March 17, 2008 WIC Update

TO: Local WIC Provider Administrators, WIC Coordinators and WIC Nutrition Coordinators
SUBJECT 1: Mid-Year Evaluations
SUBJECT 2: Enhancement Grants Update
SUBJECT 3: Income Changes in HANDS
SUBJECT 4: Time Frames for Processing Applicants
SUBJECT 5: USDA Revision 9 Nutrition Risk Factors - Effective April 14, 2008
SUBJECT 6: WIC 1 and 2 Revisions

1. Mid-Year Evaluations:  WIC will no longer require a mid-year evaluation of Local Agency Plan (LAP) goals as part of the LAP or contract monitoring. A Local WIC Provider (LWP) may continue to do a mid-year evaluation of their LAP goals if they wish, but it will no longer be required by the state office.  If you have questions, please contact glenn.studebaker@dhss.mo.gov or 573-751-6198.
2. Enhancement Grants Update:  All applications for enhancement grants have been reviewed by the district teams and the state agency panel.  The goals for this year's funding focused specifically on:
   • Increasing participation in WIC by pregnant women in their first trimester; and
   • Increasing the percentage of WIC participants who begin and continue to breastfeed.

   All requests for funding were reviewed with these goals in mind.
   
   Thirty-three (33) of the 71 projects received were approved for funding.  The approved projects have been sent for final Department Administrative approval.  As soon as we are notified that the projects are approved, agencies will be notified.  Projects (or parts of projects) that did not clearly focus on this year's enhancement project goals were not recommended for funding.  Agencies whose projects were not funded will be notified by letter in the next two weeks.
   
   Agencies with questions about their project or those who wish to discuss why their project was not funded, may contact their district team or Kathleen Davis at 573-526-2821.

3. Income Changes in HANDS:  Effective April 14, 2008, there will be changes made in HANDS concerning the income and missing proof of eligibility.  The income will be keyed on the H201/H202 screens and there is now a new field on those screens as well for missing proof.

   The missing proof field is answered with a Y (yes) or N (no), meaning he/she is missing one or more of the three required proofs.  By keying a Y in this field, the system will only allow one month of FIs (the month of the service date) and there is no longer a need to key the "P" food package into the food package code field.

   Once the participant returns in 30 days with their missing proof, simply go to the H202 screen and key N (no) in the missing proof field.  If the income dollar amount ($) needs to be changed, key that as well.  Then print FIs.

   There is also a question that you will see on the H202 screen.  The question is necessary for "behind the scenes" programming and keeping the data in sync.  The question asks if you will be keying a new cert (H401/H421) or recert (H402/H422) screen after you key this H202 screen.  If you will be keying one of the four screens, key a Y to answer the question.  If you will not be keying one of the four screens (such as a 30-day follow-up), key N to answer the question.

   Also, the Med Elig field has been removed from the H400 cert/recert screens.

   Please refer to the screen shots attached to view the new/changed fields.

   If you have questions, please contact the WIC Help desk at 800-554-2544 or Melissa Seaver at 573-751-6489. 
   
   
4. Time Frames for Processing Applicants:  There are requirements that each agency needs to meet to comply with USDA Regulations regarding time frames for serving new prenatals and infants as referenced in the WOM ER# 3.01600 Initial Contact Procedures and ER# 3.01700 Processing Time Frames for Serving Applicants.  The WIC Updates of December 3, 2007 also has information about initial contact requirements.

   Initial reports show that there are several applicants not being served within the time frames in the policies.  This may be due to keying errors in HANDS, participants rescheduling appointments, or clinic not having appointment openings.

   In order to assist your agency and provide technical assistance, a report has been developed and will be posted in Crystal on April 14, 2008.  The report name is "Contact Time Period Report".  Please check the table of contents in Crystal for the location.  The report will list all participants (P and I Category) with a service date in the last six (6) months for your agency.  It shows you the DCN, name, category code, Initial Contact Date, Service Date, and # of days between the two dates.  It is sorted by # of days difference (descending).

   When you view the new report and notice that you have applicants that have not been served within the required time frame, do the following:

   1. If applicant reschedules - must be documented in the chart and/or the H208 screen.
      
   2. If it is a keying error in HANDS, contact the WIC Help desk at WICHelpdesk@dhss.mo.gov, giving the DCN, correct contact and service dates.  You will not be able to change this on the H403/H423 screens beginning April 14, 2008.
   3. If it is due to your clinic not having openings, please contact your district TA staff and work with them to assure you can get all new applicants in within the required time frame.

