ADDITIONAL ACTIVITIES AND REQUIREMENTS WITH RESPECT TO SPECIAL SUPPLEMENTAL FOOD PROGRAM FOR WOMEN, INFANTS, AND CHILDREN.

SEC. 123. ADDITIONAL ACTIVITIES AND REQUIREMENTS WITH RESPECT TO SPECIAL SUPPLEMENTAL FOOD PROGRAM FOR WOMEN, INFANTS, AND CHILDREN. (a) In General.— Section 17 of the Child Nutrition Act of 1966 (42 U.S.C. 1786) is amended— (1) in subsection (b), by adding at the end the following new paragraph: “(17) ‘Competitive bidding’ means a procurement process under which the State agency selects the single source offering the lowest price, as determined by the submission of sealed bids, for the product for which bids are sought.”; (2) in subsection (d), by amending paragraph (2) to read as follows: “(2) (A) The Secretary shall establish income eligibility standards to be used in conjunction with the nutritional risk criteria in determining eligibility of individuals for participation in the program. Any individual at nutritional risk shall be eligible for the program under this section only if such individual— “(i) is a member of a family with an income that is less than the maximum income limit prescribed under section 9(b) of the National School Lunch Act for free and reduced price meals; “(ii) (I) receives food stamps under the Food Stamp Act of 1977; or “(II) is a member of a family that receives assistance under the program for aid to families with dependent children established under part A of title IV of the Social Security Act; or “(iii) (I) receives medical assistance under title XIX of the Social Security Act; or “(II) is a member of a family in which a pregnant woman or an infant receives such assistance. “(B) For the purpose of determining income eligibility under this section, any State agency may choose to exclude from income any basic allowance for quarters received by military service personnel residing off military installations.”; (3) in subsection (e)— (A) by striking the last 3 sentences of paragraph (1); (B) by redesignating paragraph (2) as paragraph (3); (C) by inserting after paragraph (1) the following new paragraph: “(2) The Secretary shall prescribe standards to ensure that adequate nutrition education services and breastfeeding promotion and support are provided. The State agency shall provide training to persons providing nutrition education under this section. Nutrition education and breastfeeding promotion and support shall be evaluated annually by each State agency, and such evaluation shall include the views of participants concerning the effectiveness of the 103 STAT. 895nutrition education and breastfeeding promotion and support they have received.”; and (D) by adding at the end the following new paragraphs: “(3) The State agency shall— “(A) ensure that written information concerning food stamps, the program for aid to families with dependent children under part A of title IV of the Social Security Act, and the child support enforcement program under part D of title IV of the Social Security Act is provided on at least 1 occasion to each adult participant in and each applicant for the program; “(B) provide each local agency with materials showing the maximum income limits, according to family size, applicable to pregnant women, infants, and children up to age 5 under the medical assistance program established under title XIX of the Social Security Act (in this section referred to as the ‘medicaid program’); and “(C) provide to individuals applying for the program under this section, or reapplying at the end of their certification period, written information about the medicaid program and referral to such program or to agencies authorized to determine presumptive eligibility for such program, if such individuals are not participating in such program and appear to have family income below the applicable maximum income limits for such program. “(4) The State agency shall ensure that each local agency shall maintain and make available for distribution a list of local resources for substance abuse counseling and treatment.”; (4) in subsection (f)— (A) in subparagraph (C) of paragraph (1)— (i) in clause (iii)— (I) by inserting “local programs for breastfeeding promotion,” after “immunization programs,”; and (II) by inserting “and treatment” after “alcohol and drug abuse counseling”; (ii) by amending clause (vii) to read as follows: “(vii) a plan to provide program benefits under this section to eligible individuals most in need of the benefits and to provide eligible individuals not participating in the program with information on the program, the eligibility criteria for the program, and how to apply for the program, with emphasis on reaching and enrolling eligible women in the early months of pregnancy, including provisions to reach and enroll eligible migrants;”; (iii) by redesignating clauses (viii) and (ix) as clauses (xii) and (xiii), respectively; and (iv) by inserting after clause (vii) the following new clauses: “(viii) a plan to provide program benefits under this