupt changes in level)? Do walks have non-slip surfaces? Building - Ramps Yes No N/A Do ramps have a slope no greater than a 1-foot rise in 12 feet (8.33%)? If ramps are steeper than a 5% gradient rise, are handrails provided? If there are handrails, are they at least 32 inches above ramp surface? Are the ramp surfaces smooth? Do the handrails extend 1-foot beyond the top and bottom of the ramp? Are the ramp surfaces non-slip? Do ramps have a 6-foot clearance at the bottom? Building - Entrances/Exits Yes No N/A Is at least one entrance to the building accessible to people in wheelchairs? Is at least one entrance accessible to wheelchairs on a level that would make the elevators accessible? Building - Doors and Doorways Yes No N/A Do doors have a clear opening at least thirty-two inches wide? Can doors be opened by a single effort? Is the floor of the doorway level within 5 feet from the door in the direction it swings? Are sharp inclines and abrupt changes in levels avoided at door sill? Does the speed of door closer allow the use of doors by people with disabilities? Building - Stairs and Steps Yes No N/A Do the steps avoid protruding lips at the edge of each step? Do stairs have handrails at least 32-inches above step level? 3 of 5
Attachment #1 1.08 (06/95) Do stairs have at least 1 handrail that extends at least 18 inches beyond the top and bottom step. Do steps have risers 7-inches or less? Building - Elevators Yes No N/A If more than a one-story building, are elevators available to person with a disability? Can people with disabilities, particularly in wheelchairs, enter the elevator? Are outside call buttons 48-inches or less from the floor? Are control buttons inside 48-inches or less from the floor? Are the buttons labeled with raised (or indented) letter beside them? Are they touch sensitive and easy to push? Is the elevator cab at least 5 X 5 feet? Building - Floors Yes No N/A Do floors have non-slip surface? Are floors on each story at a common level or connected by a ramp? Building - Restrooms Yes No N/A Is there at least 1 toilet with facilities for the person with a disability? Can people with disabilities, particularly in wheelchairs, enter the restroom? Do toilet rooms have turning space 60 X 60 inches for individuals in wheelchairs? Do toilet rooms that have at least one toilet stall that: is 3 feet wide; is at least 4 feet 8 inches deep; has a door that is 32 inches wide and swings out; has a handrail on each side, 33 inches high and parallel to floor, 1- ½ inches in diameter, with 1-1/2 inches between rail and wall fastened securely to wall at the ends and center? Do toilet rooms have wash basins with narrow aprons, which when mounted a standard height are no greater than 34 inches at the top and which have a clearance underneath of 29 inches? Are disposal units mounted no higher than 40 inches from the floor? Building - Hazards Yes No N/A Is lighting on ramps adequate? Are exit signs easily identifiable to all people with disabilities? 4 of 5
Attachment #1 1.08 (06/95) Section IV - Overall Evaluation Is this WIC clinic accessible to people with disabilities? ____________________________________________________________________________ If not, is there an alternative method of service developed? Is the alternative method of service posted or publicized in such a manner that potential participants are aware of the alternatives? ____________________________________________________________________________ 5 of 5
West Virginia WIC Policy & Procedure 7.02 Effective Date: 10/31/07 7.02 Publicizing WIC POLICY: The Local Agency will publicize the availability of WIC Program benefits and the location of WIC clinics. PROCEDURE: A. Local Agency Outreach Coordinator 1. Local Agency Outreach Coordinator will be designated for the Local Agency. 2. The Local Agency Outreach Coordinator will be responsible for the following: Publicizing the availability of WIC Program benefits and location of all Local Agency WIC clinics; Communicating and coordinating outreach efforts for the purpose of initiating and improving outreach activities at the State and local level including channeling all Local Agency outreach material orders and reviewing all Local Agency produced materials and news releases prior to submission to the State Agency; Meeting with the State Outreach Coordinator biannually to plan outreach strategy; Spending a minimum of eight (8) hours per week engaging in outreach activities when the Local Agency must increase caseload as specified by the State Agency;
Targeting outreach activities toward “high risk” applicants and participants and the maintenance of caseload when the Local Agency is at a maximum caseload.
