FY 13 Administrative Monitor Form by 5IQG64GM

VIEWS: 6 PAGES: 20

									                                       Missouri Department of Health and Senior Services                                     LOCAL AGENCY NAME:
                                                  WIC and Nutrition Services                                     WIC      SITES MONITORED (by #):                 MONITOR DATE(S):
   State Office Use Only

                                                                                                             Operations
                                         ADMINISTRATIVE REVIEW WORKSHEET                                       Manual
                                                                                                               (WOM),
                                                       Reporting Fiscal Year: 2013                            Health & WIC MONITOR STAFF:
                                                                                                              Nutrition                                   Repeat
                                                                                                              Handbook                                   Finding
                                                                                                                                 RATING                                                REVIEWER TIPS
                                                                                                    Scope of   (HNAH)                                       ?
                                                                                                                              Not Applicable, Meets
                                                       DESCRIPTION                                    Work    Reference         Standards, Needs
                                                                                                     (SOW)   No. or Other Improvement, or Unsatisfactory Indicate *For all findings, statement can be used for assessment when
                                                                                                                                                         Yes with                 other methods cannot be used
                                                                                                   Reference
                                                                                                       No.                NA MS NI U                        X
                           I. CERTIFICATION
                           A. Regulatory Time Frames:

                                                                                                                                                               (Clinic Observation, desk audit, and/or statement) To ensure that
                                                                                                                                                               accurate records are kept of the date of requests for service, the local
                                                                                                                                                               agency shall, at the time of each request, record the applicant's name,
                                                                                                                                                               date, phone #, address and program category in the MOWINS
                                                                                                                                                               Prescreening screen. This can be done as a Clinic Observation also to
                                              1. Prescreening is completed at initial contact.
     1                                                                                               3.1.1        3.01700                                      observe if this is being done. If you do not see it being done ask how initial
                                                 (Name, Date, Phone # and Address)
                                                                                                                                                               contact is recorded/documented. (Clinic Observation could be with a
                                                                                                                                                               phone call or a walk-in or can be assessed through Documentation) (Desk
                                                                                                                                                               Audit can be completed by reviewing Initial Contact and Date of Visit
                                                                                                                                                               report.) Prescreening is not needed for walk-in applicants who are seen
                                                                                                                                                               on their visit.


                                                                                                                                                               The Contractor shall attempt to contact any prenatal who misses her initial
                                                                                                                                                               appointment within 5 days to determine WIC eligibility and shall document
                                                                                                                                                               at the time of initial contract, an address and telephone number where the
                                                         a. All prenatals who miss their initial
                                                                                                                                                               pregnant woman can be reached. We need to ask to see the
                                                         certification
     2                                                                                               3.7.5        3.01700                                      documentation for the date of initial contact, address and telephone #.
                                                            appt. are contacted for                                                                            (Clinic Observation could be with a phone call or a walk-in or can be
                                                         rescheduling.                                                                                         assessed through Documentation) Need to see documentation if not
                                                                                                                                                               prescreened in MOWINS. Desk Audit, initial contact to cert report, check
                                                                                                                                                               for P not seen in time, then check no-show documentation in chart.



                                                                                                                                                               (Desk Audit using "Initial Contact and Date of Visit" report and checking
                                                                                                                                                               file documentation for exceptions.) Infants under six months old, prenatal
                                                                                                                                                               and members of the migrant population who plan to leave the agency first
                                                                                                                                                               appointment shall be within 10 days from initial request. All others should
                                                                                                                                                               be within 20 days from initial request. If applicant cannot make
                                                         b. Timeframes met based on review
                                                                                                                                                               appointment that is offered within required timeframe, assure there is
     3                                                   of information                              3.1.1        3.01700
                                                                                                                                                               documentation. If any of these are "n" a finding should be given.
                                                              in MOWINS.                                                                                       Appointment should be made for next available appointment if applicant
                                                                                                                                                               cancels the initial certification appointment. (This does not have to be
                                                                                                                                                               within 10 days from the initial contact date). For agencies that don't use the
                                                                                                                                                               MOWINS scheduler, ask to see other documentation they may be keeping
                                                                                                                                                               to assess this item.

