Georgia state plan for program operation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) fiscal year 1999

GEORGIA DEPARTMENT OF HUMAN RESOURCES DIVISION OF PUBLIC HEALTH STATE WIC OFFICE
Georgia State Plan for Program Operation in the Special Supplemental Nutrition Program
for Women, Infants, and Children (WIC)
Fiscal Year 1999 (October 1, 1998 to September 30, 1999)
Submitted in accordance with USDA Food and Nutrition Service
Federal Regulations 246.4(A) - State Plan
August 1998

STATE WIC OFFICE
Director's Office
Program Director - Alwin K. Peterson Budget Officer - Sandra Copeland
Coordinator Special Projects - LuVera Robertson Public Health State Office Program Consultant - Gen Hunter
Programmer Analyst - Ronnie Currie
Vendor Management Unit
Vendor Manager (Program Consultant) - Mamie Dumas-Bailey Compliance Reviewer - Vicki Morris Compliance Reviewer - Alisha Brooks Compliance Reviewer - Lorane Brown Compliance Analyst - Sharon Johnson Operations Analyst Tech - Vacant
Operations Analyst Tech - Patricia Appling Program Assistant - Amesha Kendrick
Operations Analyst Tech - Barbara Woods
Quality Improvement Unit
Quality Improvement Manager (Program Consultant) - Nina Murray Compliance Reviewer - Sonia Jackson Compliance Analyst - Eyra Edwards
Compliance Investigator Senior - Anthony Craig Rutherford Compliance Investigator - Roy Hill Compliance Investigator -Vacant
Compliance Investigator -Vance Campbell Program Assistant - Mimi Benton
Systems Information Unit
Systems Manager (Data Management Coordinator) - Vacant Operations Analyst - James Laraby Operations Analyst - Rick Smith
Data Processing Specialist - Contessia Davis Database Coordinator - Dawn Williams Program Assistant - Barbara Spencer

STATE WIC PLAN - 1999

STATE WIC OFFICE

Information Technology Unit
Budget Analyst - Joan Gregory
Program Management and Review Unit
Unit Manager (Program Consultant) - Lynn Flen Compliance Reviewer - Vacant Compliance Reviewer - Samuel Sims Program Associate - Wilma Williams Program Assistant - Mary McDonald
Operations Management Unit
Budget Analyst - Carolyn Holloway Compliance Reviewer - Jim Campbell Compliance Analyst - Vernon Lawton Paraprofessional Accountant - Andrew Miller
Administrative Support Unit
Executive Secretary - Cindy Woods Office Assistant - Vacant
Program Assistant - Juanita Williams

STATE WIC PLAN - 1999

STATE WIC OFFICE

TABLE OF CONTENTS

WIC
Chapter 1 Chapter 2
I. II. III. Chapter 3 I. II. III. IV. V. Chapter 4

Page
Goals and Objectives............................................................................................ 1 Financial Management........................................................................................ 30 Program Financial Status.................................................................................... 31 Letter of Credit .................................................................................................. 35 Local Level Requirements .................................................................................. 44 Food Delivery/Management Information Systems............................................... 49 Retail Delivery Method ...................................................................................... 50 Vendor Management.......................................................................................... 52 Direct Delivery Method...................................................................................... 52 Management Information Systems...................................................................... 52 Food Package Design......................................................................................... 59 Process For Applying to Operate A WIC Clinic.................................................. 60

Attachments: Attachment 1 - Participant Characteristic Minimum Data Set (MDS)......................................... 65 Attachment 2 - Food Allocation Based on the Priority System................................................... 76 Attachment 3 - Certification Form Changes ............................................................................... 81

OON Office of Nutrition - Goals and Objectives. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82

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CHAPTER 1
GOALS AND
OBJECTIVES

I. INTRODUCTION
The mission of the Department of Human Resources (DHR) is to assist Georgians in achieving their highest levels of health, development, independence and selfsufficiency. The Division of Public Health emphasis is on an integrated service system that assures comprehensive health services in an environment which fosters personal dignity and promotes optimal attainment of individual ability. The WIC Program serves as a gateway to comprehensive health services for maternal and child health clients. Therefore, the goal of the Georgia WIC Branch is to provide comprehensive health and nutrition services that encourage wellness, healthy life styles and preventive health care to as many low-income women, infants and children as possible.
The implementation of programs directed toward improving access to prenatal care and family planning service enhances the Division's efforts to reduce infant mortality. The reduction of the infant mortality rate continues to be a driving force for the Division of Public Health program initiatives and services. The Georgia WIC Program contributes to the Division efforts by targeting interventions to certify pregnant women during their first trimester. This client-oriented approach to service delivery enables Local Agencies to develop and implement program interventions which are suitable to the needs of the local community. The WIC Program continues to: expand the implementation of innovative initiatives which will increase certification of prenatal participants during the first trimester of pregnancy; enhance the coordination of WIC services with district immunization programs to increase the number/percentage of two year olds who are fully immunized; decrease the number/percentage of subsequent teenage pregnancies; and streamline the application process for enrolling in WIC via the Georgia Common Access Form.
The State Plan outlines strategies for administering the WIC Program in Georgia. The plan is divided into three parts. Part one summarizes progress for FY '98 objectives and lists objectives for FY'99Part two is the narrative which methodizes program strategies for the delivery of services to WIC clients. Part three summarizes the District objectives for the Georgia WIC Program. The narrative includes program strategies for caseload management, food fund management, local agency selection and ranking needs, certification and rights of program participants, public notification and comments and data management initiatives. The third part is the Procedures Manual which provides guidance to local agencies in operating the Program. The Procedures Manual is developed in a separate document.

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Summary of FFY'98 Objectives
II. OBJECTIVES
A. SUMMARY OF FFY '98 OBJECTIVES
The Objectives Summary provides an update of the State's efforts to complete FFY '98 Program Objectives. The State WIC Office, Office of Nutrition, Local Agencies and WIC Coordinators worked collectively to implement FFY '98 objectives.
This summary presents the objective accomplishments in accordance with program function. The following Program functions are included: Programmatic Administration; Quality Improvement and Food Instrument Accountability; System Information Management, Vendor Management; Financial Management and Certification and Nutrition Services.
FOOD FUND MANAGEMENT
FOOD FUND MANAGEMENT - OBJECTIVES I, II and III
Cost Containment Initiative (Rebate on Purchases of Infant Formula reducing Food Package Cost) - Objective I
In accordance with the provisions of P.L. 100-460, the Georgia WIC Program is continuing with the cost containment initiative (begun on October 1, 1988). Effective August 1, 1998 the Georgia WIC Program entered into a three (3) year contract with Ross Products to be the primary provider of infant formula to WIC participants in this state. The purpose of this initiative is to provide WIC services to more eligible women, infants and children by reducing the cost of infant formula and applying the savings to the food budget.
In order to provide the program with the best possible rebate offer, the State Department of Administrative Services (DOAS), sent copies of the Georgia Invitation to Bid (ITB) to all major formula companies. The ITB contained all relevant information including definitions of truckload sizes, provisions for billing disputes and the review and award process that potential bidders would need to make an informed bid. The ITB was reviewed and approved by USDA prior to release.
To identify and bill for infant formula, the Georgia WIC Program issues vouchers which have been imprinted with the Contractor's brand and type of formula. Vouchers are redeemable for only the brand and type of formula shown. Each month the WIC Program's data processing contractor compiles a report identifying the number of cans of formula purchased for both contract and noncontract brands by type (Concentrate, Powder and Ready-To-Feed). A copy of this report is sent to the State WIC Office and the Office of Financial Services. The Office of Financial Services then bills the formula contractor. In addition, the data processing contractor also provides a computer tape to the formula manufacturer that allows them to check the accuracy of each invoice.

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Summary of FFY'98 Objectives
The first infant formula rebate contract with Mead Johnson Nutritionals resulted in a total savings of approximately $55,350,000. The current contract with Ross products is expected to generate between $130,000,000 to $140,000,000 over the next three years. During FFY 1997, rebates on infant formula totaled over $42,000,000.
Infants certified for WIC on Contracted Formula - Objective II
The policy directive from the State WIC Office has continued to be in effect. The compliance rate for March 1998 was 96.87%. (This drop was due to the cancellation of the Infant Formula rebate contract that was awarded in January, 1998). Since inception, this policy has resulted in a continuous rate of over 99.5%.
Rate of Accuracy of Monthly Food Obligations to Expenditures - Objective III
The goal of the Georgia WIC Program was to achieve a 98% accuracy rate in Food Cost Projections in FFY `98. To date, the accuracy of such projections has averaged 93.51%.
CASELOAD MANAGEMENT
CASELOAD MANAGEMENT - OBJECTIVES IV AND V
Targeting Benefits - Objective IV
As of this writing, 77.39% of the Georgia caseload being served is certified in Priorities I-III. From October 1997 to March 1998, the average Priority I-III participation of the Georgia WIC Program was 179,746. The overall average of participation for the same period was 231,822.
For closeout month March 1998, Priority I-III participation was 181, 386 out of a total program participation of 234,391. Priorities I-III represented 77.39% of the total WIC participation for March 1998.
Early Trimester Enrollment - Objective V
The most recent figures for FFY 98 showed that 54.94% of prenatal women were certified for the Georgia WIC program during the first trimester of pregnancy.

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Summary of FFY'98 Objectives QUALITY IMPROVEMENT
QUALITY IMPROVEMENT - OBJECTIVES VI, VII and VIII
Vendor Investigation - Objective VI
The State WIC Office continues to concentrate on high risk vendors identified for investigation. Some non high risk randomly selected vendors are included in the investigation process. Nonfraudulent violations continue to acquire a warning, with an opportunity for correction before probation or disqualification is imposed.
Surveillance visits were conducted on all vendors prior to an official vendor investigation being performed. Violations occurred in approximately 90% of vendors visited for compliance investigation. Investigations are on going. Five vendor fair hearings have been held and they all concluded favorably for the State.
Quality Improvement Guidelines - Objective VII
A continued effort is being made to contact other State Agencies to evaluate their quality improvement strategies. Quarterly conference calls with other members of the southeast region, serve as a tool for input from other states. A regional strategic meeting has been scheduled for July 28, 1998. The focus of this regional meeting is to discuss investigation strategies.
Clinic changes to improve the security of WIC voucher issuance have been established. Additional changes in certain areas are still being evaluated.
Statewide training and technical assistance regarding Quality Improvement guidelines are available for local agencies as needed.
Clinic Missing Voucher Investigation - Objective VIII
An investigation is currently in progress for missing vouchers. However, only a few of these missing vouchers were paid. During FFY'98 the state had a decrease in the number of missing voucher reports.

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Summary of FFY'98 Objectives PROGRAMMATIC ADMINISTRATION
PROGRAM ADMINISTRATION - OBJECTIVES IX, X, XI, XII, XIII, XIV, XV, XVI, XVII and XVIII
Revised Income Guidelines - Objective IX
On April 15, 1998, the revised WIC Income Guidelines were implemented by all local agencies within the State as well as the Medicaid Program.
Local Agency Reviews - Objective X
By September 1998, fourteen (14) Program Reviews will be performed. As of this writing July 1998, thirteen (13) reviews have been performed and six (6) have been closed. SWO staff met on April 30, 1998 to schedule the FFY 99 Program Review dates.
Clerical training was provided by the State WIC office to meet training needs and technical assistance requests. Training sessions were held in the following districts: Macon, Columbus, Rome, DeKalb, LaGrange, Savannah and Clayton.
1999 State Plan and Procedures Manual - Objective XI
As of this writing, the State WIC Office and the Office of Nutrition have updated the State Plan and Procedures Manual based on policy memos, public comments, local agency comments and public hearing comments.
Program benefits to unserved infants and children under foster care, parents, protective services, or child welfare authorities - Objective XII
The State agency will continue to work with the Division of Family and Children Services and Local Agencies.
Improve Access to WIC Program and Health Care Services for Migrants - Objective XIII
The DHR Office of Rural Health expects to hire a migrant coordinator before the end of Federal Fiscal Year 1998. This position would benefit the Georgia Migrant population by coordinating and making available services, including WIC, to all migrants.

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Summary of FFY'98 Objectives Coordination of WIC Services with the Immunization Program - Objective XIV

All local agencies have implemented district specific strategies to coordinate WIC and immunization services. For calendar year 1997, the state immunization rate for WIC participants was 93.33%. This was an increase from the 91.9% rate during calendar year 1996.

Disseminate Referral Information of Food Assistance Programs for WIC Applicant/Participants when caseload is at Full Capacity - Objective XV

Legislation mandated that this booklet was no longer a requirement, thereby allowing the Georgia WIC program to reduce operating costs.

Expansion of WIC Services Sites - Objective XVI

State WIC Office staff met with HMO administrators and private physicians to promote to them, the benefit of having a WIC Program as a preventive health measure, without additional administrative costs.

SYSTEMS INFORMATION MANAGEMENT

SYSTEMS INFORMATION MANAGEMENT - OBJECTIVE XVIIA&B

Voucher Printing on Demand- Objective XVIIA

The Georgia WIC Program continues to diligently search for innovative practices and methods to operate an efficient and cost-effective program. In the age of high technology, printing all vouchers on demand is the most cost-effective manner to get vouchers in the hands of eligible participants. Currently, WIC vouchers are preprinted and shipped to the local agencies. Of these vouchers, 24.1% are voided for non-pick up, food package changes or proration. Additionally, approximately 23.2% of vouchers issued are manually printed using outdated dot matrix printers. An overhauling of the current voucher issuance system to Voucher Printing on Demand proposes cost-savings in the areas of voided vouchers and shipping costs. In addition, there would be considerable timesavings for both staff and participants.
In Voucher Printing on Demand, WIC clerks will be equipped with a laser printer for printing WIC vouchers on site. The laser printer will have the capability to print the voucher on blank paper stock. This will require the printer to be equipped with a cartridge that will use magnetic ink required to print the Magnetic Ink Recognition (MICR) line at the bottom of a check, which then allows it to travel through the banking system to its correct destination. The WIC/HOST software module will track the serial numbers, assign them to the participants and print them on the vouchers. This method will alleviate the aggravating problem caused from loading preprinted vouchers in the printer, then voiding them when the numbers get out of sequence. Additionally, there will be less of a security risk, because the voucher will be totally blank until it is actually issued to a participant.

System Information Management - Objective XVIIB

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Summary of FFY'98 Objectives
WIC/HOST
During the past year, the State WIC Office began implementing the WIC module of the Health Outcomes Services and Tracking System (HOST). This is an integrated system designed around a clinic/service orientation, with emphasis placed on the integration of multiple health-related activities and services. Features of the HOST system include data collection and maintenance, client tracking, service coordination, scheduling and reporting. One of the major goals of the system is to provide a single point of data capture and access for all client-related information. The WIC Module of HOST is described in detail in the Initial Advanced Planning Document (IAPD) which was approved by USDA in March of 1997. The updates to the WIC module of HOST are detailed in the Advanced Planning Document Update (APDU) submitted to USDA in March of 1998. A general description of the system and its changes are described in the Executive Summary of both APDs. The functional requirements met by WIC/HOST are outlined in the Functional Requirements section of both APDs.
ATVS
ATVS is scheduled to be completely phased out this year with the completion of the implementation of the WIC module of HOST in all 10 proposed sites. As a result, no new changes have been made to the ATVS system this year.
ARMIS
A new networked version of ARMIS is now available for distribution to our Districts. Also, a host of other enhancements have been added to ARMIS this year. Some of the major changes are outlined below:
1. Average Food Package Cost (FPC) Calculation 2. Network Enhancement 3. Restructured Report Printing 4. Modification of the Master File to include the following elements:
- Client Addresses - Zip Codes - Telephone Numbers - County Codes, etc.

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Summary of FFY'98 Objectives 5. SMI History Heading Name 6. Participation Trends Report 7. SMI Clinic/District/Unit Display 8 QI Printing. 9. Review & Modify the QI System (Closeout)
VAMP
The old Vendor Activity Monitoring and Profile (VAMP) system has been redeveloped and is now called the Vendor Integrity Profile System (VIPS). Specific details about this new system are covered in the Vendor Management Section.
VAS
The new version of the Voucher Analysis System (VAS) is still in use by the State WIC Office. This program, which was developed in Visual Basic, is used to assist the Vendor Section in comparing food packages and voucher code prices with state vendor averages and peer groups. VAS additionally provides peer group analysis, voucher code and voucher maximum price references for food packages.
GA IRS
All WIC vouchers, processed by the bank, are now being imaged onto CD-ROM. In 1997, a new system called the Georgia Image Retrieval System (GA IRS) was implemented. This system allows staff members to retrieve and print electronic images of all vouchers on CD-ROM. This system will eventually be expanded to include reports, voided vouchers and other documents.
Georgia WIC Management Information System and the Statewide Automated Food Delivery System - Objective XVIII
The Georgia WIC Program continues to operate the Georgia WIC Management Information System and Statewide Automated Food Delivery System under the terms and conditions of the new Request For Proposal (RFP) that took effect on January 1, 1997.
VENDOR MANAGEMENT
VENDOR MANAGEMENT - OBJECTIVE XIX

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Summary of FFY'98 Objectives Retail Grocer Advisory Councils - Objective XIXA
The purpose for the Retail Grocery Advisory Councils and Advisory Board is to provide a forum for WIC vendors to discuss WIC vendor management issues and policies that adversely affect this population. With the assistance of Kathy Kuzava of the Georgia Food Industry Association (GFIA), Jim Tutor (President, Georgia Association of Convenience Stores), Sean Choi (Community Relations Manager Association, Korean-American Grocer Association) and Bill McBrayer (President, Georgia Retail Association) the councils were formed. Each council included two (2) vendor/retailer representatives per peer group, per region. However, Jim Tutor, Sean Choi and Bill McBrayer deferred this task to Kathy Kuzava. In addition, the State WIC Office solicited vendor participation in these council sessions via the January issue of the WIC Vendor Newsletter.
Questions centered around issues concerning the vendor training process and vendor requirements, training tools for vendors and participants, the need for a revised vehicle of communication and minimum inventory requirements. Retail issues and concerns are important and we collaborate as partners in resolving and negotiating for positive solutions within the WIC Program's Federal and State guidelines.
WIC Retail Advisory Board:
The Advisory Board is made up of vendors/retailers throughout the state and is representative of the eight regional councils. Representatives from the State Agency included Mamie Dumas-Bailey, Sharon Johnson, Nina Murray (State WIC Office Staff) and Division of Public Health Administrators. The United States Department of Agriculture (USDA) Administrators were also invited to participate on this Board.
The Councils and Advisory Board meetings were combined due to a poor response for participation during the regional council sessions. The combined meeting was held on March 25, 1998.
Monitoring Retailer Performance/Sanction Point System:
The WIC Program agreed to pursue the implementation of a biennial vendor agreement period for Federal Fiscal Year 1999.
Vendor Activity Monitoring Profile (VAMP) - Objective XIXB
The State Vendor Activity Monitoring Profile (VAMP) database system will be adapted to a smaller system for district level use.

