216-RICR-20-05-3. WIC Program (version Amendment, 02/17/2002 to 02/26/2003)

Goals 2002 Section II WIC Eligibility and Enrollment Section II - 1 SECTION II WIC ELIGIBILITY AND ENROLLMENT Refer to WIC Procedure Manual Section 200 WIC Operations Manual Section 2 Goals 2002 Section II WIC Eligibility and Enrollment Section II - 2 Section II Eligibility and Enrollment Goal: To ensure that eligible persons are enrolled in the Program in accordance with regulatory requirements, through accurate and efficient assessments and recording. Application and Eligibility Determination Objective 1: Prompt implementation of revised income guidelines Evaluation: Rhode Island Medicaid adopted the 2001 Revised income guidelines on May 10, 2001. RI WIC obtained permission to adopt the income guidelines as of May 10, 2001. Plan: Adopt revised income eligibility guidelines at 185% of poverty level concurrent with the State's adoption for Medicaid. Obtain Regional Office approval of proposed guidelines in advance. Objective 2: Identify training needs Evaluation: Identified training needs of local agency nutritionists and support staff through surveys, Nutrition Education Plans, Patient Flow Analysis, management evaluations, and changes in rules, regulations, policies and procedures impacting local WIC sites. Plan: Identify training needs of local agency nutritionists and support staff through surveys, Nutrition Education Plans, management evaluations, and changes in rules, regulations, policies and procedures impacting local WIC sites. Objective 3: Conduct training Evaluation: Conducted monthly orientation and training for new WIC nutritionists and support staff (as needed), trained new breast-feeding peer counselors, provided three training sessions for WIC support staff, conducted four nutrition education training (avg. attendance 25), met with WIC local agency coordinators bi- monthly, and provided individual agency training during Management Evaluations (12 sites). Trained 90+ staff on new WIC Allowed Foods along with training 450+ vendors. Over 90+ staff members attended the WIC Annual Training Event. Plan: Conduct training monthly for new WIC nutritionists and support staff, train new breast-feeding peer counselors and provide quarterly training for all peer counselors, conduct three per year training for WIC support staff, conduct quarterly nutrition education training for WIC and community nutrition staff, meet Goals 2002 Section II WIC Eligibility and Enrollment Section II - 3 with WIC local agency coordinators bi-monthly. Investigate the development of a RI WIC web-training site. Objective 4: RIte Care integration Evaluation: Collaborated within the Division of Family Health to improve and increase screening and referral to WIC / RIte Care / Food Stamps / FIP through integrated outreach efforts, training and further development of role of Family Resource Counselors. Established an outreach initiative with Neighbor Health Plan of Rhode Island (major Rite Care provider). Staffed 1/4 FTE (Provider Outreach and Education Liaison position) to enhance communications with Rite Care Providers. Plan: Continue coordination with Family Resource Counselors, although DHS Outstation worker program has been dismantled. Continue efforts to reduce duplication of services in obtaining WIC required screenings from RIte Care (Medicaid) providers. Continue with implementation and evaluation of Liaison / Provider initiative. Objective 5: Assure enrollment of high priority applicants Evaluation: WIC parent consultants, WIC Client Services Unit and the Division’s Communication’s Unit collaborated in conducting a variety of surveys and interviews related to access to services, health care concerns, quality of services provided. This information was used to plan for improved outreach efforts and improved services at WIC sites. Continued participation in a division wide outreach initiative to improve access to division programs by under served and high risk Rhode Islanders. Development of Statewide Outreach Committee, comprised of staff from each local WIC agency and HEALTH, to develop an outreach strategy with an evaluation component. Plan: Continue work with WIC parent consultants and Communications in providing targeted outreach, including new / relocated WIC sites. Continue to support local agencies continued Patient Flow Analysis activities, and continue to provide technical assistance to ensure timely access to WIC services. Continue outreach efforts through managed care providers, and new providers serving the RIte Care populations through the Provider Liaison ¼ FTE position. Objective 6: Streamline eligibility determination process Evaluation: Continued follow-up training of local agency WIC staff on use of adjunctive eligibility for WIC income verification. Upgraded software at local agency sites to increase intake efficiency. Implemented coordination system re: categorical and income eligibility between WIC and FRC program. KidsNet pilot project was delayed until October, 2001. Goals 2002 Section II WIC Eligibility and Enrollment Section II - 4 Plan: Continue to support local agencies' efforts in streamlining determination process. Review documentation requirements to ensure compliance with regulations while simplifying determination process. Implement pilot project with KidsNet, to identify risks associated with elevated blood lead levels. Objective 7: Separation of Duties Evaluation: The State Agency incorporates SOD monitoring into the biennial Management Evaluations performed. No WIC local agencies were sited for SOD non- compliance in FY 2001 Plan: Require local WIC agencies