                                            2. Follow-up completed on no-shows and
     5                                                                                               3.7.4        3.07000                                      Ask WIC Coordinator what their process is for no-shows.
                                            missed
                                               appointments.
                           B. Eligibility assessment completed properly and
                              information obtained from appropriate source
                              documentation:
                                            1. Proof of Identity:
                                                         a. Correct source verified for proof of                                                               (Clinic Observation) Assure correct source documentation was used as
   11                                                    identity and                                3.1.4        3.03850                                      proof, and the proof taken was recorded appropriately. (Agency staff is not
                                                            recorded appropriately.                                                                            allowable 3rd party.)
                                                        b. Pending Proof indicated if                                                                          (Clinic Observation) Must select "pending proof" if proof not presented
   13                                                                                                3.1.4        3.03850
                                                        appropriate proof was                                                                                  during certification or recertification.
                                                            not presented at certification
                                                        c. Person present at certification. or                                                                 Clinic Observation of a certification should be done to see if areas are
   16                                                                                                3.1.4        2.02700
                                                        approved                                                                                               covered correctly.
                                                           exemption
                                              2. Proof of Residency: documented.
                                                                                                                                                               (Clinic Observation) Assure correct source documentation was used as
                                                         a. Correct source verified for proof of
                                                                                                                                                               proof, and the proof taken was recorded appropriately. If participant
   20                                                    residency                                   3.1.4        3.01800
                                                                                                                                                               marked as homeless, a statement of situation must be signed and scanned
                                                            and recorded appropriately.                                                                        into MOWINS.
                                                        b. Pending Proof indicated if                                                                          (Clinic Observation) Must select "pending proof" if proof not presented
   22                                                   appropriate proof was                        3.1.4        3.01800                                      during certification or recertification. HDFS Screen will not be accepted as
                                                            not presented at certification.                                                                    verification of Residency after October 1, 2006.
                                              3. Proof of Income:
                                                                                                                                                               (Clinic Observation) Assure correct source documentation was used as
                                                                                                                                                               proof, and the proof taken was recorded appropriately. If zero income
                                                          a. Correct source verified for proof
                                                                                                                                                               reported, LWP staff ask appropriate questions and scan Affidavit into
   27                                                    of income and                               3.1.4        3.02000
                                                                                                                                                               MOWINS. (Desk Audit can be used for zero income documentation.)
                                                              recorded appropriately.                                                                          Assure Household size determined correctly. Assure appropriate
                                                                                                                                                               factfinding questions are being used.
                                                              b. Pending Proof indicated if                                                                    (Clinic Observation) Must select "pending proof" if proof not presented
   29                                                                                                3.1.4        3.02000
                                                              appropriate proof                                                                                during certification or recertification.
                                              4. Proof of Incomewas not presented at
                                                                   - Adjunct Eligibility:
                                                              a. Adjunct Eligibility properly                                                                  (Clinic Observation) HDFS Screen (system verification) will be
   34                                                         verified and                           3.1.4        3.02000                                      acceptable with active status. Assure MO HealthNet is not used for
                                                                 documented.                                                                                   household unless it is an I or P.
                                                                                                                                                               (Clinic Observation) LWP assures participant/guardian/proxy
                                              5. Client informed of food redemption                               3.05600                                      understands care and use of the FI at certification and recertification.
   36                                                                                                3.3.1
                                              procedures.                                                         1.01400                                      Proper procedure at the store should be discussed in detail, and
                                                                                                                                                               importance of client ID folder stressed.
                                                                                                                                                               (Clinic Observation) Written notification of eligibility is given when
                                              6. Ineligibility notification provided (where                                                                    applicant with the right to a fair hearing is determined ineligible at
   38                                                                                                3.1.4        3.03300
                                              appropriate).                                                                                                    cert/recert visit. Final food package provided if participant came in before
                                                                                                                                                               end of eligibility for that cert period.
                                                                                                                                                               (Clinic Observation) Participant/guardian is asked to read the
                                              7. Clients are properly instructed on rights and                    2.03200                                      rights/responsibilities using current WIC-10 in appropriate language prior
   40                                                                                                3.1.4
                                                 responsibilities.                                                3.03950                                      to signing. Staff reads to those who cannot read. This should be done
                                                                                                                                                               after eligibility has been determined.
                                              8. Clients who move from another state or the                                                                    (Clinic Observation and/or Statement) LWP provides benefits for
                                              WIC                                                                                                              remainder of current cert period to any applicant who presents proper
   42                                                                                                             3.02900
                                                 Overseas Program with valid VOC are                                                                           Verification of Certification (VOC) from another state or Overseas
                                              provided                                                                                                         Program.
                                                  Statewide end of is completed prior
                                              9. services to search certification period.to
                                                                                                                                                               (Clinic Observation) (Desk Audit may be conducted with those agencies
                                              creating a                                                          3.02600
   43                                                                                                                                                          that use the scheduler, by looking for new appointments and doing a
                                                  MOWINS record when using a VOC or                               3.02900
                                                                                                                                                               statewide search on participant names to check for duplication.)
                                              prescreening
                                              10. Demographics is updated on subsequent
   44                                                                                                3.1.4                                                     (Clinic Observation) Staff updates common data at each certification.
                                                   certification.

