Policy and Procedures Manual

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Table of Contents

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Introduction Policy Number Effective Date SWO Team
WIC Policy and Procedure Manual Overview

Overview

08/12/13

OT

I. Intake

Processing Standards and Appointments

INT 01.0

08/12/13

OT

Alternative Hours

INT 02.2

08/12/13

OT

Processing Electronic Application

INT 02.3

12/01/15

OT

II. Certification

Eligibility Overview

CRT 01.0

08/12/13

OT

Certification Visit Overview

CRT 01.1

08/17/16

OT

Immunization Screening & Referral

CRT 01.1.1

08/12/13

NT

Categorical Eligibility

CRT 02.0

08/12/13

OT

Proof of Identification

CRT 03.0

02/15/17

OT

Residential Eligibility

CRT 04.0

08/12/13

OT

Certification of Homeless/Institutionalized

CRT 04.1

08/12/13

OT

Financial Eligibility

CRT 05.0

08/15/16

OT

Adjunctive Financial Eligibility

CRT 05.1

08/03/15

OT

Income Eligibility

CRT 05.2

08/13/13

OT

Proof of Income

CRT 05.2.1

08/12/13

OT

Gross Income

CRT 05.2.2

08/12/13

OT

Income Exclusions

CRT 05.2.3

08/12/13

OT

Military Proof of Financial Eligibility

CRT 05.2.4

08/12/13

OT

Migrant / Homeless Income Eligibility

CRT 05.2.5

08/12/13

OT

WIC Program Income Guidelines

CRT 05.2.6

06/01/17

OT

Nutrition Eligibility – Overview

CRT 06.0

08/12/13

NT

Determine Nutrition Risk – Anthropometric

CRT 06.1

08/12/13

NT

Determine Nutrition Risk – Hematological

CRT 06.2

08/12/13

NT

Determine Nutrition Risk – Dietary

CRT 06.3

08/12/13

NT

Determine Nutrition Risk – Other Nutr. / Medical Cond

CRT 06.4

08/12/13

NT

Table A: Virginia WIC Program Nutrition Risks

CRT 06.5

08/12/13

NT

Certification & Changes to Certification Period

CRT 07.0

08/12/13

OT

Coordination of Services and Referral Systems

CRT 08.0

08/12/13

NT

Medicaid and Social Services Referrals

CRT 08.0.1

08/12/13

NT

Drug and Substance Abuse Referrals

CRT 08.0.2

08/12/13

NT

Blood Lead Referrals

CRT 08.0.3

08/12/13

NT

Breastfeeding Referrals

CRT 08.0.4

08/12/13

NT

Ineligibility

CRT 09.0

08/12/13

OT

System Termination from the WIC Program

CRT 09.1

08/12/13

OT

Subsequent Certifications

CRT 11.0

04/01/16

OT

Infant Healthcare Confirmation

CRT 12.0

08/12/13

NT

WIC Out-Of-State Transfer Card – Issuance

CRT 13.0

05/01/16

OT

WIC Verification of Certification Card Acceptance

CRT 13.1.1

08/15/16

OT

In-State Transfers

CRT 13.2

08/12/13

OT

III. Nutrition Education

Nutrition Education Overview

NEd 01.0

08/12/13

NT

Nutrition Education Materials

NEd 01.1

08/12/13

NT

Nutrition Education Contacts

NEd 02.0

08/12/13

NT

Nutrition Education Contact – Initial

NEd 02.1

08/12/13

NT

Nutrition Education Contact-Follow-up, Low Risk

NEd 02.2

08/12/13

NT

Nutrition Education Contact – Follow-Up, High Risk

NEd 02.3

08/12/13

NT

Nutrition Education Methods

NEd 03.0

08/12/13

NT

Nutrition Education – Individual Counseling

NEd 03.1

08/12/13

NT

Nutrition Education – Group

NEd 03.2

08/12/13

NT

Nutrition Education – Web Based

NEd 03.3

08/12/13

NT

Nutrition Education Levels

NEd 04.0

08/12/13

NT

Exit Counseling Session for Women

NEd 08.0

08/12/13

NT

Mid-Certification Assessment -Children

NEd 09.0

08/12/13

NT

IV. Breastfeeding

Breastfeeding Personnel Guide

BF 01.0

08/12/13

NT

Local Agency Breastfeeding Coordinator

BF 01.1

08/12/13

NT

Breastfeeding Peer Counselor Qualifications

BF 01.2

08/12/13

NT

Breastfeeding Peer Counselor Responsibilities

BF 01.3

08/12/13

NT

Breast Feeding Contact Guidelines

BF 01.4

08/12/13

NT

Breastfeeding Education

BF 02.0

08/12/13

NT

Breastfeeding Supplies

BF 04.0

08/12/13

NT

Manual Breast Pump

BF 04.1

08/12/13

NT

Personal Use Electric Breast Pump

BF 04.2

08/12/13

NT

Multi-User Electric Breast Pump

BF 04.3

09/15/15

NT

Supplemental Nursing System (SNS)