to comply with separation of duties during certification, thus reducing the possibility of fraud and mis-use of WIC funds. Continue monitoring efforts. Objective 8: Coordinate with RI Department of Health Minority Health Initiatives Evaluation: Continued collaborated with Cultural Competence Coordinator to address cultural awareness and sensitivity issues among State and local WIC staff. Plan: Continue coordination of work with Minority Health Office in addressing needs of non-English speaking, and minority communities. In collaboration with the Division of Family Health, develop analytical tools to identify health disparities among ethnic/racial groups of WIC participants. Objective 9: Implement Department of Defense “WIC Look alike Program” Plan: Revise the WIC Procedure Manual, and train local agency WIC staff on DoD WIC style program. Focus on VOC processes to ensure access to services during times of transition. Determination of income Objective 1: Increase efficiency and accuracy in determination of income Evaluation: Provided training on adjunctive eligibility, assisted local agencies in making determination in questionable cases, provided a template form for income determination, and provided technical assistance on new WIC Federal Income Guidelines. Developed working group to encourage efficiencies among WIC and FRC programs. Preliminary studies have shown that the FRC Program was most effective in enrolling families in Rite Care (thus adjunctive eligibility). Plan: Continue assisting local agencies in making determination in questionable cases, provide technical assistance on new WIC Federal Income Guidelines, provide training to new WIC staff re: income determination policies and procedures, continue monitoring income screenings through management evaluations. Goals 2002 Section II WIC Eligibility and Enrollment Section II - 5 Nutritional Assessment Objective 1: Monitor documentation of nutrition assessment for accuracy Evaluation: Local WIC agencies conducted regularly scheduled quality assurance reviews of certification documentation (as outlined in their Nutrition Education Plans). These efforts were reviewed during Management Evaluations, conducted at required WIC agencies. All agencies reviewed were in general compliance with federal regulations. USDA standardized risk code reports were analyzed and shared with local WIC agencies. Training related to use of the Hemocue was provided to improve accuracy of blood screening. Anthropometric measurement training is provided on an as needed basis. Plan: Local agencies will conduct regularly scheduled quality assurance reviews of certification documentation (per Nutrition Education Plans). Management Evaluations will be conducted to monitor for documentation compliance. QWIC risk reports will be collected, analyzed, and reviewed with local WIC agencies; information will be used to target training, monitor on-going initiatives (breast- feeding support programs), re-direct efforts and develop new initiatives. Revisions and additions to allowed nutrition risk criteria will be implemented and staff will be informed and trained. Objective 2: Dietary assessment tools Evaluation: Rhode Island’s dietary assessment tools are used statewide. Training on use of the tools is conducted by RI WIC Nutrition Coordinator for any new staff or those needing a review (usually noted at ME). Plan: Continue to follow national initiative in the development of national dietary assessment models. Objective 3: Coordinate procedures and criteria with other Division of Family Health programs to avoid duplication and enhance access. Evaluation: WIC and the Women’s Health Screening and Referral Program continued their coordination to enhance access to nutrition services. Evaluations of lead screening results among WIC children lead to collaboration in the review of nutrition / lead materials. Started implementing the WIC / Lead / KidsNet initiative. This will allow WIC local agency staff to view KidsNet lead screening results, and act on the findings. Plan: Continue to work with lead program in ensuring that WIC eligible children with elevated lead levels are referred to WIC. Develop Kids Net connection to enable Goals 2002 Section II WIC Eligibility and Enrollment Section II - 6 local agency WIC staff access to lead screening results at the time of certification and recertification. Objective4: Biochemical and Anthropometric screening Evaluation: Upgraded infant and adult scales at local WIC agencies as needed. WIC continued to provide measurement training to new WIC staff, and monitored techniques during Management Evaluations. Continued with technical assistance regarding procedures related to new CDC/AAP/WIC blood screening guidelines. Plan: Continue to provide technical assistance on the federal regulations related to blood screening. Provide training to state and local agency WIC staff re: new Body Mass Index initiative from CDC. Continue to monitor measurements of children, allowing only light clothing ,dry diapers and removing shoes. Training for measuring will be conducted at both support staff meetings and Nutrition Education meetings. Minimize violations of Program rules and misuse of Program funds. Objective 1: Warnings and sanctions Plan: Continue to provide training to local WIC staff on importance of educating clients on their rights along with their responsibilities using the newly revised WIC rights and responsibilities information included on the WIC ID folder. Monitor participant knowledge of rights and responsibilities during Management Evaluations through parent consultant / participant interview process.