WIC ME Changes 2014

WIC ME Changes 2014 MPR MPR/Indicator/Criteria Text Change Documentation required How to verify 2.1 The WIC Program ensures that Updated policy Materials updated to Review materials for no person, on the basis of race, references MI- include revised non- non-discrimination color, national origin, sex, age or WIC 1.09, 9.02 discrimination statement. statement disability, is excluded from Updated USDA participation, denied benefits, or Non- Translators and or subjected to discrimination discrimination translation services Ask about non- under the Program. (7 CFR statements English speaker 246.7, 246.8, 246.19(b)(2), MI- Added non- services WIC Policy 1.03, 1.09, , 2.18, English 9.02) accommodations 2.2 a. The WIC Program trains new Reflects use of Record of Civil Rights Review record of Civil staff during orientation using the MI-TRAIN training module scores in Rights training Michigan WIC Civil Rights Web- module instead MI-WIC Training for each module scores in MI- based Training Module and of USDA WIC staff member. WIC Training for retakes/reviews the Michigan Civil Rights each staff member. WIC Civil Rights Training Training Module with all other staff once Record training a year, and maintains records of results in MI- the tests/reviews in MI-WIC Staff WIC Training. (7 CFR 246.8(a), FNS Instruction 113-1, MI-WIC Policy 1.09) 2.3 The WIC Program restricts the Updated policy Signed Michigan WIC Review of signed use or disclosure of information reference 1.06. Employee Confidentiality Michigan WIC obtained from program and Compliance Agreement Employee applicants and clients, and Signature Forms Confidentiality and parents or caregivers of infant Compliance and child clients. (7 CFR Agreement Signature 246.21(b), 246.26(d), FNS Forms Instruction 800-1, MI-WIC Policy 1.03, 1.06, 2.18, 9.02)

06320719478ba7f50da2ac4ca756b075.docx Page 1 WIC ME Changes 2014 MPR MPR/Indicator/Criteria Text Change Documentation required How to verify 3.1 The WIC Program has has Reflects new Requires credentials for Requires review of adequate, trained, qualified staff staffing Policy specified staff. credentials for to provide required certification, 1.07. Requires specified staff. breastfeeding and nutrition review of Requires evidence of services to adult clients, parents credentials for adequate staffing for WIC Review of single or caregivers of infant and child specified staff. eligibility determination with certifier reports and clients, and whenever possible Requires separation of duties. monitoring, to child clients and applicants. (7 adequate observation of CFR 246.2, 246.7(e), 246.10(b) staffing for WIC Requires adequate staffing staffing to ensure (2)(iii), WIC Policy 1.11, 4.19, eligibility to allow NCRD to be separation of duties. 6.07, MI-WIC Policy 1.07, 9.03, determination scheduled within 30 days. 7.01) with separation Review of schedule c. The WIC Program has a WIC of duties. to ensure availability Coordinator who meets the Requires of NCRD required qualifications and adequate appointments within carries out the duties as staffing to allow 30 days. specified in WIC Policy. (MI-WIC NCRD to be Policy 1.07) scheduled within d. The WIC Program has a WIC 30 days. Breastfeeding Coordinator who meets the required qualifications and carries out the duties as specified in WIC Policy. (MI-WIC Policy 1.07) e. The WIC Program has designated a Nutrition Education Coordinator who meets the required qualifications and carries out the duties as specified in WIC Policy. (MI-WIC Policy 1.07) f. The WIC Program has appointed a Lactation Consultant/Educator who meets the required qualifications and carries out the duties as 06320719478ba7f50da2ac4ca756b075.docx Page 2 WIC ME Changes 2014 MPR MPR/Indicator/Criteria Text Change Documentation required How to verify 4.3 The WIC Program uses the Policy updated Use of CAR Tool during Observe use of CAR USDA/MDCH WIC nutritional 2.13 certifications observed. tool during risk criteria as a basis for Specifically certifications certification. (7 CFR 246.7(e)(1), includes use of 246.7(e)(2), 246.7(g), MI-WIC CAR Tool to Policy 2.13, 2.14, 2.15, 2.16, screen for all 6.04) applicable risks a. Health and Diet Assessment: The WIC Program determines if a person is at nutritional risk through screens health and diet information (including Client Assessment (CAR) Tool) at screening at each certification, recertification and infant evaluation, and infant/child health evaluation. Infants and children shall also be screened during child evaluations. (7 CFR 246.7(e)(1), 246.7(g)(1)(iv), MI- WIC Policy 2.13, 2.14) 5.1 b. The WIC Program advises Revised Policy Available updated Medicaid Are current MA and refers each client, parent or 6.05, including application or outreach applications and/or caregiver of the types of health referral to MIHP materials reflecting Healthy outreach materials and community services that Written materials Kids, MI-Child and Healthy available in the may benefit the client, including in clinic for Michigan Plan. clinic? Maternal Infant Health Program referral to (MIHP) referrals for all pregnant Medicaid women and infants. . (7 CFR (Healthy Kids, 246.7(b)(2), WIC Policy 7.04, MI-Child, MI-WIC Policy 6.02, 6.05) Healthy Michigan Plan)

