GEORGIA WIC PROGRAM FY2014 PROCEDURES MANUAL TRAINING

1. GEORGIA WIC PROGRAM FY2014 PROCEDURES MANUAL TRAINING Presentation to: Georgia WIC Program Staff Presented by: State WIC Staff Date: November 8, 2013 November 15, 2013

2. Certification

3. Certification: CT - 4 • Income • Income in WIC means all “gross cash income before deduction”. Current income refer to all income received by the household during the month (30 days) prior to the date the application for WIC benefit is made. If the income assessment is being done prospectively (i.e. the sole support of that family has just been laid off but has been authorized to receive unemployment benefits for the next six months), “current” refers to income that will be available to the family in the next 30 days.

4. Certification: CT - 5 Note: New proofs must be obtained at each initial and subsequent certification. Proof of identification must be obtained for transfers and thirty (30)-day adjustments. No proofs should be over two months old, such as, electric bills, et c. All proof must be date-stamped up to the date proof was obtained.

5. Certification: CT - 6 • An income eligibility assessment should be made either prior to rendering WIC nutrition assessment services or as the first step in the clinic visit process. If the applicant is income eligible, he/she will be screened for nutritional risk eligibility or a clinic appointment will be given for a nutritional risk assessment. If the client is not eligible on the basis of income, the ineligibility procedures will be followed (see Ineligibility Procedures CT-XVI). If the applicant’s income changes for any reason, the applicant may reapply for WIC services at any time. Income eligibility is valid for in-stream migrant farm workers and their families for a period of twelve (12) months. The income determination can occur either in the migrant’s home base area before the migrant has entered the stream or in an in-stream area during the agricultural season.

6. Certification: CT - 6 • The Disclosure Statement (see Attachment CT-30) must be completed annually by all clinic employees who perform WIC services to inform District staff of their family participation on the Georgia WIC Program. This form must be updated if any information changes. This form must be completed by the local agency and returned to the Nutrition Services Director by September 30th of each year. A copy of this form must also remain in the county health department / WIC clinic site for audit purposes (i.e., one copy at the clinic plus one copy at the District).

7. Certification: CT - 8 • Covert (Surprise) Telephone Calls In an effort to monitor processing standards, District staff must make covert telephone calls to their local agencies quarterly. The results of those calls must be sent to the State WIC office quarterly, also.

8. Certification: CT - 8 E. Patient Flow Analysis If a clinic fails to meet processing standards for a period of over three (3) months, the state recommends that District staff should conduct a Patient Flow Analysis (PFA) to determine the cause of not meeting those standards. If a PFA is conducted, a copy of that report must be sent to the State WIC Office.

9. Certification: CT - 11 B. Participant Instructions Participant/parent/guardian/caregiver/spouse/alternate parent must be instructed on the purpose and use of the WIC ID card. The following is a guide to the information that should be given to the participant regarding the WIC ID card. Whenever possible, the participant’s proxy (ies) should be present during the explanation. 1. This WIC ID card is to identify you as an authorized WIC participant when picking up and/or redeeming vouchers. You should keep vouchers with the WIC ID card. You must have your WIC ID card in your possession when picking up vouchers, at certifications and when redeeming vouchers at the grocery store. A proxy must have the WIC ID card and additional IDs in order to pickupor redeem vouchers. Refer to the section below for more information regarding proxies. 2. Notify the clinic if the WIC ID card is lost or stolen. 3. Explain the “Expiration Date” and when the participant will be due for eligibility screening. 4. Explain shopping procedures (e.g., review allowable items, importance of separating foods, etc.). 5. Explain the purpose of the next scheduled appointment (i.e. Nutrition education, certification).