section to unserved infants and children under the care of foster parents, protective services, or child welfare authorities, including infants exposed to drugs perinatally; “(ix) if the State agency chooses to provide program benefits under this section to some or all eligible individuals who are incarcerated in prisons or juvenile detention facilities that do not receive Federal assistance under any program specifically established to assist pregnant women regarding their nutrition and health needs, a plan for the provision of such benefits to, 103 STAT. 896and to meet the special nutrition education needs of, such individuals, which may include— “(I) providing supplemental foods to such individuals that are different from those provided to other participants in the program under this section; “(II) providing such foods to such individuals in a different manner than to other participants in the program under this section in order to meet the special needs of such individuals; and “(III) the development of nutrition education materials appropriate for the special needs of such individuals; “(x) a plan to improve access to the program for participants and prospective applicants who are employed, or who reside in rural areas, by addressing their special needs through the adoption or revision of procedures and practices to minimize the time participants and applicants must spend away from work and the distances that participants and applicants must travel, including appointment scheduling, adjustment of clinic hours, clinic locations, or mailing of multiple vouchers; “(xi) a plan to provide nutrition education and promote breastfeeding;”; (B) by adding at the end of paragraph (8) the following new subparagraph: “(D) Each local agency operating the program within a hospital and each local agency operating the program that has a cooperative arrangement with a hospital shall— “(i) advise potentially eligible individuals that receive in-patient or outpatient prenatal, maternity, or postpartum services, or accompany a child under the age of 5 who receives well-child services, of the availability of program benefits; and “(ii) to the extent feasible, provide an opportunity for individuals who may be eligible to be certified within the hospital for participation in such program.”; (C) in paragraph (9)— (i) by inserting “(A)” after “(9)”; and (ii) by adding at the end the following new subparagraph: “(B) Any State agency that must suspend or terminate benefits to any participant during the participant’s certification period due to a shortage of funds for the program shall first issue a notice to such participant. Such notice shall include, in addition to other information required by the Secretary, the categories of participants whose benefits are being suspended or terminated due to such shortage.”; (D) in subparagraph (A) of paragraph (14), by inserting “, breastfeeding promotion,” after “nutrition education”; (E) in paragraph (17), by inserting before the period the following: “and to accommodate the special needs and problems of individuals who are incarcerated in prisons or juvenile detention facilities”; and (F) by adding at the end the following new paragraphs: “(18) (A) Except as provided in subparagraph (B), a State agency may implement income eligibility guidelines under this section at the time the State implements income eligibility guidelines under the medicaid program. “(B) Income eligibility guidelines under this section shall be implemented not later than July 1 of each year. 103 STAT. 897 “(19) Each local agency participating in the program under this section shall provide information about other potential sources of food assistance in the local area to individuals who apply in person to participate in the program under this section, but who cannot be served because the program is operating at capacity in the local area. “(20) The State agency shall adopt policies that— “(A) require each local agency to attempt to contact each pregnant woman who misses an appointment to apply for participation in the program under this section, in order to reschedule the appointment, unless the phone number and the address of the woman are unavailable to such local agency; and “(B) in the case of local agencies that do not routinely schedule appointments for individuals seeking to apply or be recertified for participation in the program under this section, require each such local agency to schedule appointments for each employed individual seeking to apply or be recertified for participation in such program so as to minimize the time each such individual is absent from the workplace due to such application or request for recertification.”; (5) in subsection (g)— (A) by amending paragraph (1) to read as follows: “(1) There are authorized to be appropriated to carry out this section $2,158,000,000 for the fiscal year 1990, and such sums as may be necessary for each of the fiscal years 1991, 1992, 1993, and 1994. As authorized by