06320719478ba7f50da2ac4ca756b075.docx Page 3 WIC ME Changes 2014 MPR MPR/Indicator/Criteria Text Change Documentation required How to verify 5.4 d. At each certification, Updated policy Awareness or use of Confirm staff recertification or with change of and Affidavit of Voter not in awareness and address, the client is offered an observations to possession of Picture availability of Affidavit opportunity to register to vote include Identification Form (ID during observations and the local agency sends the requirement for Affidavit) during or discussions. completed registration forms to Affidavit of Voter observation. county or township officials not in (forms may be sent as a batch) possession of and declination forms are Picture retained for 24 months. Identification (National Voter Registration Act Form (ID of 1993, MI-WIC Policy 1.10) Affidavit). 6 The WIC Program shall make Includes revised nutrition education available Nutrition to adult clients, parents or Education policy caregivers of infants and child citations. clients, and whenever possible, to child clients. Reference: (7 CFR 246.11, 246.12 and FNS Guidelines and Instructions, WIC Policy Memorandum 2008-1, USDA WIC Nutrition Services Standards (2013), MI-WIC Policy 2.13, 4.01, 4.02, 4.03, 5.01, 5.02, 5.03, 5.04, 5.05, 5.06, 5.07, ME: Certification, Record Review and Nutrition Education)

06320719478ba7f50da2ac4ca756b075.docx Page 4 WIC ME Changes 2014 MPR MPR/Indicator/Criteria Text Change Documentation required How to verify 6.2 The WIC Program ensures that Revised and Observation of assessment, Observation of client centered nutrition reordered to identification of client nutrition education. education bears a practical reflect client concerns during relationship to nutritional needs, centered certification/evaluation and household situations, clients’ assessment and interim nutrition education concerns, food preference, nutrition cultural and literacy needs. (7 education CFR 246.11, MI-WIC Policy process during 5.01, 5.03, 5.04, 5.05) certification and 6.2a The WIC Program includes evaluation in Observation of assessment prior to nutrition new Nutrition assessment during education that explores the Education certification or client’s individual concerns, Policies Chapter evaluation prior to nutritional needs, socioeconomic 5 provision of nutrition factors, food preferences, education language/literacy needs, cultural values and learning readiness. (7 CFR 246.11(b)(1-2), 246.11(e)(6), MI-WIC Policy 5.01) 6.2b The WIC Program ensures that Follow up documented on Observation/review of clients are given the opportunity NE pop-up, including note, NE follow up at to review previous nutrition date achieved. Stage recert, I/C EVAL, or education and ask questions, movement is optional. interim education with either immediately or at the next qualified staff visit (especially for self-directed available to provide nutrition education such as; on answers and site/education mall, encourage further wichealth.org, take-home behavior change. modules) and qualified staff provide answers. (MI-WIC Policy 5.05)

06320719478ba7f50da2ac4ca756b075.docx Page 5 WIC ME Changes 2014 MPR MPR/Indicator/Criteria Text Change Documentation required How to verify 6.2c c The WIC Program provides Observation of NE. nutrition education that assists the client to achieve a positive change in health habits, improve nutritional status and prevent nutrition-related problems through optimal use of the WIC supplemental foods and other nutritious foods. (7 CFR 246.11(b)(2), MI-WIC Policy 5.01) 6.2d d. The WIC Program’s Emphasis on NE Plan documented for Observation/review of Competent Professional CLIENT and cert/recert/I/C EVAL in NE Plan and Authority (CPA) and the client CPA determining client record. verification of NE together will develop a Nutrition NE topic and Plan print. Education Plan (NE Plan) at method that NE Plan printed, observe or certification and Infant or Child would most verify Miscellaneous/ Evaluation that prioritizes client benefit the client Communications (family health concerns for further at level) education and support during cert/recert/EVAL the certification period. The . Nutrition Education Plan identifies a topic and method (including breastfeeding support) to address these concerns. The CPA documents the NE Plan and provides a copy to the client. (MI-WIC Policy 5.01, 5.03, 5.04)