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Summary of FFY'98 Objectives
PROGRAM INTERVENTION
PROGRAM INTERVENTION -OBJECTIVE XX AND XXI
Develop a Plan for Electronic Benefit Transfer (EBT) System - Objective XX
The Georgia WIC Program has agreed to placement in Tier 2 of the Southeast Alliance of States (SAS) EBT Project. It is not anticipated that Georgia WIC will become actively involved in the EBT Project until the year 2000.
Improve Access to WIC Program for Participants and Prospective Applicants who are Employed or Reside in Rural Areas - Objective XXI
In addressing this objective, a survey was issued to attendees of Public Hearings in the State. Local Agencies received these responses and submitted district specific goals and objectives addressing this objective.
B. FEDERAL FISCAL YEAR 99 OBJECTIVES
FOOD FUNDS MANAGEMENT
OBJECTIVE I:
Effective August 1, 1998, the Georgia WIC Program will begin a new three (3) year Infant Formula Contract period with Ross Products.
EVALUATION DESIGN:
On August 1, 1998 a new infant formula contract will become effective. The contract was awarded to the vendor presenting the lowest net composite cost per can for iron-fortified 13 ounce concentrate; 12, 14, 14.1, or 16 ounce powder and 32 ounce Ready to feed formula based on the manufacturer's lowest or best truckload wholesale price.

Action Steps Activities/Methods
1. Survey the districts for information regarding Free Trade Orders for Milk and Soy-based products

Resources
System Information Unit, District WIC Program Staff, Local WIC Program Staff

Milestones
Quarterly

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Summary of FFY'99 Objectives

Action Steps Activities/Methods

Resources

2. New vouchers with new food packages ADP Contractor for districts on bi-monthly issuance printed and mailed to districts

3. Begin the full operation of new Infant System Information Unit, ADP

Formula Contract

Contractor, Office of Nutrition, Local

WIC Program Staff

Milestones 6/98
8/1/98

FOOD FUNDS MANAGEMENT
OBJECTIVE II:
By October 1, 1998, Districts will issue milk based contract formula to 100% of the infants certified for WIC, unless, the infant has been prescribed a specific, non milk-based formula due to a diagnosed medical condition.
EVALUATION DESIGN:
Assess percentage of WIC infants receiving contract, iron fortified formula.

Action Steps Activities/Methods

Resources

Milestones

1. Continue statewide policy concerning utilization of sole source milk based infant formula for all well WIC infants.

SWO

On-Going

2. Monitor Concentrate Rebate Compliance Report.

SWO, SMI, OON

Monthly

3. Review Trend Analysis of Compliance Report as needed.

SMI, OON

As Needed

4. Educate parents and health care providers OON, SWO, SIU, Georgia

on policy.

Chapter American

Academy of Pediatrics

On-Going

OBJECTIVE III:
By September 30, 1999, the Statewide accuracy of monthly food obligations to expenditures will be maintained at 98% or greater.

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Summary of FFY'99 Objectives EVALUATION DESIGN:
The accuracy will be assessed monthly by comparing projected food costs for each month with the final expenditures for the month (closeout).

Action Steps Activities/Methods

Resources

1. Calculate, review and submit monthly food SWO, SIU, Financial

obligations to DHR for submission to

Management Unit

USDA Regional Office.

2. Maintain monthly table, which summarizes Financial Management Unit percentage of accuracy.

Milestones On-Going
Monthly

CASELOAD MANAGEMENT
OBJECTIVE IV:
By September 30, 1999 at least 83% of WIC participants served will be Priorities I, II and III, resulting in the targeting of benefits to the highest risk participants.
EVALUATION DESIGN:
The Systems Information Unit Report which includes priority information will be reviewed monthly and the percentage of total participation classified as Priorities I-III will be assessed.

Action Steps Activities/Methods

Resources

1. Assess which Local Agencies are below the

Systems Information Unit

statewide percentage of high-risk clients served. (SWO)

2. Monitor and provide technical support to those Local Agencies, which have not maintained the established standards/caseload.

Systems Information Unit, Program Management Review Unit (SWO)

3. Assist Local Agencies in developing strategies to Program Management and

target high-risk clients.

Review Unit

4. Assist Local Agencies in developing strategies to Program Management and

maintain participation for high-risk clients.

Review Unit

Milestones 1/31/99 On-Going
On-Going On-Going

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Summary of FFY'99 Objectives
CASELOAD MANAGEMENT
OBJECTIVE V:
By September 30, 1999, increase the percentage of prenatal WIC participants certified in the first trimester from 54.94% to 60%.
EVALUATION DESIGN:
The quarterly Trimester of Enrollment Report, will be reviewed and the percentage of total prenatal WIC participants certified in the first trimester will be assessed.

Activities, Steps, Activities/Methods

Resources

1. Assist Local Agencies in developing strategies to increase early enrollment in prenatal care and WIC.

Program Management and Review Unit (PM&R), SWO, OON

2. Provide technical assistance to local agencies who have difficulty enrolling prenatal women early in pregnancy.

Same as #2

3. Develop public employer and physician awareness campaign concerning WIC Program and use of the referral form.

SWO, OON Department of Medical Assistance, District Coordinators, Department of Labor, DHR

4. Continue to explore the expansion of WIC

SWO, OON, DMA, Georgia

Services to community health centers, health

Primary Care Association,

maintenance organizations, private obstetricians Medical Association of

migrant and rural health centers.

Georgia, Georgia Academy

of Pediatrics, Migrant and

Rural Health Association,

HMO Affiliates.

Milestones
On-going On-Going On-Going
On-Going

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Summary of FFY'99 Objectives
QUALITY IMPROVEMENT
OBJECTIVE VI:
By September 30, 1999 complete compliance investigations on targeted WIC vendors.
EVALUATION DESIGN:
Comparison of High Risk Vendors designated for investigations and reports of completed investigations will be reviewed and evaluated.

Actions Steps Activities/Methods 1. Identify High Risk Vendors to be targeted for
compliance investigations.
2. Begin compliance investigations. 3. Complete targeted WIC Vendor compliance
investigations.

Resources
SWO, Vendor and Quality Improvement staff
Same as #1
Same as #1

Milestones On-Going
As identified When Possible

OBJECTIVE VII:
Continue to enhance Quality Improvement guidelines and procedures in addressing potential program abuse.
EVALUATION DESIGN:
By September 30, 1999, the Quality Improvement Plan will be updated, based on obtaining new information which would enhance current regulations.

Action Steps Activities/Methods
1. Continue to research other State agencies to evaluate quality improvement strategies.
2. Forward updates to Coordinators for comments. Results to be presented at the Coordinator's meeting.

Resources
SWO, Quality Improvement Unit
Same as #1

Milestones On-Going
On-Going

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Summary of FFY'99 Objectives

3. Provide technical assistance and training

Quality Improvement

regarding implementation of updated plan to Unit, Program

local agencies, as needed.

Management and Review

Unit

On-Going

QUALITY IMPROVEMENT
OBJECTIVE VIII: Upon receipt of notification of vouchers being stolen from a WIC clinic, start implementing investigation procedures. EVALUATION DESIGN: Compile data from the results of investigation periodically.

Action Steps Activities/Method 1. Confer with local agency to verify incident. 2. Contact contract bank to obtain vouchers.
3. Contact Georgia Office of Fraud and Abuse.
4. Conduct on-site visit to clinic.
5. Notify USDA of stolen vouchers

Resources

Milestones

Local Agency

within three 3 days

Bank

Immediately upon receiving notice of missing vouchers

Georgia DHR Office of Fraud and Abuse

As Needed

Local Agency, District As Needed Office/SWO

USDA/FCS

Within one (1) day of SWO being notified.

PROGRAMMATIC ADMINISTRATION
OBJECTIVE IX:
By April 1, 1999, implement revised WIC eligibility guidelines simultaneously with the implementation of State income eligibility guidelines for the Medicaid program.

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Summary of FFY'99 Objectives EVALUATION DESIGN:
The WIC Program will notify Local Agencies of income guideline changes and implement revised guidelines as policy by April 1, 1999.

Action Steps Activities/Methods

Resources

1. Receive official USDA notification of new income Program Management and

poverty guidelines.

Review Unit

2. Send memorandum to Districts notifying them of Program Management and the revised WIC income poverty guidelines based Review Unit (SWO) on the revised guidelines issued by DHHS.

3. Send memorandum to Department of Medicaid Assistance (DMA) informing the agency of the revised WIC income poverty guidelines.

Same as #1

Milestones 3/15/99 4/1/99
4/1/99

PROGRAMMATIC ADMINISTRATION
OBJECTIVE X:
By September 30, 1999, twelve (12) Local Agencies will have been reviewed to ensure their programmatic compliance with Federal Regulations and State Policies and Procedures. The remaining Local Agencies will be offered training and technical assistance by State Agency staff.
EVALUATION DESIGN:
Twelve (12) Local Agency programmatic and financial reviews will be conducted by Sept. 30, 1999.

Action Steps Activities/Methods

Resources

1. Local Agency review schedule for FFY'99 finalized. SWO, OON, Local Agencies

2. Prepare Local Agency reviews/technical assistance SWO, OON reports and submit to Local Agency.

3. Analyze and summarize FFY `99 Local Agency reviews/technical assistance sessions, flow sheets and submit to Program Directors.

SWO, OON

4. Close all FFY `99 Local Agency reviews.

SWO, OON

Milestones 5/98
On-going 9/99
10/01/99

OBJECTIVES XI:

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Summary of FFY'99 Objectives By August 15, 1998, the Federal Fiscal Year 1999 State Plan and Procedures Manual will be revised as needed and submitted to the USDA Regional WIC Office.
EVALUATION DESIGN:
The Federal Fiscal Year 1999 State Plan and Procedures Manual will be submitted on time.

Action Steps Activities/Methods

Resources

1. Receive final USDA approval of FFY 99 State Plan and Procedures Manual.

USDA, SWO, OON

2. Print and distribute the Procedures Manual and State Plan to Local Agencies, Clinics and others as requested.

DOAS, SWO

3. Develop and distribute Procedures Manual revisions throughout FFY `99 as necessary.

Program Management and Review Unit (SWO), Nutrition Consultant (OON)

4. Mail public hearing materials to Local Agencies. Program Management and Review Unit (SWO)

5. Mail public comment letters to solicit comments Program Management and and notify participants and advocacy groups of Review Unit (SWO) statewide regional public hearings.

6. Conduct statewide regional public hearings.

Local Agencies, SWO

7. SWO units to submit State Plan revisions to the Program Management and Review Unit.

SWO

8. Compile and analyze public comments to be included in the FFY 2000 State Plan as appropriate.

Program Management and Review Unit (SWO)

9. OON to submit revisions to the FFY 2000 State Plan.

OON

Milestones 09/15/98 10/15/98
On-going
2/99 3/99
4/99 6/99 6/99
8/1/99

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Summary of FFY'99 Objectives
PROGRAMMATIC ADMINISTRATION

OBJECTIVE XII:

Continue to ensure that program benefits are provided to unserved infants and children under the care of foster parents, protective services, or child welfare authorities, including infants exposed to drugs perinatally.

EVALUATION DESIGN:

Coordinate WIC services with the Department of Family and Children Services (DFACS) and distribute WIC literature.

Action Steps Activities/Methods

Resources

Milestones

1. Continue to provide DFACS agencies and personnel Program Management

with WIC Program information.

and Review Unit (SWO)

On-Going

2. Continue to instruct WIC local agencies to document origin of DFACS referral in "Special Use" field on turnaround document.

Systems Information Unit, (SWO), Local Agencies, Viking, Inc.

On-Going

3. Monitor monthly Viking report of number of DFACS infants and children receiving WIC Program benefits.

Systems Information Unit (SWO)

On-Going

PROGRAMMATIC ADMINISTRATION
OBJECTIVE XIII: Continue to provide access to WIC Program and health related services for migrants.
Note: Evaluation Design on the next page.

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Summary of FFY'99 Objectives
EVALUATION DESIGN:
Program enrollment information will be reviewed and evaluated quarterly to assess migrant participation in relation to the migrant population in selected service areas.

Action Steps Activities/Methods
1. Monitor migrant encounters and provide technical assistance to local agencies as needed to maintain and/or increase enrollment.
2. Review current strategies for accommodating and enrolling migrants in the WIC Program and assist local agencies having difficulties developing need appropriate strategies.
3. Assess procedures local agencies use to refer migrants to other health related resources and provide technical assistance for developing referral strategies and tracking procedures as needed.

Resources
System Information Unit, Program Management and Review Unit
SWO, Migrant Health Program
SWO, OON, Migrant Health Program, Local Agencies

Milestones On-Going
On-Going
On-Going

OBJECTIVE XIV:
Encourage local agencies to continue district specific strategies to enhance the coordination of WIC services with the district immunization programs.
EVALUATION DESIGN:
Local agencies will continue the district specific model for coordinating WIC with Immunization Services.

Action Steps Activities/Methods 1. Provide technical assistance to local agencies.

Resources
State Immunization Program & Program Management and Review Unit

Milestones On-Going

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Summary of FFY'99 Objectives

2. Collaborate with State Immunization Program and retrieve data on impact of Program collaboration.

State Immunization Program, Systems Information Unit, Policy Management and Review Unit

Quarterly

PROGRAMMATIC ADMINISTRATION
OBJECTIVE XVI:
The Georgia WIC Program will continue to encourage linkages with local community health centers (CHC) and health maintenance organizations (HMOs) for the expansion of WIC service to these facilities. Guidelines for establishing this joint venture will be completed and ready for implementation.
EVALUATION DESIGN:
The development of procedures and guidelines for establishing and/or expanding WIC service sites.

Action Steps Activities/Methods 1. Draft program strategies and procedural
guidelines.
2. Expand Pre-Application information and develop local agency selection criteria, application form and other related documents.
3. Finalize procedural guidelines.

Resources
SWO, OON Local WIC Agencies, Local/State Hospital Representatives, State HMOs, CHCs
SWO, WIC Coordinators, District Staff
SWO, WIC Coordinators

Milestones Ongoing
On-going 9/30/98

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Summary of FFY'99 Objectives
SYSTEMS INFORMATION MANAGEMENT
OBJECTIVE XVIIA: Implement the printing of all vouchers on demand to assure the most cost-effective method of delivering vouchers to participants.
EVALUATION DESIGN: By December 1999, all 21 Districts will be printing all vouchers on demand.

Action Steps Activities/Methods 1. Preliminary Evaluation and Report:
2. Phase 1 Implementation:
- Buford - Southside - Heard County - East DeKalb 3. Phase 2 Implementation:
- Gilmer County - Forest Park - Thomas County - Kirkwood 4. Pilot Evaluation and Report:
5. First Quarter Phase 3 Implementation:
- Gwinnett and LaGrange - DeKalb and Dalton
6. Second Quarter Phase 3 Implementations:
- Clayton and Albany - Athens and Dublin - Grade and Waycross

Resources
System Information Unit, Independent Evaluator
Systems Information Unit, EDP Coordinators

Milestones May 1998
June 1998

Systems Information Unit, EDP Coordinators

July 1998

Systems Information Unit, Independent Evaluator
Systems Information Unit, EDP
Coordinators

August 1998 Sept. 1998
Oct. 1998 Nov. 1998

Systems Information Unit, EDP Coordinators

Jan. 1999March 1999

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Summary of FFY'99 Objectives

7. Third Quarter Phase 3 Implementations:
- Rome and Brunswick - Gainesville and Columbus - Cobb and Valdosta
8. Fourth Quarter Phase 3 Implementations:
- Augusta and Savannah - Macon - Fulton
9. Final Evaluation and Report:

Systems Information Unit, EDP
Coordinators

April 1999 June 1999

System Information Unit, EDP Coordinators

July 1999 Sept. 1999

System Information Unit, Independent Evaluator

Oct. 1999 Dec. 1999

SYSTEMS INFORMATION MANAGEMENT OBJECTIVE XVIIB

Continue to implement a fully integrated Health Department environment by replacing the WIC Automated TAD and Voucher System (ATVS) with the Health Outcomes Services and Tracking System (HOST).

EVALUATION DESIGN:

By December, 1998, the remaining four (4) districts currently using ATVS will be converted to the HOST system.

The staff members from the Georgia WIC Program, along with staff members from DHR's Information Technology (IT) Unit will perform the installations, conversions and trainings
in all four (4) remaining districts. Specific steps and schedules involved in this process are outlined below:

Action Steps Activities/Methods 1. Records Maintenance

Resources

Milestones

MACON

MIS Host Staff, Macon 4/10/98 - 5-1-98 District Staff

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Summary of FFY'99 Objectives
2. Training of District Staff

Systems Information Unit, MIS HOST Staff, Macon District Staff

Session I 5/6/98 - 5/8/98
Session II 6/15/98 - 6/18/98

3. HOST Installations in the Macon District

Systems Information Unit, MIS HOST Staff, Macon District Staff, ADP Contractor

5/11/98 - 6/30/98

4. HOST Data Conversion

Systems Information Unit, MIS HOST Staff, Macon District Staff

5/11/98-6/30/98

5. On-site Support in the Macon District

Systems Information Unit, MIS HOST Staff, Macon District Staff

5/11/98-6/30/98

6. Full Operation of HOST in the Macon District

Macon District & Clinical Staff

6/30/98

7. On-going HOST Support

Systems Information Unit, MIS HOST Staff, Macon District Staff

6/30/98 - Until

GRADY

1. Records Maintenance 2. Training of District Staff 3. HOST Installations at Grade
4. HOST Data Conversion 5. On-site Support at Grade

MIS Host Staff, Grade Staff
Systems Information Unit, MIS HOST Staff, Grade Staff
Systems Information Unit, MIS HOST Staff, Grade District Staff, ADP Contractor
Systems Information Unit, MIS HOST Staff, Grade Staff
Systems Information Unit, MIS HOST Staff, Grade District Staff

6/22/98-7/1/98 7/6/98-7/8/98 7/9/98-7/22/98
7/9/98-7/22/98 7/9/98-7/22/98

6. Full Operation of HOST at Grade 7. On-going HOST Support

Grade Clinical Staff Systems Information

7/22/98 7/22/98 - Until

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Summary of FFY'99 Objectives
1. Records Maintenance . Training of District Staff

Unit, MIS HOST Staff, Grade Staff
FULTON
MIS Host Staff, Fulton District Staff
Systems Information Unit, MIS HOST Staff, Fulton District Staff

3. HOST Installations at Fulton District

Systems Information Unit, MIS HOST Staff, Fulton District Staff, ADP Contractor

4. HOST Data Conversion

Systems Information Unit, MIS HOST Staff, Fulton District Staff

5. On-site Support at Fulton District

Systems Information Unit, MIS HOST Staff, Fulton District Staff

6. Full Operation of HOST at Fulton District

Fulton District Staff

7. On-going HOST Support

Systems Information Units, MIS HOST Staff, Fulton District Staff

VALDOSTA

1. Records Maintenance

MIS Host Staff, Valdosta District Staff

2. Training of District Staff

Systems Information Unit, MIS HOST Staff, Valdosta District Staff

7/6/98-7/31/98 8/3/98-8/7/98 Session II 8/10/98 - 8/14/98 8/10/98-9/18/98
8/10/98-9/18/98 8/10/98-9/18/98
9/18/98 9/18/98 - Until
9/10/98-9/30/98
10/5/98-10/7/98

3. HOST Installations at the Valdosta District

Systems Information Unit, MIS HOST Staff, Valdosta District Staff, ADP

10/8/9810/26/98

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Summary of FFY'99 Objectives

Contractor

4. HOST Data Conversion

Systems Information Unit, MIS HOST Staff, Valdosta District Staff

5. On-site Support in the Valdosta District

Systems Information Unit, MIS HOST Staff, Valdosta District Staff

6. Full Operation of HOST in the Valdosta District Valdosta District & Clinical Staff

7. On-going HOST Support

Systems Information Units, MIS HOST Staff, Valdosta District Staff

10/8/9810/26/98
10/8/9810/26/98
10/26/98 10/26/98 - Until

VENDOR MANAGEMENT
OBJECTIVE XVIIIA: Continue to collaborate with eight (8) Retail Regional Councils and the Advisory Board for the purpose of enhancing vendor management policies and procedures.
EVALUATION DESIGN: All new policies and procedures will be incorporated into FFY `99 Vendor materials and State Plan.