section 3 of the National School Lunch Act, appropriations to carry out the provisions of this section may be made not more than 1 year in advance of the beginning of the fiscal year in which the funds will become available for disbursement to the States, and shall remain available for the purposes for which appropriated until expended.”; (B) by redesignating paragraphs (2) and (3) as paragraphs (4) and (5), respectively; (C) by inserting after paragraph (1) the following new paragraphs: “(2) (A) Notwithstanding any other provision of law, unless enacted in express limitation of this subparagraph, the Secretary— “(i) in the case of legislation providing funds through the end of a fiscal year, shall issue— “(I) an initial allocation of funds provided by the enactment of such legislation not later than the expiration of the 15-day period beginning on the date of the enactment of such legislation; and “(II) subsequent allocations of funds provided by the enactment of such legislation not later than the beginning of each of the second, third, and fourth quarters of the fiscal year, and “(ii) in the case of legislation providing funds for a period that ends prior to the end of a fiscal year, shall issue an initial allocation of funds provided by the enactment of such legislation not later than the expiration of the 10-day period beginning on the date of the enactment of such legislation. “(B) In any fiscal year— “(i) unused amounts from a prior fiscal year that are identified by the end of the first quarter of the fiscal year shall be recovered and reallocated not later than the beginning of the second quarter of the fiscal year; and 103 STAT. 898 “(ii) unused amounts from a prior fiscal year that are identified after the end of the first quarter of the fiscal year shall be recovered and reallocated on a timely basis. “(3) Notwithstanding any other provision of law, unless enacted in express limitation of this paragraph— “(A) the allocation of funds required by paragraph (2)(A)(i)(I) shall include not less than ⅓ of the amounts appropriated by the legislation described in such paragraph; “(B) the allocations of funds required by paragraph (2))(A)(i)(II) to be made not later than the beginning of the second and third Starters of the fiscal year shall each include not less than ¼ of e amounts appropriated by the legislation described in such paragraph; and “(C) in the case of the enactment of legislation providing appropriations for a period of not more than 4 months, the allocation of funds required by paragraph (2)(A)(ii) shall include all amounts appropriated by such legislation except amounts reserved by the Secretary for purposes of carrying out paragraph (5).”; (D) in paragraph (5) (as redesignated by subparagraph (B) of this paragraph), by striking “$3,000,000” and inserting “$5,000,000”; and (E) by adding at the end the following new paragraph: “(6) Upon the completion of the 1990 decennial census, the Secretary, in coordination with the Secretary of Commerce, shall make available an estimate, by State and county (or equivalent political subdivision) of the number of women, infants, and children who are members of families that have incomes below the maximum income limit for participation in the program under this section.”; (6) by amending subsection (h) to read as follows: “(h) (1) (A) Each fiscal year, the Secretary shall make available, from amounts appropriated for such fiscal year under subsection (g)(1) and amounts remaining from amounts appropriated under such subsection for the preceding fiscal year, an amount sufficient to guarantee a national average per participant grant to be allocated among State agencies for costs incurred by State and local agencies for nutrition services and administration for such year. “(B) (i) The amount of the national average per participant grant for nutrition services and administration for any fiscal year shall be an amount equal to the amount of the national average per participant grant for nutrition services and administration issued for the fiscal year 1987, as adjusted. “(ii) Such adjustment, for any fiscal year, shall be made by revising the national average per participant grant for nutrition services and administration for the fiscal year 1987 to reflect the percentage change between— “(I) the value of the index for State and local government purchases, using the implicit price deflator, as published by the Bureau of Economic Analysis of the Department of Commerce, for the 12-month period ending June 30, 1986; and “(II) the best estimate that is available as of the start of the fiscal year of the value of such index for the 12-month period ending June 30 of the previous fiscal year. “(C) In any fiscal year, amounts remaining from amounts appropriated for such fiscal year under subsection (g)(1) and from amounts appropriated under such section for the preceding fiscal year, after carrying out subparagraph (A), shall be made available for food 103 STAT. 899benefits under this