06320719478ba7f50da2ac4ca756b075.docx Page 6 WIC ME Changes 2014 MPR MPR/Indicator/Criteria Text Change Documentation required How to verify 6.2e e. The WIC Program ensures Reordered, new Observe that materials are Observation that information is available to policy citation available and provided if raise awareness about the indicated. dangers of using drugs and other harmful substances. (7 CFR 246.11(b)(1), MI-WIC Policy 5.03) 6.5 Moved BF Coordinator to Moved 6.5a to staffing 3.1, renumbered a, b, c, 3.1a, d renumbered others 7.1 The WIC Program notifies Updated to Use of Food Guide Distribution of current clients about authorized foods reference Food Food Guide and provides clients the Guide authorized Food Guide. (7 CFR 246.10, MI-WIC Policy 7.02, 8.06) 7.2 The WIC Program’s Competent Updated Policy Credentials for CPA staff. Credentials for CPA Professional Authority (CPA) reference 1.07 Record Review that CPA staff. assigns food packages that are staff assign WIC food Record Review that appropriate for clients, taking packages CPA staff assign WIC into consideration their age and food packages dietary needs. (7 CFR 246.10(b) (2)(iii), 246.10(c), MI-WIC Policy 1.07, 7.01, 7.03, 7.04, 7.05)

06320719478ba7f50da2ac4ca756b075.docx Page 7 WIC ME Changes 2014 MPR MPR/Indicator/Criteria Text Change Documentation required How to verify 7.3 a. The WIC Program CPA/RD Combined Record review and Record review approves and provides special criteria a & b, observation showing demonstrates dietary formula and food updated policy CPA/RD follows procedures compliance with packages as indicated for clients reference 1.07 for special food package special food package with special dietary needs, authorization. documentation and based on complete medical assignment. documentation received for: •Standard infant (Class I) formulas after 1 year of age. •Soy beverage food package for children •Hypoallergenic infant (Class II) formulas. •Specialty formulas (Class III) •Other special food packages as indicated per policy. (7 CFR 246.10(c)(1), MI-WIC Policy 1.07, 7.03) 7.4 a. The WIC Program designates Included Completed LA “Returned Review completed LA a staff person to be responsible securing and Formula Policy” detailing “Returned Formula for securing and monitoring the monitoring the responsibilities, security, Policy” detailing appropriate distribution of returned formula inventory and responsibilities, returned formula to clients or to person issuance/donation. security, inventory eligible programs. (MI-WIC responsible for Use of revised inventory and Policy 8.05) distribution. log. issuance/donation. Noted change in Observe use of formula revised inventory log. inventory log 8.05A, 9/10/13

06320719478ba7f50da2ac4ca756b075.docx Page 8 WIC ME Changes 2014 MPR MPR/Indicator/Criteria Text Change Documentation required How to verify 8.1 a. The WIC Program ensures Clarified that Benefit issuance reviewed Record review of that the client has access to no “client has to ensure that client doesn’t benefit issuance. more than three complete (non- access to no have benefits extended prorated) months of food more than 3 beyond 3 complete months. benefits at one time. (7 CFR complete 246.12(r)(7), MI-WIC Policy months of 8.01) benefits at a time, instead of issued at a time. 9.1 a. The WIC Program maintains Updated policy Review records identified Local agency complete and accurate records reference, policies, breastpump including, but not be limited to, included issuance records, information pertaining to required local financial operations, equipment agency policies, purchases and inventory, local if not noted agency policies and procedures, elsewhere training, quality assurance/audits/record reviews. (7 CFR 246.7, 246.17(b)(2), 246.19(b)(6), 246.25(a)(1), MI-WIC Policy 1.11, 1.12, 4.04, 5.08, 6.03, 9.03, 10.01) 9.2 c. The WIC Program follows Includes security Daily and Bulk inventory Observation of Bridge procedures for security of WIC of WIC Bridge record maintenance. Card security and Bridge Cards, keeping bulk Cards in criteria. review of daily and supplies secured and unissued bulk inventory logs. WIC Bridge Cards in a locked file cabinet or other secure area to prevent theft or misuse. (7 CFR 246.2, 246.7(l)(1), 246.12, MI-WIC Policy 8.08, 8.09)