Action Steps Activities/Methods
1. Reconvene Retailers Advisory Board to discuss WIC Management policies that govern WIC Vendor issues.

Resources
SWO Rep. Retail Assoc. Rep. Wholesalers Chain Store Corp. Office Rep.

2. Give suggestions and recommendations to

SWO, DPH, FH

SWO, DPH Director and Family Health Branch Branch

Director.

Administrators

Milestones 8/98 & 11/98
Ongoing

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Summary of FFY'99 Objectives
VENDOR MANAGEMENT
OBJECTIVE XVIIIB:
Adapt the State Vendor Activity Monitoring Profile (VAMP) database system to a smaller system for district level use. The State Vendor Activity Monitoring Profile (VAMP) database system has been renamed Vendor Integrity Profile System (VIPS).
EVALUATION DESIGN:

Action Steps Activities/Methods 1. Stakeholders brainstorming session to
discuss database design and district needs.
2. Stakeholders discussion session to evaluate hardware and software needs.
3. District VIPS development stage 4. Demonstration of District VIPS system
design and discussion of final modifications prior to roll out.
5. Beta testing of District VAMP system prior to roll out.

Resources

Milestones

Vendor Unit, Quality Improvement Unit, System Information Unit, WIC Program Coordinators, WIC Center Coordinators, ADP Contractor

November 1998

Vendor Unit, System Information Unit, WIC Program Coordinators, WIC Vendor Coordinators, ADP Contractor

January 1999

System Information Unit and ADP Contractor

February 1999

Vendor Unit, Quality Improvement Unit, System Information Unit, WIC Program Coordinators, WIC Vendor Coordinators, ADP Contractor

March 1999

Vendor Unit, Quality Improvement Unit, System Information Unit, WIC Program Coordinators, WIC Vendor Coordinators, ADP Contractor

March-April 1999

6. Manual Development and Automated Help Vendor Unit, Quality

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May 1999
STATE WIC OFFICE

Summary of FFY'99 Objectives Action Steps Activities/Methods Option Development
7. District wide VIPS Training and Installation
8. District VIPS System Evaluation Discussion Session

Resources
Improvement Unit, System Information Unit, WIC Program Coordinators, WIC Vendor Coordinators, ADP Contractor

Milestones

Vendor Unit, Quality Improvement Unit, System Information Unit, WIC Program Coordinators, WIC Vendor Coordinators, ADP Contractor

June-August 1999

Vendor Unit, Quality Improvement Unit, System Information Unit, WIC Program Coordinators, WIC Vendor Coordinators, ADP Contractors

October 1999

PROGRAM INTERVENTION

OBJECTIVE XIX:

To remain abreast of changes and new developments in EBT and its possible effects on the Georgia WIC Program.

EVALUATION DESIGN:

A progress summary of researched information including possible strategies for implementing an EBT System for the Georgia WIC Program.

Action Steps Activities/Methods

Resources

Milestone

1. Continue participation in EBT-WIC Task Force with FNS and DHR Food Stamps EBT Task Force .

SWO, EBT Task On-going Force, FNS, DFACS

2. Attend national/regional/state conferences.

SWO, EBT, EBT Task Force

On-going

3. Track the implementation of Food Stamps EBT. SWO

On-going

PROGRAM INTERVENTION

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Summary of FFY'99 Objectives
OBJECTIVE XX:
Continue to improve access to the WIC Program for participants and prospective applicants who are employed or reside in rural areas.
EVALUATION DESIGN:
By January 1, 1999, Local Agencies will assess and develop for implementation, plans for modifying clinic schedules to accommodate employed applicants/participants and those participants/applicants residing in rural areas.

Action Steps Activities/Methods

Resources

1. Districts to assess clinic hours of local agencies to identify clinics with increased need for flexible or extended hours to accommodate participants/applicants with special needs.

Local Agencies

2. Local agencies to identify/estimate the percentage of working participants in respective areas.

Local Agencies

3. Local agencies to review identified needs. Evaluate present system of scheduling appointments and develop a plan to accommodate participants/ prospective applicants who work or reside in rural areas.

Local Agencies

4. Local agencies to implement plans to improve WIC Program access to employed and rural participants.

Local Agencies

Milestones 11/30/98
12/15/98 11/1/98
1/1/99

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CHAPTER 2
FINANCIAL MANAGEMENT
I. Program Financial Status II. Letter of Credit
III. Local Level Requirements

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SECTION I - PROGRAM FINANCIAL STATUS
A. Financial Management System
Summary The financial management system of each local agency, in keeping with State agency requirements, is charged with overseeing and operating the WIC Program budgets and expenditures according to Food and Nutrition Services (FNS) guidelines and instructions.
Funded by allocations from the state agency, the local agencies are required to submit administrative budgets for WIC administrative expenditures, client service expenditures, nutrition education expenditures and breastfeeding expenditures to the state agency. The budgets used are classified by line item as follows: 1. Direct Salaries (including salaries, hourly labor, FICA, retirement and health insurance); equipment (equipment costing $1,000 or more, lease purchases, rental of equipment and equipment costing less than $1,000). 2. Other operating expenses (including supplies and materials, repairs and maintenance, utilities, printing, rents other than real estate, insurance and bonding, other operating expenses, computer software, travel, building rent, per diem fees, contracts, telecommunications and postage). 3. Intra-inter agency transactions.
The local agencies must submit original budgets and revisions for approval before monies can be expended. The state Grant-in-Aid system will not allow reimbursement of expenses incurred without prior approval.
The local agencies submit a Monthly Income and Expenditure Report to the Public Health Grant-in-Aid office and the State WIC Office. These reports are monitored by the state agency staff and comparisons made to approved budgetary amounts. During program reviews, expenditures and supporting documentation are checked to ensure program compliance.
B. Time Reporting
Random Moment Sample Study (RMSS)
The Division of Public Health has 2 RMSS, each serving a different purpose:
One is the State-level Administrative RMSS, which is used to allocate indirect administrative costs of the division to its programs. Costs included in this pool are personnel costs and related support costs for the divisional administrative offices and for each of the nineteen district offices. The WIC Program, as a part of the Division of Public Health, shares in the distribution of costs from this cost pool.

In addition to the divisional indirect administrative costs discussed above, departmental

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indirect administrative costs and statewide central service costs are distributed to the division's programs via the results of the State-level Administrative RMSS. Costs included in this pool include the departments' administrative offices such as the Commissioner's Office, Personnel Budgeting, Financial Services, etc. and the indirect costs of the various state agencies that provide services to the Department of Human Resources, such as our Department of Administrative Services, the Georgia Building Authority, the Department of Archives and Records, etc.
The second RMSS is the County Public Health RMSS. These costs are used to distribute all county health department costs for which the department has agreed to reimburse. The costs of all county personnel and related support costs are included in this cost pool. All costs incurred to operate and implement the programs offered by the county health departments are included in this cost pool.
The mechanics are the same for both of the RMSS. They are designed to replace the use of time sheets and in that function, their results are used exactly as the results of time sheets. The theory is that when there is a pool of costs that are attributed to more than one program, a fair method of allocation is to distribute these costs in the same proportion that the workers, whose wages/salaries and benefits help comprise the cost pool, spend their time. In order to measure how workers spend their time, time sheets were formerly employed. However, they were cumbersome, burdensome and easily manipulated.
The RMSS was designed to measure employees' time in a more scientific and accurate way. By taking a randomly selected sample, (a sample of randomly selected employees at randomly selected times and determining the amount of time spent on divisional programs), we are able to impute these results to the population as a whole. We conduct our sample on a quarterly basis. It has a standard deviation of +/-3%. It is audit-able and conforms to scientific standards by its ability to mathematically describe a specific population. Our results are given in the following context: We are 95% certain the results of our samples reflect the characteristics of the population under study with a standard deviation of +/-3%.

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INDIRECT COST AGREEMENT

Mr. Jesse Separs, Director Division of Cost Allocation Department of Health and Human Services 101 Marietta Tower, Suite 1607 Atlanta, Georgia 30323

July 12, 1991

Dear Mr. Spears:

Enclosed is the Cost Allocation Plan for the Georgia Department of Human Resources (DHR) for the state fiscal YEAR beginning July 1, 1990. For administrative purposes this plan is designated GA DHR 91-0. This Cost Allocation Plan is the consolidation GA DHR 88-0 and all subsequent amendments and as such contains no material changes for State Fiscal Year 1991. The narrative of the Cost Allocation Plan has been editorially revised and all organization charts and financial schedules have been updated. Schedules included in the Cost Allocation Plan include statewide costs submitted to the Division of Cost Allocation by the Georgia Department of Administrative Services for approval.

For State Fiscal Year 1991, previous references to "authority" in the narrative chapters of the Cost Allocation Plan have been deleted. In lieu of citations of authority, DHR has replaced former Appendix A - Glossary of Terms with a new Appendix A - Funding Grants: CFDA Numbers. The new Appendix is an alphabetic listing of descriptive funding source titles with the associated identifying numbers from the Catalog of Federal Domestic Assistance.

For State Fiscal Year 1991, the Georgia Children's Trust Fund commission was attached to DHR for administrative purposes. Rather than add a new appendix to reflect this change, Appendix E - Health Planning Agency has been replaced by new Appendix E - Attached Agencies, which includes both the Health Planning Agency and the Children's Trust Fund Commission.

Approval of Cost Plan amendment 88-6 was contingent upon the subsequent submission of amendment 88-7 which was to have incorporated changes to the random moment samples as recommended by DCA and the Family Support Administration (FSA). DHR requested reconsideration of DCA's decision regarding proper treatment of strikes against workers who were away from their usual stations at the time of the randomly selected moment. Appendix B of DHR Cost Plan could not be submitted until an agreement was reached; this also resulted in a delay in submission of the recompiled Cost Plan 91-0. This issue was not resolved until March 1991 when representatives of DCA, FSA and DHR met and reached an agreement. By that time state and local random sampling had already been completed for three quarters. FSA agreed to allow the delay of implementation of the compromise until the fourth quarter of the state fiscal year.

At this time we also submit Cost Allocation Plan amendments 91-1, 91-2 and 91-3 which are materially comprised of changes to Appendix B, Random Moment Sample Studies. Changes have been made to the random moment sample forms and/or instructions for each quarter of the state fiscal YEAR in response to the DCA/FSA/DHR agreement and as needed to capture time study data for revised or new programs. Changes contained in each amendment are summarized below:

Amendment 91-1; Salary supplements paid to county Department of Family and Children Services workers (previously direct charged to count fund sources) were allocated to all programs which participate in the cost of regular salaries. No new cost center was created. Allocation methodology is the same as that used for regular salaries of county employees. Change was effective for the November 1990 sample.

Amendment 91-2; New activity code "At-Risk Child Care" was added to the social services instrument. Space was provided for workers signatures on the social services and eligibility instruments. Changes were effective for the February 1991 sample.

Amendment 91-3; Activity code P was amended to read "TANF At-Risk Child Care." Item 865 AFCD At-Risk Child Care was added to Section II - Major Service on the eligibility instrument. Instructions were amended for eligibility worker strikes which occur while workers are away from their desks. Changes were effective for the May 1991 sample.

Questions about this Cost Allocation Plan should be directed to Mr. Charles Prescott at 656-4718 or to me at 656-2072.

Sincerely,

Wayne E. Burrell, Director Office of Financial Services

cc: Mr. Charles Prescott

WEB:slb

Enclosure

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Georgia Department of Human Resources
COST ALLOCATION PLAN

CHAPTER
REVISION NO. 91-0

REVISED 7-1-90
REVISION EFFECTIVE DATE 7-1-90

CERTIFICATION
BY THE GEORGIA DEPARTMENT OF HUMAN RESOURCES
INDIRECT COST PROPOSAL
AND
COST ALLOCATION PLAN
I hereby certify the information in the Georgia Department of Human Resources' Indirect Cost Proposals and Cost Allocation Plans for the fiscal year beginning July 1, 1990, is correct to the best of my knowledge and belief and that I am authorized to file this proposal. I further certify that procedures were utilized to prevent costs from being allocated to Federal Programs as indirect costs that have already been treated as direct program costs and to assure that consistent treatment was accorded similar costs, to assure that costs have not been treated as indirect costs to Federal program inconsistent with statutory restriction governing those programs.
Wayne E. Burrell, Director Office of Financial Services

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SECTION II - LETTER OF CREDIT
I. A description of the State's method of accounting for and disbursing funds from the Letter of Credit (LOC).
The proposed budget for Fiscal Year 1999 will be submitted as an amendment to the plan no later than thirty (30) days after receipt of Georgia's grant award, including any negotiated amount from USDA.
A. Letter of Credit Drawdowns - Food
The Office of Financial Services of the Department of Human Resources makes drawdowns from the Letter of Credit. A reimbursement system is used to assure that withdrawals are not in excess of immediate cash needs. Withdrawals from the Letter of Credit are made semi-weekly. Food reimbursements are determined by the daily clearing from a unique bank account for WIC food vouchers. Since the disbursements are made through a unique bank account, the dollar amount of the food vouchers cleared (representing the actual paid disbursements) is obtained from the DHR bank by telephone on a daily basis. When the draw request is paid and available for state use, the draw represents the previous two (2) or three (3) days expenses.
When rebate checks are received from the formula contractor, the WIC programmatic accountant makes a copy of the check and forwards it to the cash manager. The check and deposit information is given to the cashier for recording in DHR accounting records and for depositing in the bank. The cash manager takes the amount of the rebate into consideration before making any future draws on the food Letter of Credit.
B. Letter of Credit Drawdowns - Administration
The administrative reimbursement is more complex than the food reimbursement. The Department's annual budget was analyzed to determine the ratios of the different federal and state funds which comprise each type of expenditure. This is called the funding mix. Disbursements from the Operating, Grant-In-Aid and the Payroll accounts are entered into a computer program containing the funding mix and the historical check clearing patterns of these three (3) bank accounts. The computer program adds the total funds eligible for reimbursement from the three (3) bank accounts, by day and stores this information in a program ledger. When reimbursement is requested, the draw represents the projected clearing in those bank accounts for the previous two (2) to three (3) days. Clearing patterns and the funding mix are updated periodically to insure that projections can be as accurate as possible. Near or at the end of each month, it will be determined whether conversion authority exists. If conversion authority exists, the administrative expenditures to date will be compared to the amount of availability on the administrative Letter of Credit. If the Letter of Credit does not have any availability and conversion authority exists, the WIC

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programmatic accountant will make an entry in the DHR accounting records to use food funds for administrative costs. A copy of the entry will be given to the cash manager so the cash manager will be aware of the need to draw the food funds immediately rather than during the reconciliation process.
II. A description of the system to ensure that accounting records reflect the current authorized amount for each fiscal year and the remaining balance for each fiscal year (Please include rebates and their effects on the system).
A. Cost Containment Initiative
In accordance with the provisions of P.L. 100-460, the Georgia WIC Program is continuing with the cost containment initiative begun on October 1, 1988. Effective August 1, 1998 the Georgia WIC Program entered into a three (3) year contract with Ross Products to be the primary provider of infant formula to WIC participants in this state. The purpose of this initiative is to provide WIC services to more eligible women, infants and children by reducing the cost of infant formula and applying the savings to the food budget.
In order to provide the program with the best possible rebate offer, the State Department of Administrative Services (DOAS), sent copies of the Georgia Invitation to Bid (ITB) to all major formula companies. The ITB contained all relevant information including definitions of truckload sizes, provisions for billing disputes and details on the review and award process that potential bidders would need in order to make an informed bid. The ITB was reviewed and approved by USDA prior to release.
To identify and bill for infant formula the Georgia WIC Program issues vouchers which have been imprinted with the Contractor's brand and type of formula. Vouchers are redeemable for only the brand type shown. Each month the WIC Program's data processing contractor compiles a report identifying the number of vouchers cashed for both contract and non-contract brands and type (Concentrated, Powdered and Ready-To-Feed). A copy of this report is sent to the State WIC Office and Office of Financial Services. The Office of Financial Services then bills the formula contractor. In addition, the data processing contractor provides a computer tape to the formula manufacturer that allows them to check the accuracy of each invoice.
The first infant formula rebate contract with Mead Johnson Nutritionals resulted in a total savings of approximately $55,350,000. The current contract with Ross Products is expected to generate between $130,000,000 to $140,000,000 over the next three years. During FFY 1997 rebates on infant formula totaled over $42,000,000.
III. A description of the checks and balances in effect to ensure that withdrawals from the LOC are not in excess of immediate cash needs and are in compliance with the Cash Management Improvement Act (CMIA).
A. State WIC Office expenditures and local agency expenditures are reported on a cash basis of accounting.
1. Budget/Expenditure Plan
Local Agencies are required to submit a cost allocation budget and may, at their discretion, also set up budgets for administration, nutrition education, client services and breastfeeding. The budgets used are classified by line item as follows: 1. direct salaries (including salaries, hourly labor, FICA, retirement and health insurance); equipment

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(equipment costing $1000 or more, lease purchases, rental of equipment and equipment costing less than $1000) 2. other operating expenses (including supplies and materials, repairs and maintenance, utilities, printing, rents other than real estate, insurance and bonding, other operating expenses, computer software, travel, building rent, per diem fees, contracts, telecommunications and postage) 3. intra/inter agency transactions.
The local agencies must submit original budgets and revisions for approval before monies may be expended. The state Grant-in-Aid system will not allow reimbursement of expenses incurred without prior approval.
The optional WIC Administrative Budget is prepared by compiling budgeted amounts submitted by local agencies and adding to the budgeted amount for the state agency. Services supported entirely by WIC funds include anthropometric measurement, hematological testing, nutrition counseling and education and breastfeeding education and support.
Unliquidated obligations are identified both monthly and at year end. Monthly unliquidated obligations are recorded on the FNS 498 report, page 2, line 16b and yearly, on the FNS 227 closeout report, part C - Status of Grant Award, line 21.
2. Local Agency Overhead
a. Some districts charge a portion of overhead expenses through the indirect cost allocation plan. The expenses not included in the plan are absorbed by the county providing the service.
b. The majority of districts have elected not to charge these costs to the programs when the county providing the service is supporting the activity fully.
3. Monitoring of Local Agency Expenditures
The local agencies submit a Monthly Income and Expenditure Report to the Public Health Grant-in-Aid Office. These reports are monitored by the state agency staff and compared to approved budgetary amounts.
During program reviews, expenditures and supporting documentation are checked to ensure program compliance.
The State office as well as the local agencies, in keeping with generally accepted accounting principles will monitor all purchases to ensure no obligations are claimed as expenditures prior to full payment.
Further monitoring of local agency and county expenditures can be made through the use of the official state accounting system - U.A.S. (Uniform Accounting System). Counties are identified by division, district, county and program.
4. Monitoring of State Agency Expenditures
The expenditures of the state agency are monitored by the DHR Office of Financial Services and Division of Public Health and only allowable costs are charged to the federal grant program. The documentation to support these charges is maintained in the Office of Financial Services. The Department's Office of Audits and the State Office of Audits conduct regular reviews of financial activity in the WIC program. Indirect costs assessed by the Department and the Division are included in the DHR Cost Allocation Plan approved by DHHS.

