Page 3

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