The Outreach Coordinator will be responsible for contacting agencies or organizations in the Local Agency geographic area which specifically serve racial/ethnic groups or other protected groups underrepresented in the general population (see Civil Rights Policy 1.08). a) such agencies or organizations will be added to the Community Network Agencies list (see Attachment #1, 7.03) to ensure that equal efforts are made to inform underrepresented populations of WIC services and benefits Example: Instead of distributing WIC flyers community-wide, flyers should be distributed only to resources serving pregnant women, such as obstetrician offices and childbirth classes. B. Local Agency Produced Outreach Materials 1 of 3
West Virginia WIC Policy & Procedure 7.02 Effective Date: 10/31/07 7.02 Publicizing WIC State Agency approval of all outreach materials, including but not limited to, flyers, posters, brochures, promotional item messages, press releases, and advertisement copy is required prior to distribution. The Local Agency Outreach Coordinator is responsible for obtaining approval from the State Agency Outreach Coordinator. 1. The copy sent to the State Agency for approval should be the same form, quality, color, etc. that will be distributed, if possible. 2. The State Outreach Coordinator will send written approval or disapproval of all material submitted within ten (10) days upon receipt. 3. Disapproved materials must be revised and resubmitted for approval. 4. Outreach material may be faxed to the State Outreach Coordinator for immediate approval when there is insufficient time for advance planning for outreach needs. 5. The Local Agency Outreach Coordinator must provide the State Agency Outreach Coordinator with eleven (11) additional copies of materials in the final form. One (1) copy of the material will be distributed to each Local Agency Outreach Coordinator to be maintained in a resource file; and One (1) copies will be maintained in a resource file at the State Agency. C. Publicizing the WIC Program 1. Media-related activities (see Attachment #1 7.02 and #2 7.02) may include: News releases (see Attachment #3 7.02); Newspaper feature stories; Public service announcements; and Distribution of flyers, pamphlets and posters. 2. A Release Form (see Attachment #4 7.02) must be signed by the WIC payee/parent/ guardian prior to the use of identifying information, written or recorded comments and/or photograph of the participant in a media-related activity. 3. The Local Agency will publicize WIC a minimum of two (2) times per year and include: A description of the WIC Program; Participant eligibility criteria; 2 of 3
West Virginia WIC Policy & Procedure 7.02 Effective Date: 10/31/07 7.02 Publicizing WIC Name, location, clinic hours and phone numbers of Local Agency WIC clinics; and The FNS-approved nondiscrimination statement (see Civil Rights Policy 1.08) REFERENCES: 1. SFP 96-009, Use of the USDA’s Nondiscrimination Statement 2. SFP 97-136, USDA’s Nondiscrimination Statement 3. DR 4300-3, 1999 Equal Opportunity Public Notification Policy ATTACHMENTS: 1. Suggestions for Developing Successful Media Relations 2. Public Relations Handbook 3. Sample printed Media Press Release 4. Release Form 3 of 3
West Virginia WIC Policy & Procedure 1.25 Effective Date: 01/01/00 1.25 Racial Classification POLICY: The Local Agency will have the applicant/participant “self-determine” race during certification. PROCEDURE: A. Self -Determination of Race 1. Each applicant or participant must be asked to self-identify race during a certification appointment. B. Documentation of Race 1. Staff may choose to verbally ask applicant/participant directly to classify race. 2. Staff may choose to have applicant/participant write down racial classification. Note: Local Agency may develop a short form that lists racial classifications so the participant may document his/her race. 1 of 1
XI. CIVIL RIGHTS
(Please indicate) State Agency: West Virginia. for FY 2025
The Civil Rights section of the State Plan covers the training of State and local staff on issues, rules and regulations related to civil rights, public notification of nondiscrimination requirements, the monitoring of local agencies and clinics for compliance with civil rights regulations and rules, the collection of relevant racial/ethnic information and procedures for handling civil rights complaints. During disasters, emergencies, public health emergencies, or a supply chain disruption, including infant formula recalls, the State agency may request to implement existing and allowable regulatory flexibilities or waivers to support the continuation of Program benefits and services. Waivers granted under Access to Baby Formula Act of 2022 (codified at 7 CFR 246.4a(30)) or temporary provision(s) authorized by Congress are not permanent amendments to the State Plan; however, State agencies should consider any historical amendments as the result of waivers granted under prior waiver authority to develop policies and procedures for current and future disasters.
A. Administration - 7 CFR 246.4(a)(17): describe the procedures the State will use to comply with the civil rights requirements described in 246.8, including the processing of discrimination complaints.
B. Public Notification Requirements and Nondiscrimination Notification - 7 CFR 246.8(a)(1): describe the policies and procedures used to ensure that public notification regarding nondiscrimination in the WIC Program reaches all participants and potential participants in an appropriate language (246.8(c)) through WIC Program materials.