                                                                                                                                                               (Clinic Observation) LWP should check computer record (ShowMeVax),
  400                                         11. Documented immunization status is verified. 3.6.1, 3.6.2        1.01800                                      card, or file. If no record or not on ShowMeVax, then should be marked
                                                                                                                                                               "Not Up To Date". Send updates to SMV as needed.

                           C. Proxy policy:

                                                                                                                                                               Policy is followed consistently for each participant. Clinic Observation:
                                                                                                                                                               Agency staff can type names without form when proxies are added or
                                                                                                                                                               changed during certification visit. Agency scans form in addition to typing
                                              1. Local Agency follows proxy policy
   52                                                                                                3.3.1        3.03800                                      new names when proxies are added or changed in the middle of a
                                              consistently.
                                                                                                                                                               certification period. Proxies must be 18 to re-enroll and 16 to pick up FIs
                                                                                                                                                               and/or go to store. They must sign the folder prior to going to the store and
                                                                                                                                                               be instructed on their responsibilities.

                           II. CIVIL RIGHTS COMPLIANCE
                           A. Current version of Civil Rights Posters are prominently
                                                                                                                                                               (Clinic Observation) Civil Rights Posters are posted:
                               posted for all applicants and participants to read:
                                                                                                                  1.05600                                      1. At all times the agency is open for business.
                                * The WIC Fair-Hearing poster, (10/11)
   60                                                                                                T&C          1.05700                                      2. At all sites where WIC clinics are conducted.
                                * USDA “...And Justice for All” poster, (12/99)                                   3.01100                                      3. Where applicants as well as participants are likely to see them. For
                                * DHSS “Non-Discrimination" poster and (11/11)                                                                                 example, each reception/waiting area.
                                * Transfer poster




(Rev. Date 09-12)
                                                                                                                                                                                                                                                Page 1 of 20
                                                                                                                          WIC




   State Office Use Only
                                                                                                                      Operations
                                                                                                                        Manual
                                                                                                                        (WOM),
                                                                                                                       Health &
                                                                                                                       Nutrition                                      Repeat
                                                                                                                       Handbook                                       Finding
                                                                                                                                           RATING                                                           REVIEWER TIPS
                                                                                                  Scope of              (HNAH)                                           ?
                                                                                                                                         Not Applicable, Meets
                                                     DESCRIPTION                                    Work               Reference           Standards, Needs
                                                                                                                      No. or Other   Improvement, or Unsatisfactory   Indicate    *For all findings, statement can be used for assessment when
                                                                                                   (SOW)
                                                                                                                                                                      Yes with                    other methods cannot be used
                                                                                                 Reference
                                                                                                     No.                             NA MS NI                  U         X