10. Certification: CT – 11 - 12 • Proxies • General 6. If a proxy picks up vouchers or brings a child in for subsequent certification or half certification, WIC clinic staff must ensure that adequate measures are taken for the provision of nutrition education and health services to the participant. 7. Documentation of proxies must be recorded on the following: • Georgia WIC Program ID Card • Certification Form • Computer 8. Explain the purpose of the next schedule appointment (i.e. Nutrition education certification)

11. Certification: CT – 14 • Grandparents as Guardians • There are many situations where the grandparents serve as temporary or even become permanent guardians for children on the Georgia WIC Program. If the grandparent has the proper documentation with regards to certification, (ID, residency, income proofs) he/she may have the right to act on behalf of the WIC participant. These situations may arise due to an applicant/participant/guardian/caregiver/spouse/ alternate parent not being able to come for WIC services for a short period of time. In these cases, the grandparent may serve as the guardian.

12. Certification: CT – 14 • Joint Custody In joint legal custody, both parents share the ability to have access to educational, health, and other records and have equal decision-making status where the welfare of the child is concerned. Each parent’s information must be documented in the medical record along with all legal documentation from court.

13. Certification: CT – 14 • Other Legal Custody • The Georgia WIC Program could never list all of the possible guardianship situations or persons who may have temporary and permanent custody of a child. As long as the proper documentation with regards to certification is presented, (ID, residency, and income proofs) the participant may be placed on the program.

14. Certification: CT – 18 • Look for the “total income” line item on the income tax return. Use the dollar amount on this line and divide by twelve (12). This is found on the following forms: Form 1040EZ: Line 4, Form 1040A: Line 15 and Form 1040: Line 22.

15. Certification: CT – 21 • Procedures for Completing the Verification of Residency and/or Income: (1) Write in the name(s) of the WIC applicant(s) along with the address that is given. (2) Sign your name at the bottom portion of this form along with date given to the WIC participant. (3) Complete or fill in the date that the form must be delivered back to the clinic. (4) Once the form is received, write in the date received and have the person who received it sign the letter. (5) Form should be completed when the applicant/participant does not have proof of residency in their name

16. Certification: CT – 24 • Procedures when applicant/participant fails to bring back proof: It is the responsibility of the clinic to terminate participants who fail to bring back proof to the clinic within thirty (30) days of certification. Under no circumstances should a second, subsequent 30-day certification period be used if an applicant fails to provide the required documentation of income before the temporary certification period expires.

17. Certification: CT – 25 Income Inclusions n. Student Grant, Scholarship (does not include Pell Grant).

18. Certification: CT – 26-27 • Income Exclusions u. Self-Employment – Both farm and non-farm, self-employed persons are assessed for WIC income eligibility using net income rather than gross income. In families where adult members are self‑employed, they may not know their net income. To calculate net income, use the most current Internal Revenue Service (IRS) tax return as a basis for calculating net income for both farm and non-farm self-employed income.

19. Certification: CT – 29 • Documented Proof of Income 2. A statement from employers for allemployed persons in your household. Attach non-letterhead statements from employers to the No Proof Form and file in the health record. 3. Current tax return (W-2 or 1040) from previous year up until April 15th of the current year (e.g., 2009 W-2 can be accepted up until April 15, 2011). 4. On-going financial records (for self-employed only). 5. Unemployment notice. 6. Other (see List of Income Inclusions). All proof of income should not be more than thirty(30) - days old with the exception of the most recent tax return.

20. Certification: CT – 32 Medical Data 2. The Hematological Data Date… • Blood work should not be performed on infants younger than nine (9) months of age, unless there is a medical reason. In most cases, infants will have their first blood work performed around twelve (12) months of age. • All children are required to have blood work at each certification. If the hemoglobin is low at certification, repeat at half-certification. Children less than two years must have blood work at half-certification. For children 2 and over, blood work does not have to be performed at the half-certification if normal at certification. • Use the one of following procedures to follow-up for abnormal blood work:

21. Certification: CT – 33 Use the one of following procedures to follow-up for abnormal blood work: a. For infants and children receiving their health care through the health department, follow the protocol for treatment of low hemoglobin. • For infants and children receiving health care from a private provider, refer the participants with low hemoglobin values to their providers. At the next certification (subsequent or half) visit repeat the hemoglobin test or enter a referral value from the private provider. • Blood work within the normal range at certification is valid for children for twelve (12) months beginning at twenty-four (24) months of age. • Postpartum, breastfeeding women who have breastfed for six (6) months are not required to have to have blood work performed at their mid-assessment visit unless there is a medical reason.