C. Compliance Review and Monitoring Activity - 7 CFR 246.8(a)(2): describe the policies and procedures used to monitor and review local agencies to verify that they are in compliance with civil rights laws and regulations.
D. Data Collection and Reporting - 7 CFR 246.8(a)(3): describe the methods used to collect and monitor racial/ethnic data in compliance with title VI of the Civil Rights Act of 1964.
E. Complaint Handling - 7 CFR 246.4(a)(17): describe the policies and practices used to ensure civil rights complaints are handled properly at the State and local level.
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A. Administration 1. The State agency designates an individual to coordinate, implement, conduct training, and enforce civil rights efforts. ☒ Yes ☐ No a. The following methods are used to inform and update State and local agency staff of their obligations under civil rights rules, regulations, and instructions:
State Local
Agency Agency
Briefing for new employees ☒ ☒
Handouts for new employees ☒ ☒
Memos and updates
☒ ☒
Presentations by civil rights coordinator ☒ ☐
Presentation by staff other than WIC Program ☐ ☐
Other
☒ ☐
If other, specify: Annual online training is required and verification of completion is monitored by the State Agency.
b. Civil rights training is provided annually State agency staff ☒ Yes ☐ No Local agency staff ☒ Yes ☐ No
c. Civil rights training includes the following:
State Local
Agency Agency
Collection and use of racial/ethnical data ☒
☒
Effective public notification systems ☒
☒
Complaint procedures
☒ ☒
Compliance review techniques
☒ ☒ Resolution of noncompliance
☒ ☒
Requirements for reasonable accommodation ☒ ☒
of persons with disabilities
Requirements for language assistance ☒ ☒
Conflict resolution
☒ ☒
Customer Service
☒ ☒
If other, specify: XI Appendix-A Policy and Procedure 1.08, Policy and Procedure 1.08- Civil Rights; XI
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Appendix-B 1.08 Civil Rights Attachment 1, 1.08- Civil Rights, Attachment #1
DETAIL: Civil Rights Appendix and/or Procedure Manual (citation): N/A.
2. The State agency has copies of the following materials on file: ☒ FNS Instruction, 113-1 ☒ Title VI (1964), 7 CFR 15 ☒ Title IX, Education Amendments, 7 CFR 15a (sex discrimination) ☒ Section 504, Rehabilitation Act of 1973, 7 CFR 15b ☒ Racial/Ethnic data collection policy and reporting requirements ☒ Age Discrimination Act of 1975, 45 CFR Part 91 ☒ Americans with Disabilities Act, 28 CFR Part 35 ☒ Civil Rights Restoration Act of 1987 ADDITIONAL DETAIL: Civil Rights Appendix and/or Procedure Manual (citation): XI Appendix-A Policy and Procedure 1.08, Policy and Procedure 1.08, Article D- Civil Rights
3. The State agency's policy for reasonable accommodation includes the most up-to-date provisions for individuals with disabilities. ☒ Yes ☐ No (Refer to FNS Instruction 113-1, Civil Rights Compliance and Enforcement–Nutrition Programs and Activities)
ADDITIONAL DETAIL: Civil Rights Appendix and/or Procedure Manual (citation): XI Appendix-A Policy and Procedure 1.08, Policy and Procedure 1.08; Article H- Civil Rights
B. Public Notification Requirements and Nondiscrimination
1. Public Notification a. The State agency requires its local agencies to include the nondiscrimination statement and civil rights complaint procedure on the following (check all that apply):
☒ Outreach letters to the general public ☒ Radio announcements ☒ Program information letters ☒ Publications ☒ Program information brochures ☒ Posters
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☒ Program information bulletins ☒ Newsletters ☒ Newspaper announcements ☒ Referral material ☒ Internet ☒ Television announcements ☒Letters of invitation in the public hearing process ☒ Certification forms to be signed by participants ☒ Application forms (including computer-based forms) ☐ Other (specify): N/A. b. The State agency requires that the USDA nondiscrimination poster, "And Justice For All," or an FNS- approved substitute be displayed in the following places frequented by applicants and participants:
☒ Clinic waiting rooms ☐ Food instrument issuance offices ☐Group/individual nutrition education areas ☐Test kitchens ☐ Distribution centers or locations ☒ Other (specify): Common Areas c. Check the group categories that the State agency and its local agencies publicly inform of the following information (check all that apply; see key below): 1 2 3 ☒ ☒ ☒ Availability of Program benefits ☒ ☒ ☒ Eligibility criteria for participation ☒ ☒ ☒ Location of LA/clinics operating WIC Program and (800) telephone numbers ☒ ☒ ☒ Hours of service of LA/clinics operating WIC Program ☒ ☒ ☒ Rights and responsibilities ☒ ☒ ☒ Nondiscrimination statement ☒ ☒ ☒ Civil rights complaint procedure 1 = general public 2 = grassroots/community organizations that deal with potentially eligible low-income individuals 3 = potential eligible individuals/participants
d. The State agency ensures that advocacy/minority organizations and the general public are informed of the benefits/policies listed above (please provide the appropriate Procedure