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5. Purchasing, Contracting and Property Management
All State agency purchasing, other than supplies from the Department of Human Resources Central Supply is conducted by the Procurement Office for DHR. Federal Regulations, including 7-CFR 3016, A-90 and A-87 guidelines are complied with by the Procurement Office. Prior approval from FNS must be obtained before the State agency can approve the following purchases:
a. Automated management information systems
b. Management studies for State or local agencies
c. Capital expenditures over $25,000
d. Non-major ADP equipment
The Purchasing authority for the Georgia Department of Administrative Services (DOAS) complies with the requirements of 7 CFR Part 3017. This federal regulation provides guidance for systematic policy and procedures implementation for nonprocurement debarment and suspension. This regulation applies to all debarments and suspensions of persons, firms, or corporations from consideration for award of contracts imposed by the Department of Administration Services,
Purchasing and Surplus Property Division. The list of disbarred/suspended vendors is maintained by State Purchasing. The state agency does not conduct business with any debarred or suspended vendor. Contracts for services are initiated and written by the State agency following applicable guidelines. Consultation is provided by the Office of Financial Services and the Division of Public Health Contracts Office. Companies which the State agency has major on- going contracts with are:
-- Viking Computing, Inc. -- Southside Health Care, Inc. -- Fulton /DeKalb Hospital -- Premier Bank -- Ross Laboratories

Executive departments and agencies shall participate in a government-wide system for nonprocurement, debarment and suspension. A person (vendor) who is debarred or suspended shall be excluded from Federal financial and nonfinancial assistance and benefits under Federal programs and activities. Debarment or suspension of a participant (vendor) in a program by one agency shall have government-wide effect.
Each local agency conducts its own purchasing through the District Health Office. The Southside, Inc. and Fulton /DeKalb Hospital WIC Programs purchase through their own internal mechanisms. Each local agency has been provided a copy of the Federal guidelines and instructed that WIC purchases must be made in accordance with those guidelines. Policies and procedures for purchases made with State Grant-in-Aid funds are given in the Grant-in-Aid Policies and Procedures Manual and are in compliance with Federal requirements.
Local agencies are contractual providers of the state, therefore they are subject to

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DOAS guidelines for "Debarment or Suspension of Vendors." DOAS complies with the requirement of 7 CFR Part 3017 and maintains a list of disbarred/suspended vendors. State Agencies shall comply with the requirements governing nonprocurement debarment/suspension in accordance with 7 CFR 3017. For WIC property control procedures in accordance with A-102, see Section AD of the Procedures Manual. The property control procedures are applicable for nutrition education property management and to the debarment/suspension requirements for property management.

6. Identification of Obligations

The FNS-498 Report is prepared by the Office of Financial Services using the following reports: a. UNMATCHED REDEMPTIONS REPORT (EWRR3400G)

This report lists Manual Vouchers which have been redeemed but for which:

1. No matching issue record has been received by the ADP Contractor, or 2. No valid certification exists.

b. WIC FOOD COST PROJECTION REPORT (EWWRR401G)

Lists food allocation by District/Unit, shows following information:

Food Grant Accumulated Expenditures To Date Calculated Expenditure For Current Month Sub-Total Of Expenditures Remaining Total Projected Expenditure for Fiscal Year Available Monthly Grant Remaining Projected End of Year (Over/Under) Projected Percent Of Grant Expended for Fiscal Year Actual Percent of Grant Expended for Fiscal Year

c. FOOD EXPENDITURES (EWRR800G)

Shows number of computer generated and manual vouchers created by WIC Type along with Voids. Also includes the same information listed for vouchers codes in Report EWRR900G.

d. MONTHLY REPORT OF VOUCHER EXPENDITURES BY VOUCHER CODE (EWRR900G)

Gives following information for each voucher code:

# Computer Issues # Manual Issues

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# Voids # Net Issues # Cashed
Value of Cashed Vouchers Average Cost/Voucher # Uncashed Vouchers Value of Uncashed Vouchers

7. The Office of Financial Services uses the following steps to prepare the FNS-498 Report:

a. The food obligation amount is taken from the WIC Director's memorandum which is obtained from the data processing contractor's WIC FOOD COST PROJECTION REPORT, less the estimated amount of rebates provided by the State WIC Office.

b. The net amount is equal to the total amount of vouchers that have been cashed for three (3) months, including the issue month. This amount also equals the "total" line on food outlays for the issue month.

c. The food outlay section is completed using the FOOD EXPENDITURES, UNMATCHED REDEMPTION, the RECONCILIATION OF USER and FACS 2012 reports for manual adjustments.

(1) The current month amount is calculated by taking the current amount from the FOOD EXPENDITURES REPORT + Early Redemptions (from Reconciliation of User) + Unmatched Redemptions + Redeemed Late (from Reconciliation of User) + Bank Exceptions (from Reconciliation of User) + Manually issued checks for stale dated vouchers (manual journal vouchers - Accounts Payable file) - refunds (manual journal vouchers Accounts Payable file).

NOTE:

The stale dated vouchers are included in the current month. Because of the small amount of these in respect to total dollars [less than one (1) percent], we determined that it would not be cost effective to identify the actual month of issue. Also, the original month of issue would have already been closed out on the FNS-498 Report.

(2) Prior months are taken from the FOOD EXPENDITURES REPORT and adjusted for the vouchers that were cashed early during that month. Example: The May amount cashed in June would be adjusted for the June amount that had been cashed early in May since we would have originally reported that under May.

d. To ensure that the correct amount is being reported, the total of "c" above would be compared to what is on the books. These amounts must match exactly.

e. The participation information is received from the WIC Director's memorandum which is obtained from the data processing Contractor's

ETHNIC PARTICIPATION BY PRIORITY REPORT (EWRR990G) each month.

f. The administrative costs for outlays are taken directly from the Fiscal Accounting and

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Control System (FACS) which identifies all costs by program based on codes used by WIC. The costs are picked up from a monthly 2012 FACS report and added to the previous monthly outlays. This total is compared to the FACS 4100 report to insure accuracy. Any expenditures covered by converted food funds are arrived at in the same manner because the FACS 2012 is a project report. These costs are recorded on an administrative project and food fund source. When the WIC accountant does the comparison to the FACS 4100 report, he/she must adjust for these costs since the 4100 report is a by fund source.
g. The administrative costs of unliquidated obligations represents the total from the FACS 2039 report less costs not reportable except one (1) month at a time. For the unliquidated obligations, we have been informed by the USDA Regional Office that contract costs can only be claimed for the month being reported. Example: The data processing contract is not put on the July report unless we have not paid the July invoice and then it is put on for only the amount or estimated amount of the July invoice. The indirect cost for the first two (2) months of the quarter is an estimated amount and is shown as an obligation since indirect cost is only posted once per quarter. This amount is estimated by obtaining an average for the past four (4) quarters of indirect cost and dividing the result by twelve. This result is used for the first month of a quarter and this result times two (2) is used for the second month of the quarter. There is no estimate used for the third month of the quarter since the indirect cost will be the actual cash expense indirect cost and reported as a cash outlay.
(3) The rebate check is recorded through a journal voucher to WIC food. The distribution between the months that the check represents is obtained from VIKING INFANT FORMULA REBATE REPORT (EWVR16MG). This journal voucher is adjusted in the proper months from the amounts calculated in steps 1 and 2 above.
8. Nutrition Education Expenditures
WIC Regulations mandate that nutrition education expenditures equal at least one-sixth (1/6) of the State agency's total administrative and operational costs. The State agency will take the following steps to ensure that nutrition education spending is at an adequate level.
a. Monthly grant-in-aid reports from local agencies will be monitored to determine nutrition education spending levels. The State agency will then

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record monthly state and local administrative expenditures and compare nutrition education expenditure percentages to determine whether one-sixth (1/6) of all administrative expenditures are for nutrition education.
b. If the one-sixth (1/6) requirement is not being met by an agency, the State will determine the cause and work with the local agency to establish spending patterns at the appropriate level. This may entail shifting funds from administration to nutrition education.
c. The State agency will provide technical assistance and consultation to local agencies to assist them in planning nutrition education expenditures.
d. If an agency persistently fails to meet the nutrition education spending share, the State agency may reduce that agency's administrative allocation up to one-sixth (1/6), unless documentation is available to justify low nutrition education expenses. Currently, in-kind contributions are not documented and are not included in the minimum requirement for nutrition education.
9. Breastfeeding Expenditures
WIC regulations mandate the amount of the administrative grant that must be spent on breastfeeding promotion activities. Local agencies must budget the allocation amount on a special program code set up for the breastfeeding promotion program. The State agency will take the following steps to ensure that breastfeeding spending is at an adequate level:
a. Monthly grant-in-aid reports from local agencies will be monitored to determine breastfeeding spending levels. The State agency will then record monthly state and local breastfeeding expenditures to ensure breastfeeding expenditures are being reported accurately and are allowable breastfeeding activities.
b. The State agency will provide technical assistance and consultation to local agencies to assist them in planning breastfeeding expenditures.
c. State and local agency breastfeeding expenditures will be reported on the final 269 report.
10. Client Service Expenditures
WIC regulations mandate that Client Service expenditures must be accounted for separately from general WIC administrative expenditures.

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Client Service expenditures include all those costs expended to deliver food and other client services and benefits.
11. Indirect Costs
The state agency operates in accordance with the approved department/division indirect cost allocation plan. This plan details the services provided to the WIC program under this agreement. The indirect costs are charged by organizational codes to the appropriate programs. There are three levels of costs: statewide, departmental and divisional.
Local agencies may charge allowable indirect costs to the WIC program upon submission and approval of an indirect cost allocation plan. These plans are reviewed by state agency staff during on site monitoring visits and by local agency and departmental auditors. Please see the enclosed DHR Indirect Cost Allocation Plan.
12. Local Agency Financial Management System
The Master Agreement for the Division of Public Health, paragraph 115 requires that local agencies maintain their financial management system in accordance with 45 CFR Parts 74.60 and 74.61 (Subpart H) and Georgia Code Annotated, Section 31-3-8.
The DHR Administrative Policy and Procedure Manual and the DHR Grants to Counties Manual give specific instructions in the operation of a financial management system at the local level. The WIC Procedure Manual provides information which is specific to the WIC program.
IV. A description of the procedures in effect to recognize rebates when determining immediate cash needs.
See Section II.B.
SECTION III - LOCAL LEVEL REQUIREMENTS
I. A description of how the local agencies are operating a financial management system consistent with State agency requirements.
See Chapter II - Section I.
II. A description of the State level management reviews conducted at local agencies and time frames.

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See State Agency Monitoring Section in the Procedures Manual.
III. A description of how the State monitors fiscal operations at the local level.
See State Agency Monitoring Section in the Procedures Manual.
IV. A description of the method used to allocate administrative funds among local agencies.
A. Allocation of Administrative Funds
1. Initial Allocations
The procedure the state agency uses to allocate administrative funds is based on the use of a flat yearly cost per participant. This is determined by the following formula (See Attachment II):
a. Determine the maximum administrative monies available for allocation after the program overhead expenses have been subtracted. These overhead expenses are costs associated with the data processing mainframe contractor, Office of Nutrition expenses, the State WIC office expenses and DHR indirect costs.
b. Average participation is calculated for the local agencies using the most recent two months closeout participation.
c. Divide the total district administrative allocation (as determined in step 1) by the statewide caseload to determine the yearly cost per participant.
The individual district allocations are calculated based on the number of persons served by each district as follows:
The yearly cost per participant is multiplied by each district's average caseload to determine their allocation.
2. Re-Allocations during the state fiscal year:
Reallocations are made whenever funds become available to distribute to the local agencies. This is accomplished as follows:
a. Add the new available administrative money to the existing administrative total to arrive at the new administrative total.
b. The average participation for each local agency must be updated using the most recent two months closeout participation.

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c. Divide the new administrative total by the updated statewide participation to calculate the new yearly costs per participant.

d. Multiply the new cost per participant by each district's updated average participation to calculate their new allocation.

NOTE: A "hold harmless" rule is in effect during the state fiscal year which prevents a local agency from experiencing a reduction in funding for this period.

V. A description of the procedures used to develop allocation standards in cooperation with local agencies.

A. Food Funds Allocation Methodology

In the process used to determine food obligations, data from three reports, generated by our data processing contractor, are mathematically projected on a spreadsheet.

District participation figures based on October closeout are divided by priority and WIC types, i.e. Priority I Women, Priority II Infants, etc. These figures are taken from the Ethnic Participation by Priority Report (EWRR980G).

Next, the October district specific food package costs are taken from the Food Package Expenditure Report (EWRR340G) and added to the spreadsheet.

Then, using the Food Expenditure Report (EWRR8009), the 12 month forward rolling average redemption rate for each district is computed and added to the spreadsheet.

Multiplying a district's participation figure for a single priority times the appropriate food package costs, times the average redemption rate for that district, equals the total food allocation projected for that priority. Depending on which priorities are to be served, the dollar amounts can then be added across to determine total district allocation.

When food funds are reallocated, it may be necessary to reallocate administrative funds. (See Attachment II)

B. Food Funds

The allocation and reallocation of food funds is based on a methodology developed by the WIC Allocation Advisory Committee. This includes an analysis of each district's participation at the beginning of the fiscal year by WIC type, within priority. The
projected amount to be spent for the total fiscal year is then calculated and, based on priorities, the committee determines which priorities will be served. The methodology for allocating food funds is described in the Financial Management Section of the State Plan. When food money is reallocated, it may be necessary to reallocate administrative funds. C. Administrative Funds
The allocation of administrative funds is based on an average cost per participant. First, the cost of State agency operations (State WIC Office and Office of Nutrition)

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is subtracted from the total administrative grant received from USDA. Of the remaining funds, additional yearly expenses are deducted from the adjusted administrative balance (indirect cost paid to DHR, ADP contractor fees). The new adjusted balance is then available for statewide District (Local Agency) distribution and is allocated based on a Statewide average cost per participant and participation of the last 2 closed out program months.
D. WIC Allocation Advisory Committee
The WIC Allocation Advisory Committee is charged with assisting the State Agency and Division of Public Health with developing an acceptable methodology for allocating federal grant funds to Local Agencies. Since FFY '90 the Georgia WIC Program has been allocating administrative funds based on the methodology described in the Financial Management Section of this document.
This Georgia WIC approved funding formula has been well accepted by local agencies due to its accuracy and fairness.
Additionally, the Georgia WIC Allocation Advisory Committee makes recommendations to the State Agency/Division of Public Health concerning caseload management strategies; these recommendations are considered and modified if necessary. The committee is chaired by a District Health Director. Other members of the committee include representatives of small, medium and large WIC clinics in the capacity of District WIC Coordinator, District Program Manager and District Health Director. Each category (coordinator, manager, director) has one representative from a small, medium and large size clinic.
The committee meets a minimum of two (2) times per year, first in January or after the federal grant award notification; and in July or August to determine reallocation funds distribution and the succeeding year's caseload strategies. However, meetings are convened on an as needed basis. Committee members rotate every two (2) years. To ensure committee continuity and integrity, one member from each category

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becomes a member of the succeeding rotation.
VI. A description for distributing operational and administrative funds, including start-up funds, if applicable, to local agencies.
A. Use of Funds
The Georgia WIC Program is 100% federally funded and officially operates on the federal fiscal year calendar (October 1 through September 30).
However, Georgia DHR fiscal budgets are allocated on the state fiscal year calendar (July 1 through June 30).
VII. A description of the procedures for amending budgets to reflect changes in funding levels and individual local agency funding needs.
A. The Department of Human Resources' Office of Financial Services receives its yearly budget instructions from the Office of Planning and Budget. When funding levels change, budget amendments are created by OFS and instructions are given to the Division level. Funds are then distributed to the local agencies by means of program specific allocation formula. This distribution process is contingent upon local agency funding needs.

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CHAPTER 3
FOOD DELIVERY/MANAGEMENT INFORMATION SYSTEMS
I. Retail Delivery Method II. Vendor Management III. Direct Delivery Method IV. Management Information Systems V. Food Package Design

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SECTION I - RETAIL DELIVERY METHOD
I. A description of all food delivery systems that the State plans to use during the year including any special provisions for the homeless or for the delivery of special formulas [246.4(a)(14)(i), 246.4(a)(14)(ix)].
See the Food Delivery Section of the Procedures Manual.
II. A description of any special food delivery procedures in the event of a natural disaster [246.4(a)(14)(i)].
See the Disaster Plan in the Procedures Manual.
III. Copies of all food instrument types [246.4(a)(14)(v)].
See the Food Package Section of the Procedures Manual.
IV. A description of food instrument security and accountability procedures at the State level [246.4(a)(14)(v), 246.12(1)].
See the Food Delivery and Quality Improvement Sections of the Procedures Manual.
V. A description of procedures for shipment of food instruments between all points [246.4(a)(14)(v), 246.12(1)].
See the Food Delivery Section of the Procedures Manual.
VI. Names of companies, other than vendors, under contract to operate or assist the State in operating the food delivery system [246.4(a)(14)(vii)].
Viking Computing, Premier Bank, Ross Laboratories, Mitchell and McCormick, Human Soft, Inc. (DeKalb System).
VII. A description of State procedures for follow-up on reports of lost or stolen food instruments [246.4(a)(14)(v)].
See the Quality Improvement Section of the Procedures Manual.
VIII. A report on the reconciliation rate for the previous year and an assurance that the State agency will fulfill food instrument reconciliation requirements in the coming year [246.12(n)].

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Reconciliation The Georgia WIC Program, in conjunction with its ADP contractor, Viking Computing, utilizes a series of monthly reports that provide complete tracking for every voucher issued.
These include:
BANK TRANSACTION LISTING which lists each voucher cleared by the bank during the processing month by serial number, date cleared, dollar amount and transaction code.
BANK EXCEPTION REPORT. This report identifies vouchers which cannot be reconciled to the Issue Records either because the voucher number is not recognized as currently valid, or because the voucher number has already been placed in a final status.
CLOSEOUT RECONCILIATION REPORT which provides a one to one reconciliation report that shows at a detailed voucher level, the disposition of each voucher which was created during the month that is currently being closed out.
VOUCHERS REJECTED BY THE BANK, lists detailed data of vouchers rejected by the contract bank during the screening and prepayment audit. The report is summarized at the county level within each District/Unit. This includes both computer and manual vouchers.
For Manual Vouchers (including those prepared by clinics using automated systems) there are the UNMATCHED REDEMPTIONS REPORTS which include CUMULATIVE UNMATCHED REDEMPTIONS showing those vouchers that cannot be matched to either an issue record or valid WIC ID or Certification period.
In addition, the State WIC Office receives microfilm records of all vouchers processed during the month.
This combination of reports and microfilm allows the WIC program to track every voucher and determine its final disposition.
On January 1, 1997 the Georgia WIC Program entered a new contract with Viking for Data Processing services. All of the above mentioned reports continue to be used along with a new report, VOUCHERS PAID BY ADMINISTRATIVE CHECK, which will provide even better controls by listing in detail those vouchers rejected by the bank for reasons such as being over the maximum amount but subsequently approved by the WIC Office for payment.
IX. A description of the State's plan to monitor local agency compliance with food delivery and accountability requirements [246.19(b)].
See the Monitoring Section of the Procedures Manual.