BF 04.4

08/12/13

NT

Breastfeeding Breast Shells

BF 04.5

08/12/13

NT

Breastfeeding Breast Pads

BF 04.6

08/12/13

NT

Breastfeeding Nipple Shields

BF 04.7

08/12/13

NT

Breastfeeding Contraindications

BF 05.0

08/12/13

NT

V. Food Delivery Services

Allowable Foods

FDS 01.0

08/12/13

NT

Allowable Food Selection Criteria

FDS 01.1

08/15/16

NT

Food Packages

FDS 02.0

08/12/13

NT

Prescribing the Food Package

FDS 02.1

08/12/13

NT

Maximum Food Allowed

FDS 02.2

10/01/14

NT

Food Package I and II – Infant

FDS 02.2.1

08/12/13

NT

Food Package III – Special Needs

FDS 02.2.2

10/01/14

NT

Food Package IV Child

FDS 02.2.3

10/01/14

NT

Food Package V – Pregnant and Providing Mostly Breast Milk

FDS 02.2.4

10/01/14

NT

Food Package VI- Postpartum

FDS 02.2.5

10/01/14

NT

Food Package VII – Fully Breastfeeding

FDS 02.2.6

10/01/14

NT

Tailoring Food Packages

FDS 02.3

08/12/13

NT

Lactose Reduced / Lactose Free Food Pkg

FDS 02.3.1

08/12/13

NT

Convenience Food Package

FDS 02.3.2

08/12/13

NT

Calcium Fortified Juice

FDS 02.3.4

08/12/13

NT

Soy Milk Substitution

FDS 02.3.5

10/01/14

NT

Changing a Food Package

FDS 02.4

08/12/13

NT

Addition of Juice / Cereal to Infant Food Package

FDS 02.4.1

08/12/13

NT

Contract Infant Formula

FDS 03.1

08/12/13

NT

Contract Formula Samples

FDS 03.1.1

08/12/13

NT

Ordering Contract Formula Samples

FDS 03.1.2

08/12/13

VT

Medical Documentation for Special Formula and Supplemental Foods

FDS 03.2

08/12/13

NT

Special Needs Formula Issuance and Inventory

FDS 03.2.1

08/12/13

NT

Special Formula Ordering

FDS 03.2.2

08/12/13

VT

Formula/Medical Foods for Medicaid Participants

FDS 03.2.3

08/12/13

NT

Medicaid Verification Over the Maximum of Formula

FDS 03.2.4

08/12/13

NT

Approved Formulas

FDS 03.3

08/12/13

NT

Non-Approved Formula / Products

FDS 03.4

08/12/13

NT

Security of eWIC Cards and Card Sleeves

FDS 04.1

08/12/13

OT

Food Benefits Issuance

FDS 04.2

08/01/17

OT

Food Benefit Issuance without Physical Presence

FDS 04.2.1

08/01/17

NT
Prorating of Food Prescriptions

FDS 04.4

08/12/13

NT

Voiding Food Benefits

FDS 04.6

08/12/13

OT

Replacing eWIC Cards

FDS 04.7

11/01/14

OT

VI.  Participant Rights and Responsibilities

Participant Rights and Responsibilities

PRR 01.0

08/15/16

OT

Proxy

PRR 02.0

11/01/15

OT

Caretaker

PRR 02.1

08/17/16

OT

Confidentiality and Release of Information

PRR 03.0

08/15/16

OT

Complaints and Civil Rights Procedures

PRR 04.1

08/15/16

OT

Fair Hearings

PRR 06.0

08/12/13