**In order to prepare for the HANDS change, a report showing participants not served within 365+ days has been posted in the "Participant Information" folder.  The name of the report is "365+ Days Contact Period".  In looking at these records, they are most likely keying errors in HANDS.  Please review this report and make the necessary changes to the records in HANDS before April 14, 2008.  After this date, the help desk will have to make the changes for you.

If you have any questions about the time frames policies, please contact your district TA team.

If you have any questions about the Crystal Report(s) or HANDS changes, please contact the WIC help desk at 800-554-2544 or Melissa Seaver at 573-751-6489.

5. USDA Revision 9 Nutrition Risk Factors - Effective April 14, 2008
   USDA has approved a new allowable risk criterion and updated two other risk criteria:

• New risk factor #904 Exposure to Environmental Tobacco Smoke (ETS);
• Updated risk factor #371 Maternal Smoking; and
• Updated risk factor #340 Nutrition Related-Risk Conditions.
  
  Updated risk factor #340 Nutrition-Related Risk Conditions was affected as a result of changes to risk factor #348.  In Missouri, all of the USDA nutrition-related risk conditions #341 through #362 are currently incorporated into the overall risk factor #340.
  
  ER#2.04450 which included risk criterion for risk factor #300 (Z1) Pregnancy Induced Conditions and risk factor #340 (Z3) Nutrition-Related Risk Conditions was separated into two individual policies to allow easier updating of risk factors.  Please see the attachments regarding additional clarification. Print these attachments and keep them on hand as they will supersede the 2006 WOM policies until the 2008 WOM is available.
  
  Making revisions linked to Revision 9 led to minor changes in several other policies. Risk factors #371 and #904 will be automatic risk factors assigned, dependant upon responses to the questions in the computer system and on the WIC-1 and WIC-2.  Information highlighting changes to the computer system and WIC-1 and WIC-2 forms is included in the attached document.
  
  The Nutrition Coordinator is responsible for providing training to all LWP staff on Revision 9 materials during the months of March and April 2008 utilizing attached materials.  Beginning in March 2008 the State agency will incorporate Revision 9 information in the WIC Basic Orientation training for trainees.
  If you have questions regarding these risk factors or information, please contact your district nutritionist for technical assistance.
  
  Note: Please return the "Acknowledgement Sheet" indicating you have received this notification. 

6. WIC 1 and 2 Revisions:  The WIC Certification forms for Woman (WIC 1) and Infant/Child (WIC 2) have been revised due to screen changes and implementation of new risk factors.  During the week of March 17, 2008, the warehouse will begin shipping a 2-3 month supply of the forms to all local WIC providers.  The effective date to use the revised WIC 1 and WIC 2 is April 14, 2008.  Please destroy old forms (06/07 version) and order additional forms  (04/08 version) from the warehouse as needed.  If you have questions and/or suggestions, please contact Takako Tagami at Takako.Tagami@dhss.mo.gov

Attachments:
ER# 2 .05850 Maternal Smoking Risk Factor 371.doc
ER# 2.02800 Cert Recert and Infant Follow-up Components - rev. 2-28-08.doc
ER# 2.04450 Risk Factor 300.doc
ER# 2.04475 Risk Factor 340.doc
ER# 2.04550 Guidelines for Assigning Dietary Risk Factors rev 2-28-08.doc
ER# 2.05825 Exposure to Tobacco Smoke Risk Factor 904.doc
ER# 2.10300 Prenatal Weight Gain Chart.doc
ER# 2.10400 Growth Charts.doc
Income Change Screen Shots 30 day follow-up.pdf
Income Change Screen Shots New Cert.pdf
Income Change Screen Shots New Prenatal Cert but has been.pdf
Income Change Screen Shots Recert.pdf
Revision 9 Acknowledgement.doc
Revision 9 Nutrition Risk Factors training information.doc
RF Summary Sheet Infant Child_Rev 9.doc
RF Summary Sheet Women_Rev 9.doc
Risk Factor (without 2 digit number) Definitions Table for 2.02800.doc
Summary of Priorities by Risk Factors for ER# 2.02800.doc