22. Certification: CT – 37 CERTIFICATION PERIODS • Certification periods are: • Breastfeeding Women: for one (1) year from the date of initial and/or subsequent certification as a postpartum, breastfeeding woman. Eligibility ends when the certification period is over, when the breastfed infant turns one (1) year old or when breastfeeding is discontinued, whichever comes first. • Note: The certification period for the breastfeeding woman is one (1) year; however, she must receive a mid-assessment between 5-7 months of her delivery date as a breastfeeding postpartum woman if she is still breastfeeding an infant less than one (1) year of age.

23. Certification: CT – 37 CERTIFICATION PERIODS • Certification periods are: • Infants:certified at age greater than six (6) months: for one (1) year from date of certification. • Children: for one (1) year from the date of each certification may continue eligibility until they reach their fifth birthday, if assessed at nutritional risk.

24. Certification: CT – 45 • Staff Signature(s)/Printed Name - The local WIC official signature, print name and date confirms that income, residency and family size are correct as stated by the applicant/participant. The signature, print name and date also verifies/witnesses the participant’s signature. An appropriate signature consists of first and last name and title of person verifying income and witnessing the participant’s signature.

25. Certification: CT – 45 f. Applicant/Participant Signature/Printed Name The participant/parent/spouse/guardian/ caregiver/ alternate parent or proxy must be asked to read, sign, print name and date the following statement each time they are certified (if unable to read, must have it read to them)

26. Certification: CT – 56 • Transferring a Foster Child: • When transferring a foster child from one WIC clinic to another WIC clinic, intra-state policy also applies. If a foster child is placed in a different home during the valid certification period, the foster parent must present all legal documentation. The new foster parents should sign a Release of Information Form in order to receive entire WIC record of the child (see Attachment AD-4).

27. Certification: CT – 57 • Migrant Transfer • When a migrant visits your clinic, automatically issue an EVOC card. In-stream migrant farm workers (and their families) with expired verification of certification (VOC) card must be considered income-eligible, provided that their income is redetermined once every twelve (12) months.

28. Certification: CT – 58 • Required Data on the EVOC and Paper VOCcards Required data on the EVOC and Paper VOC cards is as follows: 25. The Thirty(30)-Day return date and the missing proof information, if applicable, (hand write on paper card)

29. Certification: CT – 59 VOC Card Inventory (Paper) • Issuance 6. Name/City/State participant is moving to or if issued to a migrant. Print “migrant” in space for City and State.

30. Certification: CT – 68 Certification for Home Visits • Procedures   3. Vouchers must be created prior to leaving the WIC clinic. The client must sign the voucher receipt or voucher register. If blank manual vouchers are used, a copy must be turned into the clinic. The signed receipt or register or voucher copy must be filed and maintained according to standard operating procedures

31. Certification: CT – 74 • A transit clinic is a site where WIC staff does not have an office in the hospital but make rounds to determine eligibility for the Georgia WIC Program. Transit clinic staff must bring documents, vouchers, etc., to the hospital. These clinics do not store records on site.

32. Certification: CT – 46Pending USDA final review and approval Physical Presence (Certification Form) (D) – Disabilities – The local agency must grant an exception to applicants who are qualified individuals with disabilities and are unable to be physically present at the WIC clinic because of their disabilities, or applicants whose parents or caregivers are individuals that meet this standard. Examples of such situations include: a. A medical condition that necessitates the use of medical equipment that is not easily transported. b. A medical condition that requires confinement to bed rest; and c. A serious illness that may be exacerbated by coming into the WIC clinic. d. Mother/baby breastfeeding dyad: Hospitalized breastfed infant(s). The “Mother/baby breastfeeding dyad” applies to breastfeeding mothers whose infant has not been released from the hospital.