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Manual citation of materials used): ☐ Annually ☒ More frequently
ADDITIONAL DETAIL: Civil Rights Appendix and/or Procedure Manual (citation): XI Appendix C 7.02 Publicizing WIC, Policy and Procedure 7.02- Publicizing WIC
2. Nondiscrimination Notification a. The State agency or local agency: ☒ Provides applicants/participant with key information, such as applications and materials describing eligibility criteria and procedures for delivery of benefits, in appropriate languages other than English in areas where a significant proportion of people with limited English proficiency (LEP) reside. ☒Provide applicants/participants with key information, such as applications and materials describing eligibility criteria and procedures for delivery of benefits using inclusive language. ☒ Appropriate bilingual staff, volunteers, or other translation resources are available to serve applicants and participants in areas where a significant proportion of people with limited English proficiency (LEP) reside. ☒ All rights and responsibilities listed on the certification form are read to or by the applicants and participants in the appropriate language, or if the participant is sight or hearing impaired and requires assistance. ☐ In circumstances where the applicant completes WIC certification using an online application Tool, the rights and responsibilities and the nondiscrimination statement is available in the language most spoken by the applicant.
b. The State agency provides WIC Program materials and translators in the following languages (Check all that apply; M = Materials, VT = Volunteer Translators, PT = Paid Translators, BS = Bilingual Staff): M VT PT BS ☒ ☐ ☐ ☐ English ☒ ☐ ☒ ☒ Spanish ☐ ☐ ☐ ☐ French ☐ ☐ ☐ ☐ Vietnamese ☐ ☐ ☐ ☐ Chinese ☐ ☐ ☐ ☐ Other Asian/Pacific (specify): N/A.
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☐ ☐ ☐ ☐ Tribal (specify): N/A. ☐
Braille ☐ ☒ ☒ ☐ Sign language Interpreter ☐ ☐ ☐ ☐ Other languages (specify): N/A. ADDITIONAL DETAIL: Civil Rights Appendix and/or Procedure Manual (citation): A DHHR contract was awarded to 911 Interpreter Services for use for WIC by WIC and all clinics when an interpreter is needed. The paid services have a variety of languages available to use.
C. Compliance Review and Monitoring Activity 1. Compliance Review a. Civil rights reviews of local agencies are conducted:
☒ Separately ☐ In conjunction with another department, organization, or service as part of an overall review ☐ Other (specify): N/A. b. The State agency reviews all its local agencies for civil rights compliance with the Civil Rights requirements when it does its reviews. ☒ Yes ☐ No
ADDITIONAL DETAIL: Civil Rights Appendix and/or Procedure Manual (citation): XI Appendix-A Policy and Procedure 1.08, Policy and Procedure 1.08, Article E- Civil Rights
2. Monitoring Activity a. In addition to the local agency reviews, the State agency uses the following means to ensure that local agencies operate in a nondiscriminatory manner: ☒ Review of the racial/ethnic enrollment and/or participation data applications ☒ Review of denied ☒ Review of complaints ☒ Review of participant surveys ☒Participant interviews ☐ Review of waiting lists ☐ Other (specify): NA.
b. The State agency checks for the following in local agency applications:
☒ The local agency has corrected all past substantiated civil rights problems or noncompliance situations ☒ The Civil Rights Assurance is included in the State-Local Agency Agreement ☒ A description of the racial/ethnic makeup of the service area is included in the application ☒ The local agency uses inclusive language with developing its program materials ☒ Appropriate staff, volunteers, or other translation resources are available in areas where a significant proportion of people with limited English proficiency (LEP) reside
c. The State agency checks for the following in its civil rights reviews of its local agencies:
☒ Case records include racial/ethnic data ☒ Where applicable, an explanation of why the racial/ethnic WIC participant level is not proportionate to the income eligible racial/ethnic population ☒ The local agency has conducted civil rights training for its staff ☒ The project area displays the USDA nondiscrimination poster, “And Justice For All,” or an FNS-approved substitute ☒Program information has been provided to applicants, participants, and grassroots organizations or similar minority groups ☒ The nondiscrimination policy statement and civil rights complaint procedure are included on all printed materials such as applications, pamphlets, forms, or any other materials distributed to the public ☒ Racial/ethnic data are collected and maintained on file for 3 years ☒ The local agency has corrected all past substantiated civil rights problems or noncompliance situations ☒ Civil rights complaints are handled in accordance with the procedures outlined in FNS Instruction 113-1 ADDITIONAL DETAIL: Civil Rights Appendix and/or Procedure Manual (citation): XI Appendix-A Policy and Procedure 1.08, Policy and Procedure 1.08- Civil Rights.