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SECTION II - VENDOR MANAGEMENT
I. A description of the vendor management (food delivery) system as it operates at the State agency level, including instructions for local agency [246.4(a)14(i)].
II. A narrative description of vendor selection, including a list of selection criteria, limitation criteria, if applicable and the application form [246.4(a)14(ii)].
III. A copy of the standard written vendor agreement between food vendors and the State (or local) agency [246.4(a)(14)(iii)].
IV. A description of the procedures designed to control participant abuse of the program [246.12(k)(2)].
V. A description of the system for monitoring food vendors to ensure compliance and prevent fraud, waste and abuse, including: [246.4(a)(14)(iv)]. - the functional breakdown between State and local agency responsibilities for vendor management - monitoring system - high risk criteria - investigation system - sanction system - vendor/participant complaint system
VI. Administrative appeal procedures for food vendors (may be placed in fair hearing section of the Procedures Manual) [246.4(a)(17)].
VII. A description of the procedures to review food instruments for errors or overcharges, including pre-payment and post-payment edits, reclaim, rejection and adjustment procedures (May be included in general food delivery system description) [246.4(a)(14)(vii)].
See the Vendor Section of the Procedures Manual for items I - VII above.
SECTION III - DIRECT DELIVERY METHOD
I. A description of how infant formula requiring a physician's prescription is issued.
See Food Package Section of the Procedures Manual.
SECTION IV - MANAGEMENT INFORMATION SYSTEMS
I. A narrative summary of changes made to the WIC management information system(s) in the past year.

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AUTOMATED DATA PROCESSING

HOST

A summary of all changes made to HOST are outlined in the 1998 Advanced Planning Document Update for WIC/HOST submitted to USDA in March of 1998.

ARMIS

A new networked version of ARMIS, with several added enhancements, is now available for distribution to our Districts. Some of the major changes are outlined below:

1. Average FPC (Food Package Cost) Calculation 2. Network Enhancement 3. Restructured Report Printing 4. Modification of the Masterfile to include the following elements:

-

Client Addresses

-

Zip Codes

-

Telephone Numbers

-

County Code, etc.

5. SMI History Heading Name 6. Participation Trends Report 7. SMI Clinic/District/Unit Display 8. QI Printing 9. Review & Modify the QI System (Closeout)

ATVS

ATVS is scheduled to be completely phased out this year with the completion of the implementation of the WIC module of HOST in all 10 proposed sites. As a result, no new changes have been made to the ATVS system this year.

VAMP

The old Vendor Activity Monitoring and Profile (VAMP) system has been redeveloped and is now called the Vendor Integrity Profile System (VIPS). More specific details about this new system are covered in the Vendor Management Section.

VAS

The new version of the Voucher Analysis System (VAS) is still in use by the State WIC Office. This program, which was developed in Visual Basic, is used to assist the Vendor Section in comparing vendor food package and voucher code prices with state average and peer groups. VAS additionally provides peer group analysis and food package, voucher code and voucher maximum price references.
GA IRS
All WIC vouchers, processed by the bank, are now being imaged onto CD ROM. In 1997, a new

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system called the Georgia Image Retrieval System (GA IRS) was implemented. This system allows staff members to retrieve and print electronic images of all vouchers on CD ROM. This system will eventually be expanded to include reports, voided vouchers and other documents.

Y2K CONTINGENCY PLAN

The Georgia WIC Program is taking every effort to ensure that all WIC systems are Y2K compliant by December of 1998. As a result several surveys of all WIC-owned software and any hardware that operates a WIC system have been conducted by the Georgia WIC Program and Keane and Associates. In addition, the Georgia WIC Program is forwarding quarterly status reports to USDA indicating the progress of our systems towards total Y2K compliance. All systems (HOST, Athens, DeKalb, Mitchell & McCormick and Viking Computing) are included in these reports. All District staff have been informed of the urgency of Y2K compliance and periodic updates will be provided to the Districts. In the event that one of our systems are not Y2K compliant by January 1, 2000, the following Contingency Plan will apply:

1) For Districts that have systems other than HOST, we will employ the following plan:

< Load the HOST system onto a Y2K compliant PC system in each local health department and continue to operate an automated certification and voucher issuance system;

< In the event that HOST is not compliant, we will return to a manual certification and voucher issuance system until the system is made compliant.

2) For Districts that are currently using HOST or new Districts that will be converting to HOST in the near future, the following plan will be employed:

<

Operate a manual certification and voucher issuance system until the

HOST system is made compliant.

3) In the event that the mainframe system operated by the ADP contractor is not compliant, we will employ the following strategies:

< Manual printing of all WIC vouchers locally at each clinic site,

< Manual processing of all WIC data,

< Manual reconciliation of all WIC data and

< Manual creation of all WIC reports

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A Summary of the State of Georgia's Efforts Towards Y2K Compliancy
In order to assist us in our efforts to become Y2K compliant, the state of Georgia has created the State Information Technology Policy Council. The State Information Technology Policy Council has developed a series of guidelines to assist all agencies in becoming Y2K compliant. In addition, the State of Georgia has established policies and procedures for the testing of all state systems.
The State of Georgia's Compliance Testing and Year 2000 Certification Policy is based upon three (3) key points:
1) Heads of the State Agencies will certify in writing the compliance of their mission critical systems.
2) Compliance evaluations will follow State Y2K Standards.
3) Testing of mission critical systems must be done in a fully Year 2000 compliant environment.
In addition, the State Information Technology Policy Council has established a set of standards to be followed in order to ensure total Y2K compliancy. Listed below are the standards against which the compliance of all systems will be evaluated. All standards must be met to achieve "Y2K Compliant" status in the State of Georgia.
< No value for current date will cause interruptions in desired operations.
< All hardware, software and firmware products, individually and in combination, shall successfully transition with the correct system date, without human intervention, including leap year calculations.
< All manipulations of date-related data (dates, duration, days of the week, period start and end dates, etc.) will produce the desired results for valid dates and treat invalid date values as errors.
< No date ambiguity will exist on screens or reports within the application domain.
< All date elements contained in applications, interfaces and data storage that span 100 years or where ambiguity regarding the correct century could result, are expanded as necessary to include the century.
The minimum requirements for passing Y2K testing in the State of Georgia are:
< The application must successfully process data with the system date set on or after 1/1/2000.

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< The application must successfully process data with transaction and master file dates advanced to 1/1/2000 and beyond.
< At a minimum, the following dates or business conditions must be tested on each system: < 9/9/1999 (all nines in expiration dates) < 12/31/1999 through 1/2/2000 (transition testing) < 2/29/2000 (test for leap year handling) < 2/30/2000, 2/29/2001 (test for invalid date) < 3/1/2000 (test for rollover from leap year) < Valid Period End Processing Cycles (weekly, monthly, quarterly, annually, as appropriate for
application) < The application must properly recognize weekends and holidays in the Year 2000 and beyond. < The application must test date manipulation processing for: < Accessing archived data < Date comparisons < Calculations based on dates < Sorting on date sequence < Special dates such as all zeroes or all nines. e following standards apply to the testing of the IT infrastructure such as PCs and workstations, network and work components, telephone equipment, test equipment along with associated system software (e.g., operating tem, utilities, sorts) and any other IT infrastructure needed for the proper operation of a software application.
Acceptance criteria used for testing must be defined in writing by agency IT staff and users.
Testing criteria must be developed and tested using written test cases.
All test results must be recorded.
Acceptance tests must be performed by agency users.

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< Y2K test must be performed by agency users.
< Tests must be performed by person other than the remediation technician.
< Errors in testing must be documented and corrected.
The State has established various levels of Y2K compliancy for all systems (i.e., Y2K Compliant, Y2K Ready, Y2K Limited Risk, Non-Compliant and Exempt). Each system must strive for the highest level of Y2K Compliancy established by the State (Y2K Compliant). In order to meet this high level of compliancy, each system must meet the following criteria:
1) No value for the current date can cause interruptions in the desired operation of the system.
2) All hardware, software and firmware products, individually and in combination must successfully transition with the correct system date, without human intervention, including leap year calculations.
3) All manipulation of date-related data (dates, duration, days of week, etc.) must produce desired results for valid dates and treat invalid dates as errors.
4) No date ambiguity should exist on screens or reports.
5) All hardware must transition to Year 2000 without human intervention.
6) All date elements contained in applications, interfaces and data storage that span 100 years or where ambiguity regarding the correct century could result must be expanded as necessary to include the century.
7) All systems must be tested in a fully Y2K compliant test environment.
DHR's Efforts Towards Y2K Compliancy
In order to ensure that all WIC systems are totally Y2K compliant, the following steps will be taken:
1) A test environment will be established that is certified by the State Information Technology Policy Council as being Year 2000 compliant. This will include both the client and server platforms.
2) Test scripts will be created that will include functional testing of the HOST system with the Year 2000 test dates established by the State Information Technology Policy Council. These test scripts will use actual WIC client cases as test data.
3) The scripts will be tested by staff members from IT, Keane & Associates, the State WIC Office and several staff members from the Districts.
4) The test data will be transmitted to Viking for processing.

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5) Viking will process the test data and provide a dump of the data for our review and analysis.
6) Staff members from IT, Keane & Associates and the State WIC Office will review the dump of the test data for Y2K compliancy.
7) The findings of the tests will be documented and a summary report will be created that will be shared with USDA and other appropriate entities.
8) Any failures in the test results will be properly documented and an action plan will be developed to correct the inaccuracies.
9) Goal date for completion of tests: October 1, 1998
The current version of HOST has already passed preliminary compliancy tests in a standalone and network environment. The State WIC Office plans to assure that a stand alone PC that is already Y2K compliant is available in each local health department so that the current version of HOST can be used to operate an automated certification and voucher issuance system in the event of a failure.
Third Party Systems
The DHR Office of Information Technology will not be involved in testing any county and privately owned third party systems that operate an automated certification and voucher issuance system in our districts (i.e., Athens, DeKalb, Mitchell & McCormick, Viking). All third party systems are currently reporting their progress towards Y2K compliancy to the State WIC Office and USDA on a quarterly basis. In order to further ensure that all Districts that operate a third party system are compliant, the State WIC Office will require that following steps to be taken:
< All third party contractors must test their systems using the same guidelines established by the State Information Technology Policy Council.
< All third party contractors must run the same test scripts and WIC client cases used to test the HOST system.
< Each third party contractor is required to obtain an independent consultant to further certify their Y2K compliancy.
< The independent consultant will provide a written report of all tests and the findings.
< The independent consultant will inform the State WIC Office of any failures in the test results and develop an action plan to correct the inaccuracies.
< The independent contractor will provide the State WIC Office with a sworn affidavit certifying that the system hardware and software have been tested and found to be totally Y2K compliant according to the standards set forth by the State Information Technology Policy Council.
< Goal date of completion of tests: October 1, 1998.

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The State WIC Office will provide the third party systems assistance in this process.
In the event that any of the third party contractors cannot provide a sworn affidavit that the third party system is totally Y2K compliant according to the standards set forth by the State Information Technology Policy Council, the Districts will be offered a stand alone version of HOST as a backup. If a District is found to be non-compliant and refuses to use the HOST system as a backup, the non-compliant District will resort to a manual certification and voucher issuance process until their system is made compliant.
II. Participant Characteristics Minimum Data Set of the MIS State Plan format if there have been changes since you last submitted this checklist.
A. PARTICIPANT CHARACTERISTIC STUDY
See Attachment I.
SECTION V - FOOD PACKAGE DESIGN
I. A description of the standard or commonly used food package for each participant category including Food Packages I - VII that the State plans to use during the year including any special provisions for the homeless [246.10(c)].
II. A list of all State approved infant formulas (including the standard contract formulas), exempt infant formulas, special formulas and medical foods [246.10(f)].
III. A copy of the current State authorized food list [246.10(b)].
See Food Package Section of the Procedures Manual for items I - III above.

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CHAPTER 4
PROCESS FOR APPLYING TO OPERATE A WIC CLINIC

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SECTION I - PROCESS FOR APPLYING TO OPERATE A WIC CLINIC
Local agencies must be public or private, health or human service agencies, in accordance with Section 246.5(d) of the WIC Regulations. The application must demonstrate the agency's ability to operate a WIC Program in accordance with WIC Federal Regulations and State policies.
The Georgia WIC Program operates in all 159 counties in the State and is operated by public health departments and two (2) Atlanta based contracted agencies (Grade Hospital and Southside Health Care, Inc.). During FFY 98, Georgia WIC continued its goal of exploring the expansion of WIC services to non-public health agencies/providers. These new WIC sites may include Migrant Health Centers, Health Maintenance Organizations, Community Health Centers and/or private provider offices.
Applications will be accepted for purposes of expanding services in a current Program area. In considering such an application, the State Agency will evaluate the performance of existing programs in the areas in question. An application will be considered for approval if the existing agency/agencies is/are not able to expand the services to the priority residents/participants of the area and/or are not utilizing all available food/administrative funds.
Upon request from an agency interested in operating a WIC Program, the State agency will supply, within fifteen (15) days of inquiry, a pre-application information package consisting of the following documents:
1. A cover letter explaining, at minimum, the overall application process, time frames involved, criteria for selection of agencies and information concerning the appeal process in the event that the application is denied.
2. A copy of the WIC Program Regulations, 7 CFT Part 246.
3. A list of basic requirements for inclusion in the local agency application to operate a WIC Program. This will include staffing and equipment requirements, as well as clinical and nutritional regulatory mandates.
4. A listing of State and Local Agency resources.
5. A copy of the Memorandum of Understanding between the State Agency and the local agency. (The Memorandum of Understanding is included in Section AD of the Procedures Manual).
6. A copy of the most current State Plan, Procedures Manual and Georgia WIC Information Packet.
7. Examples of nutrition education materials and participant training tapes.
Selection criteria for local agencies will be consistent with the requirements of 7 CFR 246.5. [246.7 (M)]. Applications will also be reviewed for assurance that at minimum:

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1. The local agency has corrected all past substantiated civil rights problems and/or noncompliance situations.
2. The Civil Rights Assurance is included in the State/Local Agency Agreement.
3. Civil rights complaints are being handled in accordance with procedures outlined in the Rights and Obligations Section of the WIC Procedures Manual.
4. Clinic sites, certification offices, vendors and other food distribution sites do not deny access to any person because of his or her race, color, national origin, language, age, sex, or handicap.
5. Appropriate staff, volunteers and/or other translation resources are available in areas where a significant proportion of non-English or limited English-speaking persons reside.
6. A description of the racial/ethnic makeup of the service area is included in the application.
7. The agency has the ability to provide appropriate WIC services to applicants and participants in accordance with USDA and State WIC regulations and policies.
8. The agency space availability is adequate to provide WIC services.
9. The agency demonstrates the ability to manage financial obligations in accordance to USDA and State regulations and policies.
10. The agency will demonstrate the ability to ensure the security of WIC vouchers at all times.
11. The agency agrees to have all agency staff attend any required meetings and trainings.
12. The agency agrees to comply with all USDA and Georgia WIC reporting and documentation requirements.
13. The agency demonstrates the ability to comply with all WIC Program automated data processing requirements.
14. The agency agrees to make all documents and records available for review and audits.
15. An agency serving homeless participants agrees to ensure that the homeless facility does not:
a. Accrue financial or in-kind benefits from a person's participation in the program;
b. Subsume foods provided by the WIC Program into a communal food service, but are available exclusively to the WIC participant for whom they were issued;

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c. Allow the homeless facility to place constraints on the ability of the participant to partake of the supplemental foods and nutritional education available under the Program.
16. The local agency agrees to contact the homeless facility periodically to ensure continued compliance with these conditions.
17. The local agency requires the homeless facility to notify the State or local agency if it ceases to meet any of these conditions.

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GEORGIA DEPARTMENT OF HUMAN RESOURCES DIVISION OF PUBLIC HEALTH STATE WIC OFFICE FFY `98 STATE PLAN
ATTACHMENTS

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GA WIC PROCEDURE MANUAL

Attachment I

B. PARTICIPANT CHARACTERISTICS MINIMUM DATA SET (MDS)

The Participant Characteristics Minimum Data Set (MDS) contains data items which are reported to FCS electronically by State agencies for one report month on all or a sample of participants. The MDS has required data items which must be collected and reported. The Supplemental Data Set Specifications (SDS) is comprised of optional data items which State agencies may collect and report. Please check those data items the State agency currently collects in its Management Information Systems and those data items it is planning to collect within the next two years.

REQUIRED: Participant Characteristics Minimum Data Set

State Agency MIS: Collects

X

State Agency ID. A unique number that permits linkage to the WIC State agency

where the participant was certified.

X

Local Agency ID. A unique number that permits linkage to the local agency where

the participant was certified as eligible for WIC benefits.

or

X

Service Site ID. A unique number that permits linkage to the service site where

certified. Either local agency ID or service site ID may be reported according to the

level the State Agency feels appropriate. At a minimum, State agencies must provide

agency names and addresses for each ID provided on their files.

X

Case ID. A unique record number for each participant which maintains individual

privacy at the national level.

General Instructions: Participant or Case Ids for each participant should continue to maintain individual privacy at the national level. States are requested to generate these Ids in the same manner that was applied for PC92 to allow longitudinal tracking of participant characteristics. This task can be accomplished by applying the PC92 algorithm to construction of PC98 participant Ids.

X

Client Date of Birth: Month, day and year of participant's birth reported in

MMDDYYYY format.

X

Client Race/Ethnicity: The classification of the participant into one of the five (5)

racial/ethnic categories: white; black; Hispanic; American Indian or Alaskan Native;

or Asian or Pacific Islander. The ethnic categories, white and black, include only

those persons who are not of Hispanic origin.