06320719478ba7f50da2ac4ca756b075.docx Page 9 WIC ME Changes 2014 MPR MPR/Indicator/Criteria Text Change Documentation required How to verify 12.1 d. For agencies/clinics that are Clarified that all Immunization policy Review Imms/WIC within a local health department Health outlining agreed upon collaboration policy a local agency policy related to Department collaboration between WIC for each Health WIC/Immunization collaboration based WIC and Immunizations. Department LA. is on file and is being followed. Programs must Observe (MI-WIC Policy 6.03) have and follow collaboration in clinic. a local agency policy for Immunization collaboration. 4.2a Adjunct Eligibility- Is authorized Included Healthy Medicaid verification using Observation during person asked about Medicaid Michigan Plan in card and other verification cert/recert. (Healthy Kids/Healthy MI Plan) Medicaid systems. eligibility for each client? programs If yes, is Medicaid eligibility verified through use of MI-WIC, MIHealth Benefits, Netwerks CHAMPS, MCIR or other confirmation? (MI-WIC Policy 2.06) 4.2b Is family size and number of Review of family MI-WIC Family Income Observation during expected infants reviewed at size screen cert/recert. each certification/recertification? (MI-WIC Policy 2.08) 4.2c If foster child, do you client Review of family MI-WIC Family Income Observation during enroll as a family of one using size screen cert/recert. the “foster” dropdown? (MI-WIC Policy 2.11) 5.4d Is voter registration offered at Policy change MI-WIC Additional Info Observation, ask staff every certification and screens about change of recertification and change of address not during address? (MI-WIC Policy 1.10) cert.

06320719478ba7f50da2ac4ca756b075.docx Page 10 WIC ME Changes 2014 MPR MPR/Indicator/Criteria Text Change Documentation required How to verify 5.4d Does staff check acceptable Policy change Affidavit Observation, ask staff photo ID for clients who register about use of affidavit to vote? Do not need to copy or send proof of ID with voter registration form. Are clients without acceptable ID asked to sign an “AFFIDAVIT OF VOTER NOT IN POSSESSION OF PICTURE IDENTIFICATION” Note: Staff must send affidavit if signed. (MI-WIC Policy 1.10) 5.4a Is the WIC Client Agreement Clarify when Verify print for new client in Observe during read by or read to the client in a Client Communications. cert/recert. Verify language they understand and agreement Misc/communications print for new client in signed at initial certification and needs to be (Family level) Communications. reviewed and signed by the reviewed and Misc/communications authorized person at printed (Family level) recertification? (MI-WIC Policy 2.18) 5.4b Is client notified of illegality of Clarified that dual enrollment in staff are NOT CSFP/Focus:HOPE or other required to WIC Program? (Observe: verbally review Review/issuance of WIC Dual Enrollment Agreement) (MI-WIC Policy in Client 3.03) agreement 4.4a Is proof of pregnancy obtained, Policy change- Required proof of Documentation of when applicable? For proof of pregnancy or observation proof on MI-WIC postpartum clients who miscarriage/preg on MI-WIC Client info Client info screen. miscarried, is proof of pregnancy nancy needed. screen. or miscarriage verified? (Dr. note, observation, other) (MI- WIC Policy 2.10)

06320719478ba7f50da2ac4ca756b075.docx Page 11 WIC ME Changes 2014 MPR MPR/Indicator/Criteria Text Change Documentation required How to verify 4.2d Is agency using the short cert Clarified that process if no proof of Residency, agency must ID (initial cert only), Income or allow short cert. pregnancy is provided and proof process. exists? (cite if not allowing short certs) (MI-WIC Policy 2.02, 2.03, 2.04, 2.10) 2.1c Are clients asked the questions Clarified that this Observation of regarding ethnicity/race from the is required at completion of Client screen or use data obtained initial Information/Additional from the Health and Diet History certification only. Information screen Forms? (Initial cert only) If the client declines to state their ethnicity/race, does the WIC staff record their observations, notifying the client of this? Anthro: Is a disposable sheet covered Procedure Observation of recumbent length board used to change: Use of measurement measure length ? disposable sheet covering measurement equipment Is the correct two person “Gently push Observation of procedure used? Does one down” both measurement person hold the head in knees alignment with body, keeping top of the head in contact with fixed headboard? Does the other person gently push down on both knees and bring the footboard to rest firmly against the heels?

06320719478ba7f50da2ac4ca756b075.docx Page 12 WIC ME Changes 2014 MPR MPR/Indicator/Criteria Text Change Documentation required How to verify Are the measurements recorded Immediate Observation of immediately onto a data sheet recording and measurement then converted in 1/16th inch for conversion of process subsequent recording into MI- measurements WIC? Is the child weighed only with a Use of Observation of dry diaper and T-shirt /onesie disposable sheet measurement and paper sheet on the scale? covering measurement equipment Is measurement repeated until Clarification of Observation of confirming measurements have procedure: measurement been obtained? (Within 1 oz.). Allow child to Please note the infant should be remain on scale kept on the Pediatric balance during re-weigh beam scale during confirmation unless indicated measurements unless indicated by scale by scale. Are the measurements recorded Immediate Observation of immediately onto a data sheet recording and measurement then fractions converted in conversion of process 1/16th inch for subsequent measurements recording into MI-WIC? Is the client measured without Use of Observation of shoes on a disposable paper disposable sheet measurement covered stadiometer? covering Is the client weighed wearing measurement only light, indoor clothing, equipment without shoes and the scale covered with disposable paper?