OT

VII. Administration

Caseload Assignment and Funding Allocations

ADM 01.0

08/12/13

OT

Interruption of Benefits

ADM 02.0

08/12/13

OT

Waiting Lists

ADM 02.1

08/12/13

OT

Funding Principles

ADM 03.0

08/12/13

OT

Fiscal Year Conversion

ADM 03.3

08/12/13

OT

Shared Purchases / Expenses

ADM 03.4

08/12/13

OT

Allowable WIC Expenditures and Allocations

ADM 03.5

08/12/13

OT

Unallowable Spending Costs

ADM 03.6

08/12/13

OT

Time & Effort Reporting

ADM 03.7

07/01/17

OT

Capital Expend., Eqpmnt. Cmptr. Purchase Requirements

ADM 03.8

08/12/13

OT

Building Space / Rental Cost

ADM 03.9

08/12/13

OT

Fiscal Record Keeping: General Guidelines

ADM 03.10

08/12/13

OT

CARDINAL State Accounting System

ADM 03.11

04/01/17

OT

WIC Services Plan (WSP) & Memorandum of Agreement

ADM 04.0.1

08/12/13

OT

Participant Surveys

ADM 04.0.2

08/12/13

NT

Local Agency Management Evaluations

ADM 04.1

08/12/13

OT

Audits/Reviews

ADM 04.2

08/12/13

OT

Program Abuse and Sanctions

ADM 05.0

08/12/13

OT

Dual Participation

ADM 05.1

08/12/13

OT

Collection of Improp. Issued Benefits / Claims Against Participants

ADM 05.2

08/12/13

OT

Separation of Duties

ADM 06.0

08/12/13

OT

Conflict of Interest

ADM 06.1

08/12/13

OT

Program Accessibility

ADM 08.0

08/12/13

OT

Marketing and Media Outreach

ADM 08.1

03/01/17

OT

National Voter Registration Act

ADM 09.0

08/12/13

OT

Emergency Procedures

ADM 10.0

08/12/13

OT

Record Retention

ADM 11.0

08/12/13

OT

Clinic Closure – Relocation

ADM 11.1

08/01/16

OT

Full Disclosure

ADM 12.0

08/12/13

OT

System Outage

ADM 13.0

11/01/15

OT

VIII. Vendor Management

Inadequate Participant Access Assessment

VEN 01.0

08/12/13

VT

Retail Store Contact with Local Agencies

VEN 03.0

04/01/17

VT

Solicitation Issues

VEN 04.0

08/12/13

VT

Solicitation of Gifts and Retail Stores

VEN 04.1

08/12/13

VT

WIC Shopping Options

VEN 05.0

08/12/13

VT

WIC Approved Shelf Labels

VEN 06.0

08/12/13

VT

Retailer Complaint Handling

VEN 07.0

08/12/13

VT

WIC Retailer Training

VEN 08.0

08/12/13

VT

Personal Identification Number (PIN) and eWIC Card

VEN 09.0

06/01/17

VT

IX. Forms

Release of Information Form

WIC-309

04/16

OT

Release of Information Form (Spanish)

WIC-309-S

04/16

OT

Participant Rights and Responsibilities

WIC-310

04/16

OT

Participant Rights and Responsibilities (Spanish)

WIC-310-S

04/16

OT

Caretaker Designation Form

WIC-311

06/16

OT

Caretaker Designation Form (Spanish)

WIC-311-S

06/16

OT

Proxy Designation Form.