section, except to the extent that such amounts are needed to carry out the purposes of subsections (g)(4) and (g)(5). “(2) (A) For each of the fiscal years 1990, 1991, 1992, 1993 and 1994, the Secretary shall allocate to each State agency from the amount described in paragraph (1)(A) an amount for costs of nutrition services and administration on the basis of a formula prescribed by the Secretary. Such formula shall— “(i) be designed to take into account— “(I) the varying needs of each State; “(II) the number of individuals participating in each State; and “(III) other factors which serve to promote the proper, efficient, and effective administration of the program under this section; “(ii) provide for each State agency— “(I) an estimate of the number of participants for the fiscal year involved; and “(II) a per participant grant for nutrition services and administration for such year; and “(iii) provide for a minimum grant amount for State agencies. “(B) (i) Except as provided in clause (ii) and subparagraph (C), in any fiscal year, the total amount allocated to a State agency for costs of nutrition services and administration under the formula prescribed by the Secretary under subparagraph (A) shall constitute the State agency’s operational level for such costs for such year even if the number of participants in the program at such agency is lower than the estimate provided under subparagraph (A)(ii)(I) “(ii) If a State agency’s per participant expenditure for nutrition services and administration is more than 15 percent higher than its per participant grant for nutrition services and administration without good cause, the Secretary may reduce such State agency’s operational level for costs of nutrition services and administration. “(C) In any fiscal year, the Secretary may reallocate amounts provided to State agencies under subparagraph (A) for such fiscal year. When reallocating amounts under the preceding sentence, the Secretary may provide additional amounts to, or recover amounts from, any State agency. “(3) (A) Except as provided in subparagraphs (B) and (C), in each fiscal year, each State agency shall expend— “(i) for nutrition education activities and breastfeeding promotion and support activities, an aggregate amount that is not less than the sum of— “(I) ⅙ of the amounts expended by the State for costs of nutrition services and administration; and “(II) an amount equal to a proportionate share of $8,000,000, with each State’s share determined on the basis of the number of pregnant women and breastfeeding women in the program in the State as a percentage of the number of pregnant women and breastfeeding women in the program in all States; and “(ii) for breastfeeding promotion and support activities an amount that is not less than the amount determined for such State under clause (i)(II). “(B) The Secretary may authorize a State agency to expend an amount less than the amount described in subparagraph (A)(ii) for purposes of breastfeeding promotion and support activities if— “(i) the State agency so requests; and 103 STAT. 900 “(ii) the request is accompanied by documentation that other funds will be used to conduct nutrition education activities at a level commensurate with the level at which such activities would be conducted if the amount described in subparagraph (A)(ii) were expended for such activities. “(C) The Secretary may authorize a State agency to expend for purposes of nutrition education an amount that is less than the difference between the aggregate amount described in subparagraph (A) and the amount expended by the State for breastfeeding promotion and support programs if— “(i) the State agency so requests; and “(ii) the request is accompanied by documentation that other funds will be used to conduct such activities. “(D) The Secretary shall limit to a minimal level any documentation required under this paragraph. “(4) The Secretary shall— “(A) in consultation with the Secretary of Health and Human Services, develop a definition of breastfeeding for the purposes of the program under this section; “(B) authorize the purchase of breastfeeding aids by State and local agencies as an allowable expense under nutrition services and administration; “(C) require each State agency to designate an agency staff member to coordinate breastfeeding promotion efforts identified in the State plan of operation and administration; and “(D) require the State agency to provide training on the promotion and management of breastfeeding to staff members of local agencies who are responsible for counseling participants in the program under this section concerning breastfeeding. “(5) (A) Subject to subparagraph (B), in any fiscal year that a State agency achieves, through use of acceptable measures, participation that exceeds the participation level estimated for such State agency under paragraph (2)(A)(ii)(I), such State agency may convert amounts allocated for food benefits for such fiscal year for costs of