06320719478ba7f50da2ac4ca756b075.docx Page 13 WIC ME Changes 2014 MPR MPR/Indicator/Criteria Text Change Documentation required How to verify Is measurement repeated until Clarification of Observation of confirming measurements have procedure: measurement been obtained? (Within 1/4 lb.) Allow individual Please note that the individual to remain on should NOT be asked to step off scale during re- the scale between weigh unless measurements unless indicated indicated by by scale. scale Laboratory: Does all staff wear gloves Procedure Observation of (optional: appropriate personal change: procedure. protective equipment -lab coat, Protective gown, scrubs, apron) when equipment is collecting blood? optional 12.1c Does the LA provide the Inclusion of Availability or knowledge of Observation recommended immunization policy statement current schedule and schedule to clients who are not in checklist immunization resources. up to date or don’t have a documented record? (MI-WIC Policy 6.03) Is the CDC Immunization website on the desktop to provide current recommendations and detailed information, if not suggest they do?

06320719478ba7f50da2ac4ca756b075.docx Page 14 WIC ME Changes 2014 MPR MPR/Indicator/Criteria Text Change Documentation required How to verify 4.3 Is the client screened for all Verification of Observation possible risks appropriate for the gestational age, client's status? (MI-WIC Policy review of growth 2.13) Screening includes review charts. of : Consistent use  MI-WIC of CAR Tool at Medical and Cert/recert/Infant Nutrition History Evaluation. o Health and Diet Questions screens (MI- WIC Policy 2.14) AND o Client Assessment Reference (CAR) tool for referrals and additional manual risk factors (laminated)  Does the CPA review the growth chart/prenatal grids, verifying gest. age and assessing the client’s growth (review rate of gain/percentiles using WHO/CDC or VLBW growth charts, as 06320719478ba7f50da2ac4ca756b075.docx Page 15 WIC ME Changes 2014 MPR MPR/Indicator/Criteria Text Change Documentation required How to verify 4.3a Does the CPA review the Consistent use Assignment of known Observation and risk elements on the CAR Tool of CAR Tool at manual risk after screening. assignment review. (Client Assessment Reference Cert/recert/Infant Tool) with the client for referrals Evaluation. and manually assign additional risk factors? 4.3d For clients with Class III Manual Assignment of known risk Observation and high formulas are they indicated as assignment of after screening. risk assignment high risk on the Nut. and Health High Risk for review. Summary Screen? Class III formula clients if 4.3d Are “not” applicable risks Revised Policy Assignment of known risk Review notes. assigned and the reason 5.01. after screening. Note if not documented in the notes section applicable. by the CPA? Is the reason documented and according to policy? 6.3a Is the client given the eligibility Revised policy Eligibility Explanation Observation explanation? Example: You are checked during cert/recert being enrolled in WIC today because WIC’s services (food, nutrition education, referrals, breastfeeding support) can help you with your health concerns. WIC food benefits are supplemental and available while the client is enrolled. The food provided is for the client, not the family. (MI-WIC Policy 5.03) 6.3a Does the CPA provide Observation encouragement to all pregnant clients to breastfeed unless contraindicated for health reasons? (MI-WIC Policy 5.03)

06320719478ba7f50da2ac4ca756b075.docx Page 16 WIC ME Changes 2014 MPR MPR/Indicator/Criteria Text Change Documentation required How to verify 6.3a Does the CPA provide Observation encouragement to all postpartum breastfeeding women to continue breastfeeding? (MI-WIC Policy 5.03 ) 6.2b Does the CPA stress the positive Observation long-term benefits of nutrition education and encourage the client to attend and participate in nutrition education activities? (MI-WIC Policy 5.03) 6.2d Is the Authorized Person offered Observation of information on the dangers of education. using drugs and other harmful Documentation in substances during pregnancy or NOTES, if applicable. parenting? (P.L. 100-690) (verbal preferred, also noted on Nutrition Education Plan) (MI-WIC Policy 5.03) 6.6a Is a client determined to be at NE Plan, RD refusal/non- Observation, record high-risk offered/scheduled with WIC RD review, compare with the RD for counseling? (MI- high risk reports WIC Policy 5.06) 5.1a Is a woman or infant/child with Inclusion of Documentation on Referral Observation/record no health insurance referred to Healthy screen if not on MA review for evidence Medicaid Outreach or DHS for Michigan Plan. of referral if not on Healthy Kids/Medicaid/Healthy Took out MA. Michigan Plan or MIChild reference to enrollment? (MI-WIC Policy Plan First. 6.02) 5.1b Are pregnant women and infants New Policy Referral documented Observation/record referred to MIHP, if available in review for evidence the community? of referral if on MA (MI-WIC Policy 6.05)