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GA WIC PROCEDURE MANUAL III.MANAGEMENT INFORMATION SYSTEM WIC SYSTEMS FUNCTIONAL REQUIREMENTS CHECKLIST

Attachment I

State State Agency Agency Planned Performs Function/Capabilities

NUTRITION EDUCATION AND HEALTH SURVEILLANCE

Maintain Nutrition Education Data

X

Maintain Appointment Schedules for Enrollees that are to receive

nutrition education

X

Maintain Appointment schedule of available nutrition education

sessions

X

Provide appointment notice to enrollee

X Track participation in education

X Track types of nutrition education provided

Perform Individual Client Health Monitoring

X

Capture and monitor changes in individual client health status

X

Provide individual client data to other health agencies

Perform Individual Client Nutrition Education And Diet Monitoring Capture and monitor changes in individual client dietary behavior

Perform Analysis Of WIC Population Nutrition Education And Health Surveillance Monitor changes in WIC Participant Population Health Status Monitor clients' views of WIC Program Services Monitor changes in WIC participant population dietary behavior

Provide WIC Health Statistics To Other Health Agencies

X

Provide WIC participant population data to other state health agencies

X

Provide WIC participant population data to Center for Disease Control

FOOD INSTRUMENT PRODUCTON

Maintain Food Package Database

X

Record list of approved foods and food package data

X

Record food package variations and food instrument types

X

Pro-ration of food quantities for clients with late pick-up

Print Food Instruments On Demand

X

Print regular food instruments for participants on demand

X

Print food instruments for multiple months

Print vendor-specific food instruments

X

Print pro-rated food instruments

X

Print custom-tailored food instruments

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GA WIC PROCEDURE MANUAL III.MANAGEMENT INFORMATION SYSTEM WIC SYSTEMS FUNCTIONAL REQUIREMENTS CHECKLIST

Attachment I

Print And Distribute Food Instruments In Advance Of Pick-Up

X

Print food instruments in advance of participant pick-up

X

Print food instruments for multiple months

Print vendor-specific food instrument

Monitor Food Instrument Stock Record stock receipt, shipment, and usage of food instruments

FOOD INSTRUMENT PAYMENT AND RECONCILIATION

Void Unissued And Unredeemed Food Instruments

X

Void unissued and unredeemed food instruments produce on demand

X

Void unissued and unredeemed food instruments printed in advance

Reconcile Redeemed Food Instruments

X

Process food instruments redeemed by vendors

X

Produce rejection reports for food instruments not paid to vendors

X

Check for valid vendor on redeemed food instruments

X

Check for redeemed but unissued food instruments

Produce Vendor Payment Detail

X

Produce payment detail for checks (where applicable)

X

Produce payment detail for vouchers (where applicable)

CASELOAD MANAGEMENT

Allocate Caseload

X

Determine maximum state caseload which could be served with available funds

X

Prepare local agency caseload allocation estimates

X

Record caseload allocations assigned to local agencies

Monitor Caseload

X

Track actual participation against caseload levels

X

Produce FNS reports on participation

VENDOR MANAGEMENT

Support vendor authorizations

X

Capture and maintain data on authorized vendors

X

Produce vendor history information on individual vendors

X

Track vendor authorization process

Determine high-risk vendors

X

Determine high risk vendors using basic statistical analysis (e.g. low variance,

high mean)

Determine high risk vendor using additional analysis tools

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GA WIC PROCEDURE MANUAL III.MANAGEMENT INFORMATION SYSTEM WIC SYSTEMS FUNCTIONAL REQUIREMENTS CHECKLIST

Attachment I

Monitor Vendor Education

X

Record vendor education sessions scheduled for each vendor

X

Record attendance at vendor education sessions by vendor

Track Investigations And Routine Monitoring

X

Capture compliance buys and routine monitoring data performed on vendors

X

Support constructing a sampling of vendors for investigation

X

Support record audits with data needed to evaluate vendor inventory of WIC foods

Monitor Compliance Cases And Sanctions

X

Maintain data for in-state vendor investigation cases and sanctions applied

Maintain compliance data for abusive out-of-state vendors

X

Accumulate sanction points for vendor abuse

Coordinate With Food Stamps Program

X

Maintain FSP violation data on WIC vendors

X

Report WIC sanctions to Food Stamp Program

Support Vendor Communications

X

Produce vendor lists and labels

X

Produce vendor correspondence

OPERATIONS MANAGEMENT

Monitor Administrative Operations

Maintain staffing, client load and operational characteristics on local agencies and

clinics

X

Produce client and food instrument activity reports on local agencies and clinics

Maintain Client Outreach Maintain client lists for local agencies to use for outreach

X

Track referrals of WIC participants to other health and social services

FINANCIAL MANAGEMENT

Record Grants And Budgets

X

Record nutrition services, administration and food grant for state agency

X

Maintain local agency budget information

X

Maintain state agency budget information

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GA WIC PROCEDURE MANUAL III.MANAGEMENT INFORMATION SYSTEM WIC SYSTEMS FUNCTIONAL REQUIREMENTS CHECKLIST

Attachment I

Monitor Expenditure

X

Monitor nutrition services, administration and food obligations and

expenditures

X

Monitor cash flow

X

Produce FNS 498 Report

Process Manufacturer Rebates

X

Estimate total annual rebates

X

Bill manufactures(s) for rebate

X

Monitor rebate collections from manufacturer(s)

SYSTEM ADMINISTRATION

Maintain System Data Tables

X

Maintain system data tables

Administer System Security

X

Maintain user identification

X

Maintain user capabilities

X

Monitor unauthorized access

Archive System Data

X

Archive and restore historical data

X

Purge unnecessary data

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GA WIC PROCEDURE MANUAL III.MANAGEMENT INFORMATION SYSTEM PARTICIPATION CHARACTERISTICS

Attachment I

State Agency MIS: Collects

X Certification category. The category--one of five (5) possible categories--under which a person is certified as eligible for WIC benefits: pregnant woman; breastfeeding woman; postpartum woman (not breastfeeding); infant (under 12 months); or child (12-59 months).

X Expected date of delivery or weeks gestation. For pregnant women, the projected date of delivery (MMDDYYYY format) or the number of weeks since the last menstrual period as determined at WIC Program certification.
X Date of certification. The date the person was declared eligible for the most current WIC Program certification as of April 1998. Month, day, and year should be reported in MMDDYYYY format.
X Sex. For infants and children, male or female.

X Priority level. Participant priority level for WIC Program certification at the time of the most
X Participation in TANF/AFDC, Food Stamps, Medicaid. The participant's reported participation in each of these programs at the time of the most recent WIC Program certification as of April 1998.
X Migrant status. Participant migrant status according to the federal WIC Program definition of a migrant farm worker (currently counted in the FNS 498 report).
X Number in family or economic unit. The number of persons in the family or economic unit upon which WIC income eligibility was based.
A self-declared number in the family or economic unit may be reported for participants whose income was not required to be determined as part of the WIC certification process. These participants include adjunctively income-eligible participants (due to TANF/AFDC, Food Stamp Program, or Medicaid participation) and those participants deemed income eligible under optional procedures available to the State Agency in Federal WIC Regulations, Section 246.7(d)(2)(vi-viii)(means tested programs identified by the State for automatic WIC Program income eligibility, income eligibility of Indian and instream migrant farm worker applicants).

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GA WIC PROCEDURE MANUAL III.MANAGEMENT INFORMATION SYSTEM PARTICIPATION CHARACTERISTICS

Attachment I

State Agency MIS: Collects

X Family or economic unit income
For persons for whom income is determined during the certification process, the income amount that was determined to qualify them for the WIC Program during the most recent certification as of April 1998.

FNS will convert income expressed in different measures (weekly, monthly, yearly, etc.) to annual amounts.

For descriptive purposes only, for participants whose income was not required to be determined as part of the WIC Program certification process, the self-reported income at the time of certification. These participants include adjunctively income-eligible participants and those persons deemed eligible under optional procedures available to the State Agency in Federal WIC Regulations, Section 246.7(d)(2)(vi-viii).

Zero should not be used to indicate income values that are missing or not available. Zero should indicate only an actual value of zero.

X Nutritional risks present at certification. The three highest priority nutritional risks present at the WIC Program certification current in April 1998.

X Hemoglobin or hematocrit. That value for the measure of iron status that applies to the WIC Program certification. It is assumed that the measure was collected within sixty (60) days of the certification date.

X Weight. The participant's weight measured according to the CDC nutrition surveillance program standards [nearest one-quarter (1/4) pound]. If weight is not collected in pounds and quarter pounds, weight may be reported in grams

X Height. The participant's height (or length) measured according to the CDC nutrition surveillance program standards [nearest one-eight (1/8) inch]. If height is not collected in inches and eighth inches, height may be reported in centimeters.

X Date of height and weight measure. The date of the height and weight measures that were used during the most recent WIC Program certification period as of April 1998 in MMDDYYYY format.

X Currently breast fed. For infant participants between the ages of seven and eleven months, whether or not the participant is currently receiving breast milk

X Ever breast fed. For infants between the ages of seven and eleven months, whether or not the infant was ever breast fed.

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GA WIC PROCEDURE MANUAL III.MANAGEMENT INFORMATION SYSTEM PARTICIPATION CHARACTERISTICS

Attachment I

State Agency MIS: Collects

X Length of time breast fed. For infants between the ages of seven and eleven months, the number of weeks the infant received breast milk.

X Date breastfeeding data collected. For infants between the ages of seven and eleven months, the date on which breastfeeding status was reported in MMDDYYY format.

X Food packages. The food package code(s) for the WIC food package or for all food instruments prescribed for the participant during the month.

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GA WIC PROCEDURE MANUAL III.MANAGEMENT INFORMATION SYSTEM PARTICIPATION CHARACTERISTICS

Attachment I

State Agency Collects
X

MIS Plans to Collect Supplemental Data Set (OPTIONAL)
Date of first WIC certification: Date the participant was first certified for the WIC Program in MMDDYYYY format. For pregnant, breastfeeding and postpartum women this applies to the current/most recent pregnancy and not to prior pregnancies.

X

Educational level: For pregnant, breastfeeding and postpartum women,

the highest grad or year or year of school completed. For infants and

children, the highest grade or year of school completed by mother or

primary caretaker.

X

Number in household on WIC. The number of people in the

participant's household receiving WIC benefits.

Source of prenatal care: For pregnant, breastfeeding and postpartum women, source of care for current/most recent pregnancy.

X

Date when prenatal care began: For pregnant, breastfeeding and

postpartum women, the date when prenatal care began for he most

recent pregnancy in MMDDYYYY format.

Date previous pregnancy ended: For pregnant women, the date previous pregnancy ended in MMDDYYYY format.

Total number of pregnancies: For pregnant women, the total number of times the woman has been pregnant, including this pregnancy, all live births and any pregnancies resulting in miscarriage, abortion or stillbirth.

Total number of live births: For pregnant women, the total number of babies born alive to this woman, including those who may have died shortly after birth.

X

Pre-pregnancy weight: For pregnant women only, the participant's

weight immediately prior to pregnancy. Pre-pregnancy weight may be

reported either in pounds and ounces or in grams.

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GA WIC PROCEDURE MANUAL III.MANAGEMENT INFORMATION SYSTEM PARTICIPATION CHARACTERISTICS

Attachment I

State Agency Collects

MIS Plans to Collect Supplemental Data Set (OPTIONAL)

Weight gain during pregnancy: For breastfeeding and postpartum women, the participants weight gain during pregnancy as taken immediately at or prior to delivery. Weight gain during pregnancy may be reported in either pounds and ounces or in grams.

X

Birth weight: For infants and children, the participant's weight at

birth measured according to the CDC nutrition surveillance program

standards (lbs./ounces). Birth weight may be reported in either

pounds and ounces or in grams.

Birth length: For infants and children, the participant's length measured according to the CDC nutrition surveillance program standards (1/8 inches). Birth length may be reported in either inches and eighth inches or in centimeters.

Date of last routine check-up or immunization: Month, day, and year of the last routine check-up or immunization for infants and children reported in MMDDYYYY format..

Length of time mother on WIC during pregnancy: For infant participants, the length of time mother was on WIC during this infant's prenatal period..

The following items may be reported at the discretion of individual States.

Erythrocyte protoporphyrin. That value for the measure of iron status that applies to the WIC Program certification current in April 1998.
Participation in the Food Distribution on Indian Reservations Program. The participant's reported participation in this program at the time of the most recent WIC Program certification as of April 1998.

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GA WIC PROCEDURE MANUAL III.MANAGEMENT INFORMATION SYSTEM WIC SYSTEMS FUNCTIONAL REQUIREMENTS CHECKLIST

Attachment I

C. WIC SYSTEMS FUNCTIONAL REQUIREMENTS CHECKLIST

The following checklists were taken from the WIC Functional Requirements Document (FRD) which was provided as guidance to State agencies on functions they should consider incorporating in their Management Information Systems. Please check those function/capabilities which the State Agency system currently performs or plans to perform within the next two years.

State

State

Agency Agency Function/Capabilities Performs Planned

CERTIFICATION
X X
X

Determine Basic Eligibility Of Applicant Capture basic eligibility characteristics on persons applying for WIC Maintain appointment schedule availability and produce daily appointment schedules Provide appointment notice to applicant

Determine Nutritional Risk Of Client

X

Capture required client nutrition and health characteristics needed

for certification

X Capture additional client nutrition and health characteristics

X

Assign the nutritional risk of the client

Certify Eligible Applicants

X

Capture and maintain enrollee data on certified clients

X

Issue identification card to client

X Issue identification card to client

X

Issue identification card to client

Food Package Issuance/Data

X

Prescribe enrollee food package

X

Maintain appointment schedule for enrollee food instrument pick-

up

Select and record enrollee vendor selection

Check For Dual Participation/Process Transfers

X

List dual enrollees

X

List dual participants

X

Process transfer of enrollee

Capture Investigator Data Capture enrollee record for compliance investigators

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GA WIC PROCEDURE MANUAL

Attachment II

FEDERAL FISCAL YEAR FOOD ALLOCATION

(For A Copy Of This Attachment Contact The State WIC Office At 404 657-2900)

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GA WIC PROCEDURE MANUAL CERT FORM CHANGES

Attachment III

Women's Cert Form
VOC card field for I (Issued) and R (Received).
Space for Georgia VOC Card number or name of State incoming VOC card Issued from.

Infant Cert Form
VOC card field for I (Issued) and R (Received).
Space for Georgia VOC Card number or name of State incoming VOC card Issued from.

Children's Cert Form
VOC card field for I (Issued) and R (Received).
Space for Georgia VOC Card number or name of State incoming VOC card Issued from.

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OFFICE OF
NUTRITION
GOALS AND
OBJECTIVES

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OFFICE OF NUTRITION DIVISION OF PUBLIC HEALTH GEORGIA DEPARTMENT OF HUMAN RESOURCES
Georgia State Plan for Nutrition Education in the Special Supplemental Food Program
for Women, Infants, and Children (WIC)
Fiscal Year 1999 (October 1, 1998 through September 30, 1999)
Submitted in accordance with USDA Food and Nutrition Service
Federal Regulations 246.4 - State Plan Federal Regulations 246.11 - Nutrition Education
August 15, 1998

STATE WIC PLAN - 1999

OFFICE OF NUTRITION

OFFICE OF NUTRITION
Director Frances Hanks Cook, M.A., R.D., L.D.
WIC Nutrition Program Consultants NPC - WIC (1) Carol MacGowan, M.P.H., R.D., L.D.
NPC - WIC (2) Beth Holloway, M.Ed., R.D., L.D. NPC - WIC (3) Vacant NPC WIC (4) Vacant
State Breastfeeding Coordinator NPC - WIC (1) Carol MacGowan, M.P.H., R.D., L.D.
Support Staff SS (1) Kathryn Thompson, Program Assistant SS (2) Franz Minott, Operations Analyst II

STATE WIC PLAN - 1999

OFFICE OF NUTRITION

TABLE OF CONTENTS
Page Introduction ............................................................................................................................1 Quality Assurance Model ........................................................................................................2 FFY '98 Nutrition Education Plan Summary of Objectives ......................................................3 FFY '99 Nutrition Education Plan List of Objectives ...............................................................7 Needs Assessment I.................................................................................................................9 Objective I ............................................................................................................................10 Needs Assessment II .............................................................................................................12 Objective II ...........................................................................................................................13 Needs Assessment III ............................................................................................................14 Objective III..........................................................................................................................15 Breastfeeding Promotion and Referral List ............................................................................20 Needs Assessment IV............................................................................................................22 Objective IV..........................................................................................................................23 Needs Assessment V .............................................................................................................25 Objective V...........................................................................................................................26 Needs Assessment VI............................................................................................................29 Objective VI..........................................................................................................................30 Needs Assessment VII...........................................................................................................31 Objective VII ........................................................................................................................32 Needs Assessment VIII .........................................................................................................34 Objective VIII .......................................................................................................................35 Needs Assessment IX............................................................................................................37 Objective IX..........................................................................................................................38

STATE WIC PLAN - 1999

OFFICE OF NUTRITION

INTRODUCTION
The Fiscal Year 1999 Georgia WIC Nutrition Education Plan was developed to address the health outcomes and programmatic aspects of the nutrition education component of the Georgia WIC Program. The Program needs assessment was based on:
1. Identification of health and nutrition problems of women, infants, and children in Georgia, including those participating in the WIC Program;
2. Program review reports conducted during Fiscal Years 1997 and 1998 (October 1, 1996 through September 30, 1998);
3. Evaluation of the Fiscal Year 1998 Georgia WIC Nutrition Education Plan; 4. Assessment of participant views conducted at the local agencies through consultation, site
visits, and participants Focus Groups; 5. WIC Program Ethnic Participation Report for June 1998; 6. Infant Breastfeeding Characteristics Report for FFY '97 and FFY '98 (first 6 months); 8. Quality assurance model outlined on page two (2); 9. Requests received by the Office of Nutrition.
The Georgia Department of Human Resources continues to make progress towards reaching its longrange goal, which is "A healthier generation of Georgians through primary prevention of physical and mental disabilities with early intervention and treatment." Concurrently, the goal of the Office of Nutrition is to improve the nutritional status of individuals by directing efforts toward prevention, identification, and treatment of nutrition problems. Nutrition education is the most integral strategy utilized in reaching this goal.
As the Georgia WIC Program begins Fiscal Year 1999, the Georgia Department of Human Resources currently provides prenatal care services for one third of all pregnant women in this State.
The infant mortality rate (deaths under 1 year of age per 1,000 live births) for Georgia was 9.2 in 1996, down from 10.3 in 1994. The low birth weight rate for Georgia was 8.9%, in 1995. The low birth weight for the Georgia WIC Program was 11 % in 1996 and 10.9% in 1997. Although the Georgia infant mortality rate and percentage of low birth weight infants remain high, the nutrition services provided through the Program are making a significant impact on the solution to these multifactorial issues.
Nutrition education is provided through individual participant counseling and group nutrition education classes, based on the needs identified. Implementation of nutrition education utilizes a variety of patient nutrition education materials including, but not limited to, pamphlets, slides, videotapes, food models, flipcharts, and posters. The Office of Nutrition is charged with the responsibility to supply the guidance and support needed by local agencies in the provision of effective nutrition education services.

STATE WIC PLAN - 1999

OFFICE OF NUTRITION

QUALITY ASSURANCE MODEL FOR NUTRITION SERVICES

I.

Division of Public Health and Office of Nutrition Goal: To improve the health status of participants by assuring the provision of high quality nutrition services.

II.

V.

Establishment of structure, process, outcome criteria, and standards for nutrition services. A. Program standards
1. Community assessment/ planning
2. Nutrition assessment 3. Nutrition education 4. Referral 5. Documentation 6. Evaluation 7. Staff recruitment and
training B. Guidelines for Practice C. Program and participant
outcomes
III.

Improvement of program standards.
IV.
Selection and interpretation of alternatives for program standards. A. Training/continuing
education B. Resource assistance C. Management/operational
changes D. Policy revisions

Assessment of degree of discrepancy between criteria and program participant outcomes and program standards.
A. Nutrition surveillance B. Problem oriented record
reviews C. Program reviews
ADAPTED FROM THE LANG'S MODEL

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OFFICE OF NUTRITION

FFY 1998 NUTRITION EDUCATION PLAN
Summary of Objectives
Objective I:
By September 30, 1998, ensure that 100% of local agencies have documented the provision of:
a. basic nutrition education contacts to 100% of WIC participants; b. secondary nutrition education contacts to 100% of WIC participants; c. referral screening for 100% of WIC participants; d. prescriptions for 100% of WIC participants receiving special formulas; e. dietary intakes (i.e., 24-hour recall, food frequency, diet history, etc.) for 100% of WIC
participants; f. summary and evaluation of dietary intakes for 100% of WIC participants.
Summary:
The Office of Nutrition uses eight indicators to monitor certification and nutrition education activities at the local agency level: plotting, diet assessment, risk criteria assessment, primary nutrition education contacts, secondary nutrition education contacts, breastfeeding education, high risk follow-up, and exit counseling. Exit counseling was added as an indicator in January 1998.
Local agencies are required to implement corrective actions for those areas in which less than ninety percent of the health records reviewed have appropriate documentation. The indicators provide a means of following trends in documentation and compliance with program policies. The percentages below represent the results of the program reviews completed in FFY `95- '96, the most recent complete review cycle.
1. Plotting was correct in 94% of health records reviewed in the 1995-96 review cycle.
2. Diet assessment was appropriate in 96% of health records reviewed in the 1995-96 review cycle.
3. Nutrition risk assessment and documentation was appropriate in 88% of health records reviewed in the 1995-96 review cycle.
4. Primary nutrition education contacts were documented in 94% of health records reviewed in the 1995-96 review cycle.
5. Secondary nutrition education contacts were appropriately documented in 77% of health records reviewed in the 1995-96 review cycle.