33. Rights and Obligation

34. Rights and Obligation: RO 11-12 • Conduct of the Hearing and the Appellant’s Rights • The claimant/designated representative shall be provided with an opportunity to: 1. Bring “and call” witnesses to provide testimony. 2. Advance arguments without undue interference. 3. Question or refute any testimony or evidence, including an opportunity to confront and cross‑examine adverse witnesses. 4. Submit evidence to establish all pertinent facts and circumstances in the case. • The local agency shall have the same opportunities listed above.

35. Rights and Obligation: RO 11-12 VOUCHER INFORMATION • Failure to keep appointments will reduce the number of vouchers you receive • The fruit and vegetable/cash value voucher can not be prorated. It must always be issued and must be issued in full value (e.g., $6, $7, $8 and $10) • Food packages will be prorated based on the total number of vouchers in the package

36. Administrative

37. Administrative-AD 3 • The allocation of Nutrition Service and Administration (NSA) Grant funds is based on methodology developed by the Georgia WIC Program and the WIC Allocation Advisory Committee, with final approval from the Commissioner of the Department of Public Health.

38. Administrative: AD-6 • District level administrative costs are collected through the Uniform Accounting System (UAS) subsystem of DPH’s general ledger system, Peoplesoft. • Rebates are collected from the Peoplesoft general ledger system. This amount is posted in Peoplesoft and recognized the month it is received. Rebate invoices to the infant formula contractor are developed from reports generated by Georgia WIC’s banking and data contractor based on monthly product redemptions. Rebate rates are reconciled to the appropriate contract rates. Rebates collected from the rebate contractor are reconciled to rebates invoiced.

39. Administrative: AD-12 • Ensure that no WIC funds are expended toward a computer system unless the computer system has prior written approval by the State WIC Program and USDA.

40. Administrative: AD-13 • Comply with the Georgia DPH Administrative Policy and Procedures and DPH Grants-to Counties Policies for administration of funds. • Acquire approval from the State (and USDA) for the purchase of equipment with a base unit cost of $25,000 or more such as a vehicle or telephone system. • Acquire approval from the State (and USDA) for the purchase of IT equipment procurement totaling $100,000 and more (regardless of cost per individual units or components)

41. Administrative: AD-13 • Acquire approval from the State for all purchases over $5,000 or more (including purchase from WIC local agency sub contractors). State WIC approval must be obtained before procurement expensed can be invoiced. • Approval to purchase supplies under $5,000 does not require approval from the State. However, capital expenditures (major equipment or furniture will require approval (if over $5,000).

42. Administrative: AD-14 • Updates to the Georgia WIC Program Inventory Database are required whenever new non-ADP equipment over $1,000 (one thousand dollars) or any computer related equipment or new ADP equipment for any dollar amount has been acquired. • Acquisition : Use the county asset form (See Attachment AD- 28) to log all purchased items over $1,000.00 and computer related equipment. This form should be sent to the WIC property and equipment specialist twice a year (December and May) along with supporting documents.

43. Administrative: AD-15 • Equipment that is no longer valuable and/or usable and is scheduled for destruction must be noted on Attachment AD-2. Also attach a Destruction of Surplus Property Affidavit (See Attachment AD-29) • Districts are to complete the Missing or Stolen Property Report (SeeAttachment AD-30) • Disposed electronic items must be done using a separate Property Transfer Form. Computers, laptops or any item with a hard drive would need to have a computer Tech wipe clean the hard drive and fill out the Information Assets Eradication and Software Removal form (See Attachment AD-31). (This should be done before items are approved and picked up). • Property Removal Form • Property Removal Form (See Attachment AD-32) is to be used when equipment is taken out of the building.