06320719478ba7f50da2ac4ca756b075.docx Page 17 WIC ME Changes 2014 MPR MPR/Indicator/Criteria Text Change Documentation required How to verify 6.5e Are pregnant and breastfeeding Included “other Referral documented. Observation/record clients referred to a peer BF support” review for evidence counselor or other breastfeeding of referral support person (BF Peer, IBCLC, LLL), if needed? (MI-WIC Policy 4.01) During the initial clinic visit or Reference to Observation transfer into Michigan, was the WIC Food Guide applicant, client or proxy notified about: 8.1 b . Use of Michigan WIC Bridge card - using the Michigan WIC Bridge Card video or equivalent education? (MI-WIC Policy 8.04) 7.1a . Use of WIC Food Guide/formula list (MI-WIC Policy 8.04) 4.5a . VOC for ID or transfer (MI-WIC Policy 2.19) 7.1a . Where to use the WIC benefits/vendor listing (MI-WIC Policy 8.06)

06320719478ba7f50da2ac4ca756b075.docx Page 18 WIC ME Changes 2014 MPR MPR/Indicator/Criteria Text Change Documentation required How to verify 7.1b Does the local agency notify clients of changes in the authorized Food Guide/formula insert in a timely fashion and provide materials as indicated? (MI-WIC Policy 7.02)  Staff should only issue formula insert to clients who are receiving formula, if not suggest they do. 4.2f Is ID (including ID/VOC/WIC Noted ID is Observation Bridge cards) checked before required if client food benefits are issued if client is present is present? (MI-WIC Policy 2.03)

Certification: Quality Assurance-Lab Procedures 4.3c Is a copy of the MDCH/WIC Revision date Copy or know where to find LA has copy or Laboratory Procedure Manual in on website awareness of the WIC Clinic or do staff know website. how to access from the MDCH/WIC website? (DCH-476, revised 11/21/2013) Is the hemoglobin analyzer Procedure Observation cleaned each day it is used? changed to state clean daily when used. Are microcuvettes dated when Suggestion for Vial dated Observation, lab logs they are opened and the vial use of disposed of 90 days after individually opening, if unused? (If so, wrapped suggest ordering individually cuvettes wrapped cuvettes)

06320719478ba7f50da2ac4ca756b075.docx Page 19 WIC ME Changes 2014 MPR MPR/Indicator/Criteria Text Change Documentation required How to verify Are microcuvettes or control Clarify Vial dated, noted on Lab Lab logs solutions used before their procedure Log expiration date? Anthropometric Equipment (MI-WIC Policy 2.15) 4.3b Is a copy of the Anthropometric Revision date Copy or know where to find LA has copy or Measurement Procedures in the on website awareness of WIC Clinic or do staff know how website. to access from the MDCH/WIC website? (If not, suggest they do.) DCH - 0730, revised 3/12/13 Record Review Clarify that if Document on referral grid Review referrals grid MIHP… are Other referrals documented, if available, applicable? 5.1b referral is (MIHP/Healthy Start, NFP for needed and I/PG, BE/BP, if available) should be documented Clarified that if Referral on BF screens or Review BF screens Breastfeeding BF screens Referral grid referral/assistance, PG, BE/BP? indicate 6.5e (Breastfeeding screens, NE or assistance or referral) referral this is sufficient Clarify that BF document on BF screens Review BF screens BF follow up documented (BF follow up is Contact and BF Aids and needed and 6.5e Notes)? PG, BE/IBE, BP/IBP, must be child if breastfed) documented as long as BF

06320719478ba7f50da2ac4ca756b075.docx Page 20 WIC ME Changes 2014 MPR MPR/Indicator/Criteria Text Change Documentation required How to verify Single Certifier Record Review: Modified table to Copies of Audit reviews. Review copies of Does agency ever enroll using a document review Compare with Single Audit reviews. single certifier? NO YES Certifier Report Compare with Single If yes, must audit 20% of Certifier Report records. Verify that 20% of clients certified by single certifier were reviewed by Coor. (Admin/reports/role reports/Single User Certification Report) 10.1b Is the agency performing routine audits of 20% of records certified by one staff member, as required? NA YES 9.1a Breastpump Inventory & Modified table Completed BP Agreements Review completed Issuance and instructions BP Agreements, inventory records and issuance reports 3.1a Role Report-Credential Modified table License, RD, degree Review credentials, verification and instructions verification confirm meet requirements 7.3a Formula Approval Record Combined 7 a & Med. Documentation forms, Review MDF’s and Review b food package assignments food package assignments. High Risk Record Review No citation, note NE Pop-up: NE Plan, RD Review NE Pop-up if high % of Refused, Non-WIC RD clients decline documented RD Referrals Outreach materials for Added Healthy Updated MA application Copies of Medicaid/Healthy Kids/Healthy Michigan Plan and outreach materials applications/outreach Michigan Plan outreach available materials. Access to materials MA applications Civil Rights