XI. CIVIL RIGHTS
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D. Data Collection and Reporting
1. Data Collection a. The State agency ensures the following when collecting civil rights data:
☒ All racial/ethnic categories are collected and reported as part of the program participant characteristics report ☒ Racial/ethnic data definitions are in accordance with current OMB guidance and clinic procedures are in place to ensure the data is collected accurately ☒ Data reported on participant characteristics include the number of persons on WIC master lists or persons listed in WIC operating files who are certified to receive benefits ☒ Collected racial/ethnic data and records are accessible only to authorized personnel b. The State agency maintains a civil rights file which retains collected racial/ethnic data for three years. X Yes ☐ No ADDITIONAL DETAIL: Civil Rights Appendix and/or Procedure Manual (citation): N/A.
2. The State agency instructs its local agencies to obtain a participant’s racial/ethnic category by (check all that apply): ☒ Allowing self-identification by participant (must be used at participant’s request) ☒ Visual identification by participant (must be used at participant’s request) ☐ Local agency staff personally know participant’s racial/ethnic category ☐ Other (specify): N/A. ADDITIONAL DETAIL: Civil Rights Appendix and/or Procedure Manual (citation): XI Appendix D 1.25 Racial Classification, Policy and Procedure 1.25- Racial Classification E. Complaint Handling
1. The State agency ensures the following: ☒ WIC Program applicants and participants are informed where and how they may file a complaint of discrimination by directing them to the USDA Office of the Assistant Secretary for Civil Rights (OASCR) website (https://www.usda.gov/oascr/how-to-file-a-program- discrimination-complaint) for proper Discrimination Complaint Filing processes. ☒ WIC Program applicants and participants are informed that they can file their complaints directly with the U.S. Department of Agriculture or directly with the FNS HQ Civil Rights
XI. CIVIL RIGHTS
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Division, their State agency, or their local agency. However, the local/State agency must then forward their complaint either directly to the FNS HQ Civil Rights Division or the U.S. Department of Agriculture. ☒ All local agency staff are trained in discrimination complaint procedures. ☒ All written and verbal complaints alleging discrimination based on race, color, national origin, age, sex (including gender identity and sexual orientation), or disability are accepted from applicants and participants by State agency and local agency staff and forwarded to the FNS HQ Civil Rights Division. ☒ Complaints alleging discrimination based on race, color, national origin, or age are forwarded to the FNS HQ Civil Rights Division through an FNS-established complaint procedure. (Regional Office receives copy of all complaints.) ☐ State and local agencies without an FNS-approved grievance procedure for complaints alleging discrimination based on sex or disability in place forward all complaints to the FNS HQ Civil Rights Division). ☐ Complaints alleging discrimination based on sex or disability are forwarded to the State agency that has an FNS-approved grievance procedure in place.
ADDITIONAL DETAIL: Civil Rights Appendix and/or Procedure Manual (citation): XI Appendix-A Policy and Procedure 1.08, Policy and Procedure Section 1.08, Article G
2. The State agency uses a discrimination complaint form it has developed for acceptance of a complaint. ☐ Yes ☒ No
ADDITIONAL DETAIL: Civil Rights Appendix and/or Procedure Manual (citation): N/A
3. The State agency has an FNS approved complaint procedure that ensures local agencies implement specific timeframes concerning discrimination complaints: ☒ An individual has the right to file a complaint within 180 days of the alleged discriminatory action. ☒All complaints are processed and closed within 90 days of receipt. 4. The State agency transfers complaints immediately upon receipt to the FNS HQ Civil Rights Division if no FNS-approved complaint procedure timeline is in place. Yes ☐ No ☒ If no, specify: West Virginia has an approved procedure. ADDITIONAL DETAIL: Civil Rights Appendix and/or Procedure Manual (citation): XI Appendix-A Policy and Procedure 1.08, Policy and Procedure 1.08, Article G- Civil Rights