nutrition services and administration to the extent that such conversion is necessary— “(i) to cover allowable expenditures in such fiscal year; and . “(ii) to ensure that the State agency maintains the level established for the per participant grant for nutrition services and administration for such fiscal year. “(B) If a State agency increases its participation level through measures that are not in the nutritional interests of participants or not otherwise allowable (such as reducing the quantities of foods provided for reasons not related to nutritional need), the Secretary may refuse to allow the State agency to convert amounts allocated for food benefits to defray costs of nutrition services and administration. “(C) For the purposes of this paragraph, the term ‘acceptable measures’ includes use of cost containment measures, curtailment of vendor abuse, and breastfeeding promotion activities. “(6) In each fiscal year, each State agency shall provide, from the amounts allocated to such agency for such year for costs of nutrition services and administration, an amount to each local agency for its costs of nutrition services and administration. The amount to be provided to each local agency under the preceding sentence shall be determined under allocation standards developed by the State agency in cooperation with the several local agencies, taking into 103 STAT. 901account factors deemed appropriate to further proper, efficient, and effective administration of the program, such as— “(A) local agency staffing needs; “(B) density of population; “(C) number of individuals served; and “(D) availability of administrative support from other sources. “(7) The State agency may provide in advance to any local agency any amounts for nutrition services and administration deemed necessary for successful commencement or significant expansion of program operations during a reasonable period following approval of— “(A) a new local agency; “(B) a new cost containment measure; or “(C) a significant change in an existing cost containment measure. “(8) (A) No State may receive its allocation under this subsection unless on or before August 30, 1989 (or a subsequent date established by the Secretary for any State) such State has— “(i) examined the feasibility of implementing cost containment measures with respect to procurement of infant formula, and, where practicable, other foods necessary to carry out the program under this section; and “(ii) initiated action to implement such measures unless the State demonstrates, to the satisfaction of the Secretary, that such measures would not lower costs or would interfere with the delivery of formula or foods to participants in the program. “(B) (i) Except as provided in subparagraphs (C), (D), and (E)(iii), in carrying out subparagraph (A), any State that provides for the purchase of foods under the program at retail grocery stores shall, with respect to the procurement of infant formula, use— “(I) a competitive bidding system; or “(II) any other cost containment measure that yields savings equal to or greater than savings generated by a competitive bidding system when such savings are determined by comparing the amounts of savings that would be provided over the full term of contracts offered in response to a single invitation to submit both competitive bids and bids for other cost containment systems for the sale of infant formula. “(ii) In determining whether a cost containment measure other than competitive bidding yields equal or greater savings, the State, in accordance with regulations issued by the Secretary, may take into account other cost factors (in addition to rebate levels and procedures for adjusting rebate levels when wholesale price levels rise), such as— “(I) the number of infants who would not be expected to receive the contract brand of infant formula under a competitive bidding system; “(II) the number of cans of infant formula for which no rebate would be provided under another rebate system; and “(III) differences in administrative costs relating to the implementation of the various cost containment systems (such as costs of converting a computer system for the purpose of operating a cost containment system and costs of preparing participants for conversion to a new or alternate cost containment system). “(C) In the case of any State that has a contract in effect on the date of the enactment of the Child Nutrition and WIC Reauthoriza-103 STAT. 902tion Act of 1989, subparagraph (B) shall not apply to the program operated by such State under this section until the term of such contract, as such term is specified by the contract as in effect on such date, expires. In the case of any State that has more than 1 such contract in effect on the date of the enactment of such Act, subparagraph (B) shall not apply until the term of the contract with the latest expiration date, as such term is specified by such contract as in effect on the date of the enactment of such Act, expires. “(D) (i) The