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OFFICE OF NUTRITION

6. Breastfeeding education was appropriate in 87% of health records reviewed in the 199596 review cycle.
7. Documentation of appropriate high-risk follow-up was found in 36% of relevant health records reviewed in the 1995-96 review cycle.
8. Documentation of exit counseling being provided was not evaluated in the 1995-96 review cycle.
Indicators for the FFY `97-'98 review cycle will be evaluated by August 31, 1998. This information will be provided to the local agencies by September 30, 1998 for use in program planning.
Objective II:
By September 30, 1998, evaluate the system for collecting health data (CDC Surveillance).
Summary:
The Office of Nutrition participated in a planning meeting with CDC in the Fall of 1998, the purpose of which was to evaluate how user friendly the data tables were, and how they could be made more appropriate for local use. A 1998 report of the CDC data was not produced due to a staff shortage in the Office of Nutrition. However, CDC consultants were invited to present Georgia and National data to the local agency WIC directors, on two separate occasions. In July 1998 these data were presented at a workshop in which the local agencies were given hands-on instructions on how to write results based objectives and plans.
Objective III:
To continue to increase the percentage of WIC infants in Georgia who are initially breastfed from 36% to 38% and who are breastfed until six (6) months of age from 9% to 12% by September 30, 1998.
Summary:
The semi-annual breastfeeding initiation report for FFY 98 (October 1997 through March 1998) indicates that the cumulative State breastfeeding rate in the Georgia WIC Program was 39.5%, up from 37.1% in FFY '97. This breastfeeding percentage is not reflected in the percentage of women certified as breastfeeding. In FFY '96 the Office of Nutrition and the State WIC Office developed instructions on how to certify postpartum women as breastfeeding, including those women who were not yet due for a postpartum certification. The Office of Nutrition continues to work with local agencies, in encouraging them to identify all women, as soon after delivery as possible, who breastfeed on the average of once per day and to certify them as breastfeeding.

STATE WIC PLAN - 1999

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OFFICE OF NUTRITION

The Office of Nutrition coordinated one meeting of the Georgia WIC Program Breastfeeding Advisory Committee (BFAC). This meeting was used for problem solving, updating local agency breastfeeding coordinators on new policies and expenditure requirements, sub-committee activities, and continuing education. On September 24-26, 1997 the first annual Competency Based Lactation Management Workshop was held. It is a hands-on training for staff who are new or who have limited skills in breastfeeding promotion and support. The training was well evaluated and will be repeated in September 1998.
Objective IV:
By September 30, 1998, provide nutrition education services to local agencies, and the general public by:
a. having appropriate education materials available and accessible to local agencies and the general public;
b. providing program planning and technical assistance to local agencies; c. completing the Fiscal Year 1998 Nutrition Education Plan.
Summary:
Competency Based Nutrition Skills Workshops, Levels I III were provided for local agency WIC staff. Approximately 300 local agency staff during FFY '98 attended these workshops.
Nutrition education materials were evaluated by the Nutrition Education Resources Committee and approved for purchase by the Office of Nutrition. In addition, the Office of Nutrition evaluated locally developed or purchased materials, upon request. During the local agency program reviews, materials in the clinics are assessed for appropriateness.
On July 14-16, 1998 the Office of Nutrition coordinated a workshop on how to identify data source, evaluate data, and write results based plans. The Office of Nutrition and the local agencies are now in the process of writing results based plans. The local agency plans are due in the Office of Nutrition on June 1, 1999, and will cover FFY `2000-2001.
Objective V:
By September 30, 1998, meet the training needs of persons responsible for providing nutrition education and WIC Certification services by:
a. providing inservice training and technical assistance to local agencies and State nutrition staff.
b. promoting the implementation of the American Dietetic Association Internship Program for Georgia public health nutritionists.

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OFFICE OF NUTRITION

Summary:
The Office of Nutrition coordinates and provides annual training through the Competency Based Nutrition Skills Workshops, levels I-III, the Competency Based Lactation Management Workshop, the Nutrition Assistant Workshop, and an additional workshop that is tailored to meet the needs of the local agency WIC directors.
Since 1992, the dietetic internship has had sixty-one (61) interns complete the program. Sixty (60) interns have taken the Commission on Dietetics Registration Examination. Fifty-five (55) interns have passed the examination. The 1998 class has thirteen (13) interns, making the total now enrolled in the program seventy-four (74). Of those employed in public health, approximately ninety percent have remained employed in public health after completion of the program.
Objective VI:
Develop and monitor the use of the Georgia Nutrition Guidelines for Practice by September 30, l998.
Summary:
The revised Georgia Nutrition Guidelines for Practice were distributed to the local agencies in spring 1997. On November 5 and 6, 1997 a distance learning training on how to use the guidelines was provided. The training included case studies related to select guidelines from each major topic area. During the local agency program reviews the local agency WIC directors and clinic staff are asked about how they use the guidelines in providing services.
Objective VII:
By September 30, l998, continue to target WIC services to the homeless in Fulton County.
Summary:
The Fulton County Health Department continues in its sixth year of delivering WIC services in homeless shelters. A caseload of 76 homeless participants are currently being served.
Objective VIII:
To provide specifically designed nutrition education services to homeless WIC participants by September 1998.
Summary:

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OFFICE OF NUTRITION

This objective was not accomplished. Ongoing services are provided to homeless participants. See Objective VII, above.

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OFFICE OF NUTRITION

Objective I:

FFY 1999 NUTRITION EDUCATION PLAN
LIST OF OBJECTIVES

By September 30, 1999, ensure that 100% of local agencies reviewed have documented: a. provision of basic nutrition education contacts to 100% of WIC participants; b. provision of secondary nutrition education contacts to 100% of WIC participants; c. prescriptions for 100% of WIC participants; d. dietary intakes (i.e., 24-hour recall, food frequency, diet history, etc.) and evaluation for 100% of WIC participants; e. appropriate nutritional risk assessment for 100% of WIC participants; f. accurate plotting of anthropometric measurements for 100% of WIC participants; g. encouragement to breastfeed for 100% of prenatal participants.

Objective II:

By September 30, 1999, set up a system for monthly and biannual reporting of CDC PedNSS and PNSS data to local agencies, for use in planning.

Objective III:

To continue to increase the percentage of WIC infants in Georgia who are initially breastfed from 39% to 42%, and who are breastfed until six (6) months of age from 8% to 15% by September 30, 1999.

Objective IV:

By September 30, 1999, provide nutrition services to local agencies and the general public by: a. having appropriate nutrition education materials available and accessible to local agencies and
the general public; b. providing program planning and technical assistance to local agencies for fiscal years 2000-
2001; b. completing the Fiscal Year 1999 Nutrition Education Plan.

Objective V:

By September 30, 1999, meet the training needs of persons responsible for providing nutrition education and WIC Certification services by: a. providing inservice training and technical assistance to local agencies and State nutrition staff. b. promoting the implementation of the American Dietetic Association Dietetic Internship Program for Georgia public health nutritionists.

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OFFICE OF NUTRITION

Objective VI:
Develop and monitor the use of the Georgia Nutrition Guidelines for Practice by September 30, 1999.
Objective VII: By September 30, 1999, continue to target WIC services to the homeless in Fulton County.

STATE WIC PLAN - 1999

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OFFICE OF NUTRITION

NEEDS ASSESSMENT I
In Fiscal Year 1987 a program review system was instituted in which 20% of the State clinics would be randomly selected for review. Additional clinics are selected in order to assure that at least 20% of the clinics (up to a maximum of 5) in each local agency are reviewed. In Fiscal Year '92 the State began reviewing each local agency every other year. The largest clinic in each local agency will be automatically included in each review, since it represents a majority of the participants in the local agency.
The record selection for local agency reviews is weighted towards women; 50 of the health records selected are women's, and 50% infants' and children's. Results of the reviews are used to determine where the State stands relative to selected areas of certification, and allows the Office of Nutrition to examine trends and identify problems. The results provide the rationale for making changes in policies, procedures and work plans, and planning for the provision of appropriate training and technical assistance.
A summary of program reviews conducted during Fiscal Years 1994 and 1995 revealed the following:
1. The documented provision of basic nutrition education contacts remained at 96% in Fiscal Years 1994 and 1995.
2. The documented provision of secondary nutrition education contacts remained at 78%.
3. The documentation for dietary intake and evaluation was 96%, up from 91% in Fiscal Years 1991/92.
4. The documentation for nutritional risks was 89% up from 78% in Fiscal Year 1991/92.
5. Plotting of anthropometric measurements was appropriate in 90% up from 89% in Fiscal Year 1991/92.
6. Documentation for encouragement to breastfeed was 81% up from 71% in Fiscal Year 1991/92.
7. Documentation of high risk follow-up was
8. Documentation of the provision of exit counseling was appropriate in, the local agencies which were reviewed from January through August 1998.

STATE WIC PLAN - 1999

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OFFICE OF NUTRITION

OBJECTIVE I: By September 30, 1999, ensure that 100% of local agencies reviewed have documented:
a. provision of basic nutrition education contacts to 100% of WIC participants; b. provision of secondary nutrition education contacts to 100% of WIC participants; c. prescriptions for 100% of WIC participants; d. dietary intakes (i.e., 24-hour recall, food frequency, diet history, etc.) and evaluation for
100% of WIC participants; e. appropriate nutritional risk assessment for 100% of WIC participants; f. accurate plotting of anthropometric measurements for 100% of WIC participants; g. encouragement to breastfeed for 100% of prenatal participants.

EVALUATION DESIGN:

Comparison of the program review reports from federal fiscal years 1995/96, with fiscal years

1997/98.

Action Steps

Resources

Milestones

1. Produce a summary of program review findings conducted during FFY `97/'98.

NPC - WIC (2)

12/31/98

2. Conduct a comparison of program review reports from FFY `95/'96 and FFY `97/'98.

NPC - WIC (2)

12/31/98

3. Based on the above assessment and comparison, identify specific areas or local agencies that require technical assistance.

NPC - WIC (2)

12/31/98

4. Investigate and develop appropriate methods for the alleviation of any deficiencies, (e.g. form revisions, training, alternative methods of delivering and documenting services).

All NPC - WIC

12/31/98

5. Revise FFY 2000 review

NPC WIC (1)

9/30/98

STATE WIC PLAN - 1999

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OFFICE OF NUTRITION

tool as needed.
6. Continue to research and update Nutrition Risk Criteria.
7. Conduct at least 10 local agency WIC Program reviews.
8. Monitor the health management of all WIC infants discharged on hospital based and other special formulas through local agency program reviews.

NPC WIC (2) All NPC - WIC All NPC - WIC

9/30/98 9/30/98 9/30/98

STATE WIC PLAN - 1999

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OFFICE OF NUTRITION

NEEDS ASSESSMENT II

Georgia's Pediatric Nutrition Surveillance System (PedNSS) tracks indicators for the nutritional status of the Georgia WIC pediatric population through anthropometric and hematological measurements. Georgia's Pregnancy Nutrition Surveillance System (PNSS) tracks indicators for the nutritional status of the prenatal and early postpartum population. A close relationship exists between optimal nutritional status and positive health outcomes. Thus improvements made in WIC participants' diets, through nutrition education and food supplementation, should contribute towards improved nutritional status and health outcomes.

The WIC population is at increased risk for health problems by nature of the Program's requirements for eligibility: low economic status and high nutritional risk. Measurements tracked by the PedNSS and PNSS are strong indicators for WIC Program success in Georgia as a significant number of WIC participants in 1998 were nutritionally eligible based on anthropometric and/or hematological risks.

Data from the 1997 Georgia PedNSS show the percentage of children enrolled in Georgia's WIC Program falling below the 5th or above the 95th percentile as follows:

Short stature (low height for age)

9.0%

Overweight (high weight for height)

9.0%

Low birth weight (less than 2,500 gm, or 5.5 lbs.)

10.9%

Anemia

- low hemoglobin

16.7%

- low hematocrit

13.6%

Ideally, no more than 5% of children should fall below 5% or above 95% in these health indicators.

Data from the 1997 Georgia PNSS show the percentage of women enrolled in the Georgia WIC Program falling below the 5th or above the 95th percentile as follows:

Pre-pregnancy weight status very underweight - underweight - overweight - very overweight

Anemia

- 1st trimester - 2nd trimester - 3rd trimester
- postpartum

5.1% 10.2% 13.7% 25.1%
7.1% 11.0% 34.2% 40%

STATE WIC PLAN - 1999

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OFFICE OF NUTRITION

OBJECTIVE II: By September 30, 1999, set up a system for monthly and biannual reporting of CDC PedNSS and PNSS data to local agencies, for use in planning.

EVALUATION DESIGN: System is in place. Information from the PedNSS and PNSS reports are incorporated in local agency plans.

Action Steps
1. Work with local agencies on utilization methods of the nutrition surveillance systems within the local agency nutrition services plans.

Resources All NPC - WIC

Milestones 09-30-99

2. Provide annual reports of PedNSS data to all health districts.

All NPC - WIC

09-30-99

3. Facilitate the use of monthly surveillance data in local health clinics for targeting WIC services to children at highest risk.

All NPC - WIC

09-30-99

STATE WIC PLAN - 1999

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OFFICE OF NUTRITION

NEEDS ASSESSMENT III
The Georgia Department of Human Resources, Division of Public Health Position Paper on Breastfeeding states that if the children of Georgia are to be healthy and strong, it is essential that they receive the best possible nutrition when they are infants. Research findings have documented the benefits of human milk and lactation, and support the concept that breastfeeding is one of the most important factors in ensuring optimal infant health and reducing high infant mortality. In addition to the nutritional benefits for the infant, breastfeeding offers unique physiological and psychological advantages to both the mother and the infant.
The 1984 Surgeon General's Workshop on Breastfeeding and Human Lactation recommended expanding the knowledge of health providers through continuing education programs and establishing breastfeeding support networks. A sound program of information and support is necessary to promote the successful establishment and maintenance of breastfeeding. Such a program should be integrated into the health care system and should encompass both the prenatal and postpartum period.
A prospective infant feeding study was conducted in 1986-87, the purpose of which was to set a base line and determine breastfeeding patterns of women attending WIC clinics in Georgia. The study results indicated 24% of these women initially breastfed; only 6% continued for 6 months or longer. In 1990-91, the breastfeeding study was again conducted in the Georgia WIC population. Data indicated that the rates of breastfeeding had increased to 35% for initiation of breastfeeding and to 8% for a duration of 6 months or more. These studies allowed the Office of Nutrition to start monitoring breastfeeding trends in the WIC population, set educational objectives, train public health staff, and design programs to promote breastfeeding as part of Georgia's commitment to raise a healthier generation of Georgians.
In FFY 1995, the Office of Nutrition coordinated the development of the Infant Feeding Characteristics System. Using data derived from the Infant WIC Assessment/Certification Form, a report is produced on a monthly and cumulative (by FFY) basis by county, local agency and State Agency. The March 1998 cumulative report indicated that 39.5% of infants initiated breastfeeding (up from 37.1% in FFY '97). Accurate completion of the form by clinic staff is an issue currently being addressed by the Office of Nutrition, in cooperation with local agency staff. In order to better capture 6-month and 1 year duration of breastfeeding, the WIC Assessment/Certification Form for children now includes a space for collection of breastfeeding weeks between the ages of 11 and 16 months. This data has been collected on a regular basis since January 1998, but an analysis has not yet been done.
In 1990, the U.S. P.H.S. released the report Healthy People 2000. In this report the National objective for breastfeeding is to increase to at least 75% the proportion of mothers who breastfeed their babies in the early postpartum period and to at least 50% the proportion who continue until their babies are 5 to 6 months old. Georgia's programs to promote and support breastfeeding must strive to contribute to the achievement of this objective for the Nation.

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OFFICE OF NUTRITION

OBJECTIVE III: To continue to increase the percentage of WIC infants in Georgia who are initially breastfed from 39% to 42%, and who are breastfed until six (6) months of age from 8% to 15% by September 30, 1999.

EVALUATION DESIGN: Breastfeeding data derived from the WIC/Assessment Certification Form will be used to evaluate the breastfeeding initiation and average duration rates for FFY '98 and `99.

Action Steps
1. Coordinate Statewide breastfeeding activities.

Resources NPC-WIC (1)

Milestones 09-30-99

2. Coordinate breastfeeding promotion and support efforts with Child Health, Women's Health and Immunization sections.

NPC-WIC (1)

09-30-99

3. Facilitate breastfeeding promotion and support efforts, among local agencies, through coordination and referrals. See pages 20-21 for a referral list of local agency breastfeeding coordinators.

NPC-WIC (1)

09-30-99

4. Monitor the utilization rate of breastfeeding educational materials.

NPC-WIC (1)

09-30-99

5. Evaluate breastfeeding materials, on an ongoing basis, for content and reading level.

NPC-WIC (1)

09-30-99

6. Obtain materials, as needed, for the OON breastfeeding resource files.

NPC-WIC (1)

09-30-99

STATE WIC PLAN - 1999

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OFFICE OF NUTRITION

7. Monitor breastfeeding rates throughout the State on a quarterly basis, using the Infant Breastfeeding Characteristics Report, and provide monthly reports on breastfeeding rates to each local WIC agency.
8. Implement inclusion of breastfeeding data in the CDC Pediatric Nutrition Surveillance System.
9. Work with the Office of Epidemiology and continue to investigate different methods for determining breastfeeding rates in the maternal and child health population, through public health clinics, hospitals and private health care providers.
10.Provide ongoing technical assistance to local agencies in developing, implementing, and maintaining a strong breastfeeding component in the WIC Program.
11.Work with local agencies in the development of breastfeeding program plans that work towards ensuring participant access to breastfeeding education and support during the prenatal and postpartum periods.
STATE WIC PLAN - 1999

NPC-WIC (1) NPC-WIC (1) NPC-WIC (1)
All NPC-WIC NPC-WIC (1)
- 17 -

09-30-99 09-30-99 09-30-99
09-30-99 09-30-99
OFFICE OF NUTRITION

12.Evaluate local agency updates on breastfeeding promotion and support.
13.Evaluate local WIC agency breastfeeding related activities through monitoring of health records, staff interviews, and annual breastfeeding plan updates.
14.Work with the local agencies to establish guidelines for a positive clinic environment that endorses breastfeeding as the preferred method of infant feeding.
15.Work with local agencies to establish systems for assuring that mothers who are separated from their infants are able to continue providing their infants with breastmilk.
16.Work with local agencies to assure that task appropriate breastfeeding information is included in staff orientation.
17.Work with local agencies to assure that regular educational opportunities are available to staff.

NPC-WIC (1) All NPC-WIC NPC-WIC (1) NPC-WIC (1) NPC-WIC (1) NPC-WIC (1)

09-30-99 09-30-99 09-30-99 09-30-99 09-30-99 09-30-99

STATE WIC PLAN - 1999

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OFFICE OF NUTRITION

18.Continue to encourage the expansion of the role of breastfeeding coordinators in order to provide services and training across programs.
19.Work with local agencies in the expansion of breastfeeding services through such means as peer counselor programs, support groups, pump loan programs, and coordination with the Medicaid Program.
20.Work with local agencies to form community coalitions based on the Georgia Breastfeeding Project model. Work with existing coalitions to maintain strong working groups.
21.Encourage local agencies to establish referral systems with hospital and community resources in order to assure continuity of education and support services for prenatal and breastfeeding women.
22.Encourage a cooperative initiative between local WIC agency breastfeeding projects and community or hospital task forces.