06320719478ba7f50da2ac4ca756b075.docx Page 21 WIC ME Changes 2014 MPR MPR/Indicator/Criteria Text Change Documentation required How to verify Clarified that Test results/score for each Review training log, Civil Rights Training ONLY ONLY LMS WIC staff member. test results LMS module module is training.mihealth.org allowed Revised USDA short Policy If short statement is used, Review materials non-discrimination statement clarification is it correct? where short non- “USDA is an equal opportunity discrimination provider and employer.” statement is used. Administration

06320719478ba7f50da2ac4ca756b075.docx Page 22 WIC ME Changes 2014 MPR MPR/Indicator/Criteria Text Change Documentation required How to verify Local Agency Required Updated listing LA policies or procedures Review LA policies or Policies/Procedures of required LA for required areas procedures policies or Disaster Plan (MI-WIC Policy procedures. 1.12)

The local agency shall develop a disaster plan that will include:

 A copy of the parent agency’s disaster preparedness plan, if applicable.  Local governmental/community agency emergency contact information.  State and local WIC staff contact information.  A plan for notifying clients of service disruption, relocation and availability of WIC services.

Returned Formula (MI-WIC Policy 8.05) Designate who is monitoring returned formula, and identify procedures for formula security, acceptance, inventory and issuance.

Hematological (MI-WIC Policy 06320719478ba7f50da2ac4ca756b075.docx Page 23 WIC ME Changes 2014 MPR MPR/Indicator/Criteria Text Change Documentation required How to verify Immunization Policy (MI-WIC Policy 6.03- A. 6-8) Only required if within a local health department. Local agency policy related to WIC/Immunization program collaboration, update of immunization records, appropriate information on specific childhood preventable diseases, benefits of immunization and CDC recommended immunization schedule will be provided.

Nutrition Education Collaboration/WIC Agreement Only if Collaborative Program provides Nutrition Education. Does not include Project FRESH Education. (MI-WIC Policy 5.08 – specifying what activities will be performed, who to contact…) 3.1h Does the agency have NCRD Revised policy, Schedule demonstrating Review schedule appointments available within 30 requirement for NCRD appointments days at each site? (MI-WIC available NCRD available within 30 days Policy 5.06) appts. 5.2a Is the agency in compliance with Broke out from Schedule demonstrating Review schedule scheduling within the required other questions cert/pcert appointments timeframes? for emphasis. available within 10/20 days as required

06320719478ba7f50da2ac4ca756b075.docx Page 24 WIC ME Changes 2014 MPR MPR/Indicator/Criteria Text Change Documentation required How to verify 5.2a Are pregnant applicants or Included “do not Note indicating client had Review note clients, who do not keep their mail” scenario been contacted indicating client had appointments, contacted to been contacted reschedule? (MI-WIC Policy 3.01) LA contact is required if client selected “do not mail” How? MI-WIC postcard (automatic) Autodialer/Text Message Agency follow up Other: 5.3d Does the agency schedule Included benefit Benefit issued to clients Record review of and/or perform IEVAL and issuance denial who have not kept EVAL benefit issuance CEVAL for infants and children question. appt. certified for more than 7 months? Are clients who miss IEVAL/CEVAL appointments offered another appointment? Are benefits denied if clients do not complete IEVAL/CEVALs? (MIWIC Policy 2.17) 7.4a Does the local agency designate Included LA policy/procedure for Review LA a person responsible for SECURITY as returned formula policy/procedure for returned formula security, part of returned formula. inventory maintenance and responsibilities. Interview designated distribution? (MI-WIC Policy staff 8.05) Name: 7.4c Is the Local Agency using log Revised formula Use of 9/2013 log. Use of 9/2013 log. 8.05A dated 9/2013 to document log. Secure Storage of returned returned and re-issued formula? storage formula Is the formula stored securely?