                           B. Civil Rights Statements included on all publications and
                              other forms of communication including LWP Web Sites,
                              ie., brochures, letterhead, outreach materials, radio and
                              TV announcements WIC is an equal opportunity program.
                              “In accordance with Federal law and U.S. Department of
                              Agriculture policy, this institution is prohibited from
                              discriminating on the basis of race, color, national origin,                                                                                       Ask to review any information that is sent/given to WIC participant to
                              sex, age, or disability. To file a complaint of                                                                                                    assure the correct information is included for Civil Rights. The statement
                                                                                                                                                                                 should be on anything that the LWP produces locally that is used for WIC.
                              discrimination, write U.S. Department of Agriculture,
   62                                                                                                   T&C             1.05700                                                  When there is a Web site, this statement or link must be included on the
                              Director, Office of Adjudication, 1400 Independence
                                                                                                                                                                                 Home Page of the Program information. Per WIC Update dated 5/24/10,
                              Avenue, S.W., Washington, D.C. 20250-9410 or call                                                                                                  LWPs are not required to reprint just for this change; they can use up
                              (866) 632-9992 (voice) or (202) 260-1026 (local). USDA                                                                                             remaining stock with 5/4/08 version until time to reprint.
                              is an equal opportunity provider and employer.”
                              If the material is too small to permit the full statement to be
                              included, the material will at a minimum include the
                              statement, in print size no smaller than the text that
                              “This institution is an equal opportunity provider.”
                              (Revised 4/15/10; notification to LWPs 5/24/10)

                                                                                                                                                                                 (Clinic Observation or Statement) The LWP shall have a written
                                                                                                                                                                                 procedure and documentation of all complaints. If a protected
                                                                                                                                                                                 discrimination charge (race, color, national origin, sex, age, or disability) is
                           C. Local Agency follows written procedure for handling                                                                                                made, the LWP will provide participant with MDHSS Complaint of
                              applicant or participant complaints and grievances and                                    1.05700                                                  Discrimination form, assist them in completing it, keeps a copy, and mails
   64                                                                                                   T&C
                              follows Department of Health and Senior Services (DHSS)                                   1.01250                                                  to USDA within 5 days. The LWP shall assist participants or applicants
                              civil rights procedures when appropriate.                                                                                                          who wish to lodge a civil rights complaint. The local WIC provider will
                                                                                                                                                                                 follow procedures outlined in the Civil Rights Self-Paced Module. If finding
                                                                                                                                                                                 is assigned, note in Comments which portion of procedure was not
                                                                                                                                                                                 followed.


                                                                                                                                                                                 Assure the agency is using the Race Ethnicity Report to compare with
                           D. Maintains records, compiles data and submits reports to
   68                                                                                                   T&C             1.05600                                                  what their census data shows. Need to see if they are meeting the
                              effectively enforce nondiscrimination laws                                                                                                         population need. Census data can be obtained from www.census.com.

                           E. Informational materials are provided in the appropriate                                                                                            (Clinic Observation and/or ask the WIC Coordinator what is in place.) Ask
   72                                                                                                   T&C             1.05700
                               translation, as needed.                                                                                                                           to see samples.
                           F. Facility is accessible to and usable by clients with
                              disabilities including but not limited to wheelchair bound,
   74                                                                                                   T&C             1.05700                                                  (Clinic Observation and/or ask the WIC Coordinator what is in place.)
                              walkers, hearing impaired, sight impaired and mentally
                              challenged.
                           G. Allows equal access to its program, regardless of race,
   76                                                                                                   T&C             1.05700                                                  (Clinic Observation and/or ask the WIC Coordinator what is in place.)
                              color, national origin, sex, age, or disability to participants.

                                                                                                                                                                                 Ask if agency has relocated, closed or opened a satellite, or significantly
                           H. Impact analysis is completed prior to implementing
   78                                                                                                   3.5.4           3.01500                                                  reduced service hours in this fiscal year. If so, have they completed the
                              significant service changes.                                                                                                                       Impact Analysis and submitted it to our office 60 days prior to the change?

                           III. ACCOUNTABILITY

                                                                                                                                                                                 Ask for latest audit report from state or independent audit. Record Name
                           A. Records required for audit and review are retained,                                       1.05900                                                  of Company doing audit and date it was done. We are only concerned
   82                                                                                            4.7,         6.3.1
                              including state and independent.                                                          1.06000                                                  about the WIC Findings. Need to assure if there was a finding, that it has
                                                                                                                                                                                 been resolved. Audits must have been done every 3 years.