NPC-WIC (1) NPC-WIC (1) NPC-WIC (1) NPC-WIC (1) NPC-WIC (1)

STATE WIC PLAN - 1999

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09-30-99 09-30-99 09-30-99 09-30-99 09-30-99 OFFICE OF NUTRITION

23.Collaborate with the Georgia Task Force for Breastfeeding to promote statewide membership: local agency staff, community advocates, private citizens, etc.
24.Coordinate two (2) Statewide meetings of the Georgia WIC Program Breastfeeding Advisory Committee.
25.Complete the revision of the clerical/pilot it in at least two (2) local agencies.
26.Evaluate the implementation of the Lactation Specialist SelfStudy modules statewide.
27.Update local agencies, on a quarterly basis, about new materials, workshops, and information related to breastfeeding.
28.Produce a report documenting breastfeeding activities in the State of Georgia.
29.Assist local agencies in setting up inventory systems for breast pumps, to include documentation on usage.

NPC-WIC (1)
NPC-WIC (1) NPC-WIC (1) NPC-WIC (1) NPC-WIC (1) NPC-WIC (1) NPC-WIC (1)

STATE WIC PLAN - 1999

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09-30-99
09-30-99 09-30-99 09-30-99 09-30-99 09-30-99 09-30-99
OFFICE OF NUTRITION

BREASTFEEDING SUPPORT AND PROMOTION REFERRAL LIST

Coordination among local agency breastfeeding projects is encouraged. Local agency breastfeeding coordinators, listed below, are the best source of information within the State. La Leche League of Georgia chapters exist in several communities within the State and may be contacted.

Local Agency

Breastfeeding Coordinator

Phone

1-1 (Rome)

Kathy Kerce

(706) 295-6661

1-2 (Dalton)

Carol Srymanske

(706) 272-2342

2

(Gainesville)

Mary Ann Dolan

(770) 535-5874

3-1 (Cobb/Douglas)

Lora Breda

(770)514-2328

3-2 (Fulton)

Noretta Bunyon

(404) 730-1441

3-3 (Clayton)

Vacant: Contact Kathy Thomas Nutrition Services Director

(404) 961-1330

3-4 (Gwinnett)

Marcia Morris

(770) 995-4616

3-5 (DeKalb)

Melia Phifer Clifton Springs Health Center

(404) 244-2213

Darlene Drury Kirkwood Health Center

(404) 370-4666

Tammy Fuller Doraville Health Center

(770) 457 - 4234

Becky Lyons East DeKalb Health Center

(770) 469-3129

Julia Okora Central DeKalb Health Center

(404) 298-5303

4

(LaGrange)

Becky Lewis

STATE WIC PLAN - 1999

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(706) 845-4035 OFFICE OF NUTRITION

5-1 (Dublin)

5-2 (Macon)

6

(Augusta)

7

(Columbus)

8-1 (Valdosta)

8-2 (Albany) 9-1 (Savannah) 9-2 (Waycross) 9-3 (Brunswick) 10 (Athens) 11 (Southside)
12 (Grady)

Margaret Turner Shirleen Crocker Rebecca Black Vacant: contact Jackie Miller Nutrition Services Director Vacant: contact Janet McClure Nutrition Services Director Martha Shackelford Pam Ehret Susan McLendon Nikki Black Ann Sears Dana DaCosta
Arlene Toole

(912) 274-7619 (912) 751-6488 (404) 860-8935 (706) 321-6280
(912) 333-5290
(912) 430-4111 (912) 651-2640 (912) 526-8108 (912) 264-3907 (404) 542-9004 (404) 688-1350 Extension 244 (404) 616-4933

STATE WIC PLAN - 1999

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OFFICE OF NUTRITION

NEEDS ASSESSMENT IV
The Office of Nutrition is responsible for the identification and development of resources and educational materials for use in the local agencies, including materials in languages other than English for local agencies where a substantial number of persons do not speak or read the English language.
The WIC Program Ethnic Participation Report for May 1998, revealed that Georgia's WIC Program served 22,956 Hispanic participants and 3,208 Asian/Pacific Islander participants. These figures indicated a potential non-English speaking population of up to 26,164 participants (11% of the total caseload). The total WIC caseload for May 1998 was 232,809 participants. The Office of Nutrition has targeted 11% of the WIC caseload as non-English speaking participants.
The Office of Nutrition receives requests from local agency personnel and the general public for nutrition education materials.
The Office of Nutrition is responsible for developing a State Nutrition Education Plan and providing technical assistance and training to local agencies regarding their nutrition education plans.

STATE WIC PLAN - 1999

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OFFICE OF NUTRITION

OBJECTIVE IV: By September 30, 1999, provide nutrition services to local agencies and the general public by: c. having appropriate nutrition education materials available and accessible to local agencies and
the general public; b. providing program planning and technical assistance to local agencies for fiscal years 2000-
2001; c. completing the Fiscal Year 1999 Nutrition Education Plan.

EVALUATION DESIGN: a. Summary of utilization of materials by local agency. b. Review and approval of local agency nutrition education plans for fiscal years 2000-2001. c. Completion of the Fiscal Year 1999 Nutrition Education Plan. Summary of accomplishments
for Fiscal Year 1999.

Action Steps

Action Steps

Milestones

1. Develop criteria for the evaluation of nutrition education audiovisual materials.
2. Maintain an adequate supply of nutrition education materials for districts, local agencies, and the general public.

WIC NPC (4)
Nutrition Education Resources Committee
NPC WIC (4) SS (1)

09-30-99
12-30-98 6-30-99

3. Provide technical assistance to local agencies for the development and implementation of nutrition education plans.

NPC WIC (all)

Ongoing

4. Conduct the annual nutrition education survey to determine WIC participant's views.

NPC WIC (4)

09-30-99

5. Write the results of the current year Nutrition Education Plan and develop the fiscal year 2000 Nutrition Education Plan.

NPC WIC (4)

09-30-99

6. Evaluate and approve local agency plans and progress reports.

NPC WIC (4)

09-30-99

7. Evaluate local agency utilization

NPC WIC (4)

09-30-99

STATE WIC PLAN - 1999

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OFFICE OF NUTRITION

of non-English speaking nutrition education materials. 8. Develop and coordinate pictorial Nutrition Education materials for non-English speaking WIC participants.
9. Respond to requests from the general public and document each request in OON files.
10. Provide nutrition education materials and WIC outreach materials to agencies sponsoring activities.

NPC WIC (4) NPC OON (all) NPC WIC (4)

09-30-99 Ongoing 09-30-99

STATE WIC PLAN - 1999

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OFFICE OF NUTRITION

NEEDS ASSESSMENT V
The Office of Nutrition is responsible for training staff who provide nutrition education. Methods to accomplish this include inservice training and technical assistance for professional and paraprofessional staff (nutrition assistants) at local agencies; conducting Competency Based Skills Workshops, statewide nutrition conferences and meetings; and writing continuing education articles. Training is designed to provide nutrition education training for each nutritionist, nurse, physician, and paraprofessional/nutrition assistant providing nutrition education to WIC participants.
The Office of Nutrition has identified breastfeeding, weight gain in pregnancy, and infant/child obesity as focal points for staff development.

STATE WIC PLAN - 1999

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OFFICE OF NUTRITION

OBJECTIVE V: By September 30, 1999, meet the training needs of persons responsible for providing nutrition education and WIC Certification services by:
a. providing inservice training and technical assistance to local agencies and State nutrition staff.
b. promoting the implementation of the American Dietetic Association Dietetic Internship Program for Georgia public health nutritionists.

EVALUATION DESIGN: 1. Number of health providers receiving nutrition training 2. Number of technical assistance visits c. Number of interns completing the Dietetic Internship Program, passing the Registered
Dietitian examination, and continuing employment in Public Health

Action Steps

Resources

Milestones

1. Continue DHR sponsored Dietetic Internship Program to prepare public health nutritionists for R.D. eligibility.

Director - OON

09-30-99

2. Monitor revised standards for WIC nutrition education contacts based on USDA regulations.

NPC WIC (4)

09-30-99

3. Perform at least one (1) technical assistance visit to each local agency.

NPC OON (all)

09-30-99

4. Based on the results of these visits, provide further technical assistance as needed.

NPC OON (all)

09-30-99

5. Conduct a training survey of local agencies and include local agency staff on planning committees for training targeted at clinic staff.

NPC WIC (4)

09-30-99

STATE WIC PLAN - 1999

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OFFICE OF NUTRITION

6. Provide nutrition training for approximately 1000 local health care providers:
a. Competency Based Skills Workshop Level IIII b. Competency Based
Skills for nutrition assistants
7. Through the Competency Based Nutrition Skills Workshops, provide training to staff on current nutrition issues that impact the provision of nutrition services at the local level.
8. Conduct nutrition updates during Coordinators' Meetings.
9. Provide technical assistance in the area of nutrition/medical research for all districts through the use of the internet, and other resources available to the Office of Nutrition.
10. Co-sponsor additional training with other agencies who have goals similar to those of the Office of Nutrition activities with other agencies.

NPC OON (all)
NPC OON (all) NPC OON (all) NPC OON (all) NPC OON (all)

09-30-99
09-30-99 09-30-99 09-30-99 09-30-99

STATE WIC PLAN - 1999

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OFFICE OF NUTRITION

11. Prepare and monitor training contracts and prepare summary reports.
a. Program planning for nutrition services
b. Nutrition assistant development workshop
c. Competency based skills workshops
d. Care of the Pregnant Family workshop
e. Nursing basic skills f. District training requested

NPC OON (all)

09-30-99

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OFFICE OF NUTRITION

NEEDS ASSESSMENT VI
Quality assurance is an important component of all phases of nutrition care. Health care providers need to be able to identify the essential elements of nutrition care and to assure that the services they provide are based on the most recent findings of nutrition science. All providers of nutrition care need to be able to assess nutritional status, identify nutrition related health problems, select effective intervention strategies, develop and implement nutrition care plans, and maintain patient monitoring and follow-up.
Seventy guidelines have been developed for the Georgia Nutrition Guidelines for Practice. These Guidelines cover normal as well as high-risk conditions and can be applied to the prenatal and postpartum woman, infant, and child.
Additional guidelines need to be developed to address other areas of nutrition management.

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OFFICE OF NUTRITION

OBJECTIVE VI: Develop and monitor the use of the Georgia Nutrition Guidelines for Practice by September 30, 1999.

EVALUATION DESIGN: Identify the percentage of the districts that use the Georgia Nutrition Guidelines for Practice in the management of their patients and the training of staff.

Action Steps

Resources

Milestones

1. Provide technical assistance in implementing new nutrition guidelines during Coordinators Meetings, district site visits, Competency Based Skills Workshops, and statewide training.

NPC OON (all)

Ongoing

2. Perform subjective evaluation of the Georgia Nutrition Guidelines for Practice as part of local agency program reviews.

NPC WIC (All)

09-30-99

3. Update teaching packets for Guidelines presentations when applicable.

NPC OON (All)

09-30-99

4. Provide technical assistance and training to local agencies and programs on the Georgia Nutrition Guidelines for Practice.

NPC OON (All)

09-30-99

5. Revise existing Georgia Nutrition Guidelines for Practice to assure the current research references are included.

NPC WIC (2)

09-30-99

STATE WIC PLAN - 1999

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OFFICE OF NUTRITION

STATE WIC PLAN - 1999

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OFFICE OF NUTRITION

NEEDS ASSESSMENT VII
Currently there are 10,000 - 15,000 homeless persons in the State of Georgia; 5,000 - 8,000 of which are in the Atlanta metropolitan area. Of these, 45% are women, infants and children. Besides being homeless, these individuals have limited access to medical care and nutritional support. There have been several organizations that have addressed the needs of the homeless, one of which provides medical care to this vulnerable population. The Atlanta Community Health Program for the Homeless (ACHPH) began in 1984 as a completely volunteer program with its headquarters based in St. Joseph's Hospital in Atlanta. Health professionals began providing health care to homeless persons in shelters at night.
ACHPH is one of several health care agencies in the United States that utilizes a "mobile health approach". They provide physical evaluation of health problems and treat infections, colds, etc. Hematological and anthropometric assessments are a part of the physical assessment. Persons with chronic illnesses, such as hypertension, are monitored and referred to Community Health Centers for follow-up. The Fulton County Health Department WIC Program has been working with ACHPH staff who provides WIC services to eligible homeless participants. However, these clients must travel to designated homeless shelters to receive these services. Approximately 500 participants have received WIC services through this effort since February 1989. Eligible participants are certified according to customary WIC procedures and are given thirty (30) days advance notice prior to disqualification.
Although WIC is providing benefits to homeless women, infants and children, services need to be continued to serve a greater number of WIC eligibles for WIC certification and voucher issuance as an integral part of the ACHPH mobile health care agency.

STATE WIC PLAN - 1999

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OFFICE OF NUTRITION

OBJECTIVE VII: By September 30, 1999, continue to target WIC services to the homeless in Fulton County.

EVALUATION DESIGN:

Monitor caseload participation of WIC benefits for the eligible homeless population.

Action Steps

Resources

Milestones

1. To provide on-site WIC assessment, certification, and voucher issuance to homeless individuals in various shelters located in Fulton County via the Mercy mobile health vans.

Fulton County WIC Program

09-30-99

2. To maintain two positions, a WIC nutritionist and a paraprofessional, who provide WIC certification, voucher issuance, and nutrition education as part of the Mercy mobile health team.

Fulton County WIC Program

09-30-99

3. To supply three health sites with necessary hematological and anthropometric equipment for conducting WIC assessments.
4. To integrate WIC with other health services provided by the Mercy mobile health vans, Fulton County Health Department and Grady Memorial Hospital.

Fulton County WIC Program Fulton County WIC Program

09-30-99 09-30-99

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OFFICE OF NUTRITION

5. To develop and deliver a specific nutrition education plan that will meet the specific needs of the WIC homeless population.

NPC WIC (4) Fulton County WIC Program

6. To ensure that accountability and audit trails are maintained through use of clinic code 628.

Fulton County WIC Program

7. To ensure the continuation of WIC services when subsequent voucher issuance occurs.

Fulton County WIC Program

8. To monitor the specifically tailored food packages which meet the unique needs of the homeless WIC population.

NPC WIC (4)

9. To provide participants with food packages via computerized vouchers.

Fulton County WIC Program

09-30-99 09-30-99 09-30-99 09-30-99 09-30-99

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OFFICE OF NUTRITION

NEEDS ASSESSMENT VIII
In order to assess the eligible homeless participants for WIC services according to existing policies and procedures, identification of these individuals throughout all local agencies in Georgia will be conducted.
Identification of these eligible homeless women, infants, and children will allow the provision of WIC benefits with tailored nutrition education delivery to this very needy population.

STATE WIC PLAN - 1999

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OFFICE OF NUTRITION

OBJECTIVE VIII: To provide specifically designed nutrition education services to homeless WIC participants by September 1999.

EVALUATION DESIGN: Implementation of specifically designed nutrition education services for homeless WIC participants in each district.

Action Steps 1. Provide technical
assistance to local agencies related to analyzing the homeless needs assessment.

Resources NPC WIC (4)

Milestones 09-30-99

2. Monitor the compliance of USDA Homeless Regulations within all local agency programs to include the following conditions applicable to homeless facilities and institutions: a. The program must benefit the participant not the homeless facility or institution. b. WIC foods must not be used in communal feeding. c. The homeless facility or institutional proxies may not, as a standard procedure, pick up WIC food instruments for all program participants in their respective facilities to transact the food instruments in bulk. d. No restrictions or constraints can exist relative to program participation.

NPC WIC (4)

09-30-99

STATE WIC PLAN - 1999

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OFFICE OF NUTRITION

3. To contact and maintain a status report from all homeless sites serving women, infants, and children for compliance to conditions applicable to Homeless Facilities and Institutions.
4. Evaluate procedures for certification, alternative food packages and nutrition education services for disaster victims enrolled in the WIC program.

NPC WIC (4) NPC WIC (4)

09-30-99 09-30-99

STATE WIC PLAN - 1999

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OFFICE OF NUTRITION

NEEDS ASSESSMENT IX
Since the inception of the WIC Program, federal policy has permitted state agencies to develop nutrition risk criteria, within federal parameters, for use in their local programs to determine program eligibility. In 1989, Congress mandated in Public Law 101-147 that USDA conduct a review of risk criteria and the priority system. In 1993 USDA awarded a grant to the National Academy of Sciences' Institute of Medicine (IOM) to undertake a comprehensive review of most of the nutrition risk criteria in use by WIC state agencies. In 1996, IOM released its report of this study: WIC Nutrition Risk Criteria: A Scientific Assessment. The report includes a detailed review of the literature underlying each risk criterion, along with the committee's recommendations concerning each criterion.
Following the publication of the IOM report, the National Association of WIC Directors (NAWD) and the USDA Food and Nutrition Service (FNS) established a collaborative partnership to address the issues and recommendations of the IOM report, and to develop an action plan to achieve greater consistency among state agencies in the use and application of sound and appropriate nutrition risk criteria.
State agencies are expected to implement the National Risk Criteria no later than April 1, 1999. A draft of the proposed National Risk Criteria was made available to the Office of Nutrition in April 1998, and the final copy was officially received in July 1998. The responsibility of developing a plan and implementing the National Risk Criteria was assigned to the Georgia WIC Program Procedures, Assessment, Regulations (PAR) Committee. The PAR Committee was asked to work with the local agencies and representatives of the different computer systems in local agency WIC programs in order to meet the April 1, 1999 implementation date.

STATE WIC PLAN - 1999

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OFFICE OF NUTRITION

Objective IX: To implement, by April 1, 1999, the National Risk Criteria issued under USDA WIC Policy Memorandum 98-9.

Evaluation Design: By April 1, 1999, the following activities will be completed: 1. The National Risk Criteria will be implemented. 2. Revisions will be made to the Georgia WIC Procedures Manual and to the Risk Criteria
Handbook, to include the National Risk Criteria. 3. Systems revisions will be in place in all local agencies. 4. Local agency staff will have been trained on the use of the National Risk Criteria.

Action Steps 1. Meet with representatives of all local
agency and State WIC computer systems.

Resources NPC WIC (1)
State WIC Office (SWO) Systems Unit

Milestones 05-01-98

Local Agency (LA) WIC Systems Representatives

2. Develop timeline for implementation of national risk criteria.
3. Meet with PAR Committee to evaluate national risk criteria and existing state risk criteria.

NPC WIC (1) SWO Systems Unit WIC Systems Programmers
NPC WIC (1) NPC WIC (2)

05-01-98
05-15-98 06-12-98

4. Develop chart to include national risk criteria, state risk criteria, and PAR Committee recommendations. Send out to local agencies for comment

NPC WIC (1) NPC WIC (2)

07-31-98

5. Develop computer program specifications.

SWO Systems Unit

08-31-98

6. Forward specifications to all state systems: Athens, DeKalb, Mitchell and McCormick, Viking, and HOST.

SWO Systems Unit

08-31-98

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OFFICE OF NUTRITION

7. Revise WIC Assessment/ Certification Forms.
8. Program and test new specifications on all systems
9. Develop training packets.
10. Provide local agency training.
11. Implement national risk criteria.

NPC WIC (1) NPC WIC (2) SWO Systems Unit SWO Policy Unit
SWO Systems Unit LA WIC Systems Programmers
NPC WIC (1) NPC WIC (2) SWO Systems Unit SWO Policy Unit
NPC WIC (1) NPC WIC (2) SWO Systems Unit SWO Policy Unit
NPC WIC (1) NPC WIC (2) SWO Systems Unit SWO Policy Unit Local Agencies

10-15-98 12-31-98 02-01-99 03-01-99 04-01-99

STATE WIC PLAN - 1999

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OFFICE OF NUTRITION