06320719478ba7f50da2ac4ca756b075.docx Page 25 WIC ME Changes 2014 MPR MPR/Indicator/Criteria Text Change Documentation required How to verify 5.3c Are eligible transfer clients given Updated policy Transfers cert period Observation of 1 year certification periods (from changed to 1 year from transfer, use of VOC original cert date) and scheduled cert. or cert info from for infant/child evaluations previous site. (IEVAL/CEVAL)? (MI-WIC Policy 3.04) 6.5d Does the agency provide on- Clarified BF Training log, staff meeting Review Training log, going breastfeeding training and training for WIC minutes staff meeting minutes staff activities at least quarterly? Staff and (MI-WIC Policy 4.02) How is documentation this done? In-Service? requirements Conferences? Including (but not limited to):  Initiation and maintenance of BF  Cultural diversity: sensitizing staff to their own attitudes and beliefs about BF, ways to promote, protect & support BF  Information on State and national activities that promote, protect & support BF  Is training documented on staff training log/screen or meeting minutes?

06320719478ba7f50da2ac4ca756b075.docx Page 26 WIC ME Changes 2014 MPR MPR/Indicator/Criteria Text Change Documentation required How to verify 6.5e What breastfeeding promotion Updated to BF referral and activities Review BF referral and support activities are include BF peer documented on screens, and BF screens available to clients prenatally notes and during the post-partum period? BF classes MSUE Mother to Mother BF Group BF peer Other: (MI-WIC Policy 4.01, 4.03) 9.1a Does the agency maintain an Included BP inventory materials Review BP inventory up-to-date Breast Pump Physical BP inventory? Physical inventory inventory required. Who monitors? ______How often? ______(MI-WIC Policy 4.04) 9.1b Does the agency retain all Updated policy Specified records Review record records required for audit or retained/stored and litigation until completion of the observe that obsolete audit or litigation process, or for records are specified periods? destroyed (MI-WIC Policy 1.06) 3.1 Is staff training (i.e., Civil rights, Included Screen record or training Review Screen Breastfeeding, policy, etc.) expectation that log demonstrating training record or training log ongoing and documented in the staff training is demonstrating MI-WIC User Staff Information ongoing and training Screen using the Staff training documented button or other record?

06320719478ba7f50da2ac4ca756b075.docx Page 27 WIC ME Changes 2014 MPR MPR/Indicator/Criteria Text Change Documentation required How to verify 10.1b Does the agency have clinics Included Single certifier audit records Review single where one staff member question about certifier audits and performs the entire certification? emergency report Y N single certifier 1) If yes, is an ongoing audit situations. completed as required by policy (20% of single certifier records)? 2) Does the agency retain validation of each client’s identity and income documentation? If yes, review audits performed. (MI-WIC Policy 9.03)

How does agency handle occasional/emergency single certifier situations, are these included in record reviews? 12.1 If a record is not found in MCIR, Included LA policy/procedure Observe efforts to are efforts made to link question to link WIC/MCIR WIC/MCIR record to client? If better correlate records not, suggest they do. with MCIR Has the agency provided New Policy. CPA generated, evidence Verify CPA feedback, training and guidance Included of training, discussion and generated, evidence to agency or sub-contractor staff expectation that implementation of Plans. of training, discussion 9.1a regarding these annual reviews annual reviews and implementation and findings? (MI-WIC Policy generate CPA of Plans. 1.11 for each site/contractor.

06320719478ba7f50da2ac4ca756b075.docx Page 28 WIC ME Changes 2014 MPR MPR/Indicator/Criteria Text Change Documentation required How to verify Has the agency completed the New citation, CPA and status Verify CPA generated Comprehensive Plan of Action inclusion of and steps completed from their previous WIC Annual Review documented 11.1a Management Evaluation/Annual review? (MI-WIC Policy 1.05, 1.11) Nutrition Education Policy 5.01-Nutrition Education New citations for Follow up of NE Observe and review  One year cert changes revised policies. documented on NE popup NE follow up ◦ 1 contact per quarter or ICP follow up screen documentation on NE (all statuses) popup or ICP follow ◦ Breastfeeding –more up screens occur earlier to meet client’s needs  Follow up at cert/eval of previously received nutrition education Recordkeeping and Accountability Record retention: Revised policy Observe that Stored securely obsolete records are 10/1/2010-to date destroyed. Verify NOTE - All M-TRACX records that no audits are can be destroyed outstanding. E-Notice 2014-89 (4/18/14) 3 months of benefits Clarified not Benefit inquiry Review benefit AVAILABLE more than 3 full inquiry to verify # Allow not more than 3 full months of months of benefits months benefits to be on EBT benefits loaded at a time card at a time. available to Replacement of WIC Bridge client at a time Card in clinic

06320719478ba7f50da2ac4ca756b075.docx Page 29 WIC ME Changes 2014 MPR MPR/Indicator/Criteria Text Change Documentation required How to verify Project FRESH When and how was training Clarified Project Review records and completed? Fresh training materials What methods of and record Lesson plans for client education/training are used to retention education educate clients? Inventory of stock and Are inventory/issuance records signature logs retained for the required period? (10/1/10-present)

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