                           B. Record Destruction:
                                                                                                                                                                                 These records should be kept for a minimum of three (3) years or until
                                                                                                                                                                                 closure approved by Bureau Chief. If records have been destroyed, how
                                      1. Record destruction is properly handled and
   84                                                                                                   6.3.1           1.06000                                                  were records destroyed? There should be at least one signature
                                         documentation of record destruction is retained.                                                                                        witnessing destruction and was destruction appropriate (burning,
                                                                                                                                                                                 shredding, burial)? (Check for file containing this information)
                           C. Documentation for WIC-funded equipment:
                                    1. Inventory list is available and appropriate for WIC-
                                        funded equipment and equipment is properly
                                               a. Appropriate information is on equipment
                                                                                                                                                                                 The agency must keep an inventory listing of all WIC-purchased
                                               inventory
                                                                                                                                                                                 equipment. This should include a/v equipment, computers, printers, auto
                                                   (tag numbers, type, serial numbers,                                                                                           dialers, Hemocue blood analyzers, breastfeeding pumps, (manual or
   91                                          model                                                    6.7.1           1.04900
                                                                                                                                                                                 electric) etc. Need dollar amount if they have purchased it. They do not
                                                   numbers, date, status, and cost if                                                                                            need amount if purchased by the state. Dollar amount of equipment will be
                                               bought by LWP,                                                                                                                    the same as the amount in the Scope of Work $500.
                                                   and site location, if applicable), and the
                                               b. All computer equipment, analyzers, and
   89                                                                                                   6.7.1           1.04900                                                  All items purchased with WIC funds must have a WIC tag or WIC #.
                                                   breast pumps have a green WIC tag
                                               affixed.                                                                                                                          DH-60s are kept on file (new to SOW in FY11). Upon physical inventory
                           D. All WIC-funded equipment is present and/or
   93                                                                                                   6.7.1           1.05100                                                  check, equipment on state-produced list is present or documentation is on
                              accounted for.                                                                                                                                     file.
                                                                                                                                                                                 (Question the Office Staff) This question is asked to ensure continuity of
                           E. Equipment functions properly or appropriate steps have
   92                                                                                                   6.7.2           1.05100                                                  service. If LWP staff state equipment is broken and cannot do that
                              been taken for repair or replacement.                                                                                                              service, a finding should be given.
                                                                                                                                                                                 (Clinic Observation) Are doors locked and is portable equipment out of
   94                      F. Equipment is properly secured from theft or vandalism.                    6.7.2           1.05100
                                                                                                                                                                                 site?
                           IV. FINANCIAL MANAGEMENT
                           A. WIC-24 cost reports reflect actual expenditures:
                                                                                                                        1.03400 -                                                Pull LAP and compare budget to WIC 24 to see if reimbursement was
  100                                 1. Expenditures are for items that are WIC allowable.             4.2
                                                                                                                         1.04700                                                 approved on LAP.
                                      2. Expenditures are billed under the appropriate                                                                                           Are office supplies billed under Admin Office Costs and not Facilities, etc?
                                                                                                                        1.03400 -
  102                                 budget                                                            5.2                                                                      Agency is not billing contract staff in two places at once (i.e., both the
                                                                                                                         1.04700
                                         line item.                                                                                                                              contract line and the personnel compensation line).
                                                                                                                        1.03400 -                                                Is there documentation retained proving expenditures (time sheets,
  104                                 3. Source documentation is retained.                              6.3
                                                                                                                         1.04700                                                 invoices, receipts, summary of how expenditure was calculated)
                                      4. Contractor has spent one sixth (1/6th) of the funds                                                                                     Has the contractor spent one sixth (1/6th) of the funds
                                          received/documented on nutrition education. (See                                                                                       received/documented on nutrition education (see Administrative Cost
  108                                                                                                   5.2             1.02700
                                          Administrative Cost Report from previous fiscal                                                                                        Report from previous FY if monitor is being done within 1st quarter of new
                                      yr. )                                                                                                                                      FY)
                                                                                                                                                                                 Has contractor obtained written approval (through Budget Adjustment
                                      5. Contractor has obtained written approval from
                                                                                                                        1.03300 -                                                process) to purchase items that were not approved during the LAP
                                      state
  110                                                                                                                    1.04700                                                 process. Monitor staff will use their professional judgment when deciding
                                         WIC staff for the purchase of items not included in                                                                                     how to apply such findings (and can discuss with other monitor staff prior
                                         the Local Agency Plan (LAP).                                                                                                            to issuing the finding report).
              6. Non WIC program (i.e. in-kind) funds are
                                                                                                                                                                                 Has contractor documented and reported non WIC program (i.e. inkind)
              documented                                                                                                1.03300
  112                                                                                                   4.8                                                                      funds to meet requirement of contract or LAP? See WIC 24C page of
                  and recorded to meet requirement of contract or                                                       1.04700
                                                                                                                                                                                 Online Invoicing System or In-Kind Administrative Cost Report.
              LAP.
              7. Indirect costs do not exceed eight (8) percent of                                                                                                               Indirect costs does not exceed eight (8) percent of total direct contract
  114         total                                                                                     4.3             1.04500                                                  costs (see Administrative Cost Report) - Some agencies are not eligible to
                  direct contract costs, if applicable. (See                                                                                                                     claim indirect cost.
              Administrative
              8. Staff time is documented correctly for functions                                                       1.03400                                                  Are there signed time sheets with program code accounting for all WIC
  116                                                                                               4.7, 5.2
                  performed.                                                                                            1.03500                                                  staff?
              9. Sub-contracts - Reimbursement is only for terms
                                                                                                                                                                                 Check contract if any. Are records maintained by contractor to verify
  118         of                                                                                        6.11            1.03600
                                                                                                                                                                                 billings?
                  contract and appropriate documentation is
      V. FOOD DELIVERY SYSTEM