Secretary shall waive the requirement of subparagraph (B) in the case of any State that demonstrates to the Secretary that— “(I) compliance with subparagraph (B) would be inconsistent with efficient or effective operation of the program operated by such State under this section; or “(II) the amount by which the savings yielded by an alternative cost containment system would be less than the savings yielded by a competitive bidding system is sufficiently minimal that the difference is not significant. “(ii) The Secretary shall prescribe criteria under which a waiver may be granted pursuant to clause (i). “(iii) The Secretary shall provide information at 6-month intervals to the Committee on Education and Labor of the House of Representatives and the Committee on Agriculture, Nutrition, and Forestry of the Senate on waivers that have been granted under clause (i). “(E) (i) The Secretary shall provide technical assistance to small Indian State agencies carrying out this paragraph in order to assist such agencies to achieve the maximum cost containment savings feasible. “(ii) The Secretary shall also provide technical assistance, on request, to State agencies that do not have large caseloads and that desire to consider a cost containment system that covers more than 1 State agency. “(iii) The Secretary may waive the requirement of subparagraph (B) in the case of any Indian State agency that has not more than 1,000 participants. “(F) No State may enter into a cost containment contract (in this subparagraph referred to as the “original contract”) that prescribes conditions that would void, reduce the savings under, or otherwise limit the original contract if the State solicited or secured bids for, or entered into, a subsequent cost containment contract to take effect after the expiration of the original contract. “(G) Not later than the expiration of the 120-day period beginning on the date of the enactment of the Child Nutrition and WIC Re-authorization Act of 1989, the Secretary shall prescribe regulations to carry out this paragraph. Such regulations shall address issues involved in comparing savings from different cost containment measures, as provided under subparagraph (B). “(9) For purposes of this subsection, the term ‘cost containment measure’ means a competitive bidding, rebate, direct distribution, or home delivery system implemented by a State agency as described in its approved plan of operation and administration.”; (7) in subsection (i)— (A) in paragraph (1), by striking “funds provided in accordance with this section” and inserting “amounts made available for food benefits under subsection (h)(1)(C)”; (B) in subparagraph (D) of paragraph (3)— 103 STAT. 903 (i) by striking “approved cost-savings strategies as identified in subsection (h)(5)(A)” and inserting “cost containment measures as defined in subsection (h)(9)”; and (ii) by striking “at the discretion of the Secretary, up to 5 percent” and inserting “not more than 3 percent”; and (C) by adding at the end the following new paragraph: “(7) In addition to any amounts expended under paragraph (3)(A)(i), any State agency using cost containment measures as defined in subsection (h)(9) may temporarily use amounts made available to such agency for the first quarter of a fiscal year to defray expenses for costs incurred during the final quarter of the preceding fiscal year. In any fiscal year, any State agency that uses amounts made available for a succeeding fiscal year under the authority of the preceding sentence shall restore or reimburse such amounts when such agency receives payment as a result of its cost containment measures for such expenses.”; (8) in subsection (j), by striking “each year” and inserting “every other year”; (9) in subsection (k)(1)— (A) in the first sentence, by striking “twenty-three” and inserting “24”; and (B) in the second sentence, by inserting after “the Secretary;” the following: “1 member shall be an expert in the promotion of breast feeding;”; and (10) by adding at the end the following new subsections: “(o) (1) Subject to the availability of funds appropriated for the purpose of carrying out this subsection, the Secretary is authorized to establish a demonstration program for the establishment of clinics for participants in the program under this section at community colleges that offer nursing education programs. In determining the location of clinics under this subsection, the Secretary shall consider— “(A) the location of the community college under consideration; “(B) its accessibility to individuals eligible to participate in the special supplemental food program under this section; and “(C) its willingness to operate the clinic during non traditional hours. “(2) The Secretary shall, from funds appropriated for the purpose of carrying out this subsection— “(A) evaluate any demonstration program carried out under paragraph (1); and “(B) submit to the Congress a report containing the results of such evaluation. “(3) There