WIC-314A

06/16

OT

Proxy Designation Form (Spanish)

WIC-314A-S

06/16

OT

Proxy Signature Form

WIC-314B

06/16

OT

Proxy Signature Form (Spanish)

WIC-314B-S

06/16

OT

Letter of Ineligibility

WIC-315

06/16

OT

Letter of Ineligibility (Spanish)

WIC-315-S

06/16

OT

Delayed Benefits Signature Authorization

WIC-318

08/17

 NT
Delayed Benefits Signature Authorization (Spanish)

WIC-318-S

08/17

NT
Notification of Alternative Hours Form

WIC-340

08/13

OT

Complaint Against Store Form

WIC-345A

06/17

VT

Complaint Against Store Form (Spanish)

WIC-345A-S

06/16

VT

Complaint Against Participant or Local Agency Form

WIC-345B

06/16

OT

WIC Program Complaint Form (Spanish)

WIC-345B-S

06/16

OT

WIC Civil Rights Impact Analysis Form

WIC-351

04/16

OT

Civil Rights Complaint Form

WIC-373

06/16

OT

Civil Rights Complaint Form (Spanish)

WIC-373-S

06/16

OT

Civil Rights Complaint Log

WIC-374

08/13

OT

Civil Rights Training Log

WIC-375

08/13

OT

Affidavit

WIC-383

06/16

OT

Affidavit (Spanish)

WIC-383-S

06/16

OT

Surplus Stock Formula Acknowledgment Form

WIC-388

06/17

NT

Special Formula Change Request Form

WIC-392

08/13

VT

Disqualification Letter for Program Abuse

WIC-393

06/16

OT

Disqualification Letter for Program Abuse (Spanish)

WIC-393-S

06/16

OT

Damaged / Breakage or Outdated Report for Special Formula

WIC-394

08/13

VT

Request for Special Food Package

WIC-395

08/13

NT

Special Formula Shipping Request

WIC-396

08/13

VT

Special Formula Replacement Request

WIC-397

08/13

VT

Separation of Duties Log

WIC-400

08/13

OT

eWIC Card Stock and Card Holder Inventory Log

WIC-402

08/13

OT

Contract Formula Sample Order & Delivery Form

WIC-403

08/13

VT

Damaged Contract Formula Sample Form

WIC-404

08/13

VT

Request for Ready to Feed

WIC-407

08/13

NT

Inadequate Participant Access Assessment (IPA) Form

WIC-410

08/13

VT

Racial / Ethnic Data Collection Form

WIC-415

08/13

OT

Racial / Ethnic Data Collection Form

WIC-415-S

08/13

OT

WIC System Outage Form for Eligibility

Crossroads-01

08/13

OT

WIC System Outage Form for Nutrition

Crossroads-02

08/13

NT

WIC Local Agency Personnel Contact Change

Email-01

08/13

OT

Policy Review Request Form

MISC-001

08/13

OT

X. Appendices

Combat Pay

Appendix 1

08/13

OT

Medicaid Financial Eligibility

Appendix 2

04/17

OT

Regulations Governing Dietitians and Nutritionists

Appendix 3

08/13

NT

Certification of Records Destruction Form

Appendix 6

08/13

OT

LAME Monitoring Tool.

Appendix 7

08/17

NT

Formula Manufacturers

Appendix 8

08/13

NT

Food Standards

Appendix 11

08/13

NT

Allowable Food Application Form

Appendix 12

08/13

NT

Request for New Food Item Consideration

Appendix 14

08/13

NT

Determine Nutrition Risk – Anthropometric

Appendix 15

08/13

NT

Breastfeeding Peer Counselor Standards of Practice

Appendix 16

08/13

NT

XI. Glossary

Glossary

08/13

OT