44. Administrative: AD-20 • These are the additions to the program management activities for the NSA costs: • Visual Collaboration • Individual Nutrition Education • Group Nutrition Education • Individual Breastfeeding Education • Group Breastfeeding Education • Individual Nutrition Education Certification • Individual Nutrition Education Re-Certification • Half-Certification (Children) • Mid-Assessment/Breastfeeding • Administration • District Services • Trainings/Meetings • Tele health • Tele Medicine • Paid Time Off • Mid-Certification (Infant)

45. Administrative: AD-30 • All history to be maintained for each employee regardless of employee’s status changes from WIC District to Non-WIC Direct and back.

46. Administrative: AD-51 • This is a new report available in PARs • Individual Employee Activity Report

47. Administrative: AD-62 • This is an addition to the Retention Schedule for five (5) years plus current Federal Fiscal Year • Fair Hearing and Civil Rights complaints and all related documentation

48. Administrative: AD 76-78 • XIX. LOCAL AGENCY STAFF • The Nutrition Services Director’s position is an administrative position. Attached is a copy of the current job description, which describes the responsibilities (see Attachment AD-10). 1. Nutrition Service Director • Each of the WIC districts or contract agency (Grady) must be staffed with a District Nutrition Services Director who must be at minimum a (1) full-time equivalent (FTE) public health nutritionist, (2) a Licensed Dietitian (LD) in the state of Georgia and (3) be employed in either the class of Nutrition Services Director, Nutrition Program Manager, or Nutrition Manager. Preferred qualifications are a Registered Dietitian and a Masters Degree in dietetics, human nutrition, food and nutrition, nutrition education, food systems management or a closely related field from an Academy of Nutrition and Dietetics accredited program or a closely related field. Duties include: planning, organizing, implementing, and evaluating the nutrition service component of WIC. This encompasses leadershipin the development and approval of nutrition education materials, development of the nutrition education plan, and implementation of nutrition risk criteria and food package delivery.

49. Administrative: AD 76-78 • Staffing Standards • Each WIC local agency must be staffed with a minimum of one (1) full-time equivalent (FTE) Competent Professional Authority (CPA) for every one thousand (1,000) participants, and one (1) full-time equivalent (FTE) Registered and Licensed Dietitian (RD, LD) or Licensed Dietitian (LD) for every five thousand (5,000) participants. District staff time providing direct services can be counted towards these requirements; for example District staff can perform both participant services and district responsibilities. • Job Classifications and Compensation • Nutrition positions should be appropriately classified according to the policies, procedures, and guidelines of the Department of Public Health and the Human Resources Administration Division of the Department of Administrative Services. The Nutrition class specifications should be used for nutritionists providing direct client nutrition services, and these nutritionists should receive supervision from a higher level public health nutritionist. • The class specifications, qualifications and compensation levels are to be according to the Department of Public Health and the Human Resources Administration Division of the Department of Administrative Services policies, procedures, and guidelines. • The Breastfeeding Coordinator position may be a qualified nutritionist, nurse, health educator, Certified Lactation Counselor (CLC), or International Board Certified Lactation Consultant (IBCLC). A job description for Health Educator Senior/Lactation Consultant, which may be used to assure an individual is qualified to fill this position can be found in Attachment AD-26.

50. Administrative: AD 76-78 • A Georgia Gain job classification sample job description entitled DistrictBreastfeeding Coordinator can be found in Attachment AD-27 • 2. Breastfeeding Coordinator • a. Each local agency must designate a staff person to coordinate breastfeeding promotion, education and support activities. • b. It is recommended that this position be designated as a full-time position in order to facilitate coordinating services throughout the local agency and across program lines and to adequately meet Federal requirements.  • c. It is recommended that the breastfeeding coordinator work across program lines to provide breastfeeding services, thus increasing opportunities for all current and potential WIC participants to be reached. This will also serve to integrate services, and assure that all clinic staff receive appropriate training and deliver consistent information on breastfeeding.