is authorized to be appropriated for purposes of carrying out this subsection $1,000,000 for the fiscal year 1990 and such sums as may be necessary for each of the fiscal years 1991 and 1992. “(p) (1) The Secretary is authorized to make grants to State agencies for the purpose of improving and updating information and data systems used for purposes of carrying out programs under this section. “(2) Any State that desires to receive a grant under this subsection shall submit an application to the Secretary at such time, and containing or accompanied by such information, as the Secretary 103 STAT. 904may reasonably require. Grants shall be awarded based on the need demonstrated by States in their applications. “(3) There is authorized to be appropriated for purposes of carrying out this subsection $2,000,000 for the fiscal year 1990 and such sums as may be necessary for each of the fiscal years 1991, 1992, 1993, and 1994.”. (b) Review of Priority System.— (1) In general.— During the fiscal years 1990 and 1991, the Secretary of Agriculture shall conduct a review of the relationship between the nutritional risk criteria established under section 17 of the Child Nutrition Act of 1966 and the priority system used under the special supplemental food program for women, infants, and children carried out under such section (hereafter in this section referred to as the “program”), especially as it affects pregnant women. In conducting such review, the Secretary of Agriculture shall— (A) consult with the directors of State and local agencies that operate the program and with other individuals with expertise in the field of nutrition; (B) take into consideration the preventive nature of the program; and (C) examine the risks to individuals eligible for participation in the program, particularly pregnant women, from conditions such as homelessness, mental illness, and conditions that pose barriers to receipt of prenatal care, that may be associated with an increased probability of adverse pregnancy outcome or other adverse effects on health. (2) Reports to congress.— The Secretary of Agriculture shall report to the Committee on Education and Labor of the House of Representatives and the Committee on Agriculture, Nutrition, and Forestry of the Senate concerning the results of the review conducted as required by paragraph (1). Under the preceding sentence, the Secretary of Agriculture shall submit to such committees— (A) a preliminary report not later than October 1, 1990; and (B) a final report not later than July 1, 1991. (c) Report on WIC Food Package.— (1) In general.— The Secretary of Agriculture shall review the appropriateness of foods eligible for purchase under the special supplemental food program for women, infants, and children carried out under section 17 of the Child Nutrition Act of 1966. (2) Factors.— In conducting such review, the Secretary of Agriculture shall take into consideration such factors as— (A) how effectively protein, calcium, and iron are provided to participants; (B) nutrient density of foods; and (C) the extent to which nutrients, for which program participants are most vulnerable to deficiencies, such as iron, thiamine, riboflavin, vitamin A, and zinc, are effectively provided to participants. (3) Reports.— The Secretary of Agriculture shall provide to the Congress— (A) a preliminary report on such review no later than June 30, 1991; and 103 STAT. 905 (B) a final report on such review no later than June 30, 1992. (d) Report on Costs for Nutrition Services and Administration..— (1) In general.— The Secretary of Agriculture shall review the effect on costs for nutrition services and administration incurred by State and local agencies of this section, section 213, and the amendments made by such sections (including the effect of both increases and decreases in requirements imposed on such agencies). (2) Report.— Not later than 1 year after the date of enactment of this Act, the Secretary of Agriculture shall submit to the appropriate committees of the Congress a report on the results of the review conducted under this subsection. (e) Paperwork Reduction.— In implementing and monitoring compliance with the provisions of the amendments made by this section (other than the amendment made by subsection (a)(2) to section 17(d)(2) of the Child Nutrition Act of 1966 (42 U.S.C. 1786(d)(2)), the Secretary of Agriculture shall not impose any new requirement on a State or local agency that would require the State or local agency to place additional paperwork or documentation in a case file maintained by a local agency. (f) Implementation.— (1) Breastfeeding promotion; nutrition education; out-reach.— Not later than July 1, 1990, the Secretary of Agriculture shall issue final regulations to implement the amendments made by subsections (a)(2), (a)(3), and (a)(4). (2) Extension of authorization; allocations.— The amendments made by subsections (a)(5), (a)(6), and (a)(7) shall be effective as of October 1, 1989.