                                                                                                                                                                                 (Desk Audit) Prior to visit check Benefits History - Show Details to see
                           A. When agency staff are also participants or proxies, food                                                                                           User ID of staff member. (Statement) Ask who does the routine printing
  136                         instruments are printed and issued by another staff                       3.3             1.07000                                                  of FI within their office. If they state they do, this would be a finding. (If they
                              member.                                                                                                                                            print FIs, get a statement of the circumstance that is requiring them to do
                                                                                                                                                                                 this and what the controls have been set up to assure accountability.)

                                                                                                                                                                                 Ask if any staff have relatives participating in the program. If so, ask for
                           B. When agency staff are also participants or proxies
                                                                                                                                                                                 names and household IDs. (Desk Audit) Review all charts of staff who
                              income, health assessment & nutrition assessment are
  138                                                                                                   3.2             1.07000                                                  are on the WIC program or are proxies or relatives of a participant on the
                              completed & recorded in chart by a non-related staff                                                                                               WIC Program. May use Certification History tab of participant folder to
                              member.                                                                                                                                            assess.
      C. Investigates, justifies, and requests audit exceptions for
         irreconcilable food instruments including the following:
                1. Lost/Stolen or voided and redeemed checks are                                                                                                                 (Desk Audit and statement) Checks reported Lost or Stolen and are
                    investigated, have appropriate documentation in                                                                                                              subsequently redeemed, have appropriate documentation and follow-up
  140                                                                                                   3.2             3.06200
                    MOWINS, and local agency warns or sanctions                                                                                                                  with the participant. Participant warning or sanctions are in place and
                    participants when appropriate.                                                                                                                               documented in MOWINS.




(Rev. Date 09-12)
                                                                                                                                                                                                                                                                       Page 2 of 20
                                                                                                                         WIC




   State Office Use Only
                                                                                                                     Operations
                                                                                                                       Manual
                                                                                                                       (WOM),
                                                                                                                      Health &
                                                                                                                      Nutrition                                        Repeat
                                                                                                                      Handbook                                         Finding
                                                                                                                                            RATING                                                          REVIEWER TIPS
                                                                                                   Scope of            (HNAH)                                             ?
                                                                                                                                          Not Applicable, Meets
                                                    DESCRIPTION                                      Work             Reference             Standards, Needs
                                                                                                                     No. or Other     Improvement, or Unsatisfactory   Indicate    *For all findings, statement can be used for assessment when
                                                                                                    (SOW)
                                                                                                                                                                       Yes with                    other methods cannot be used
                                                                                                  Reference
                                                                                                      No.                             NA MS NI                  U         X

                                                                                                                                                                                  (Desk Audit and statement) Voided checks are not given to the
                                                                                                                                                                                  participant and subsequently redeemed. (This does not include checks
                                      2. Local agency correctly enters and documents the                                3.04000
  144                                                                                                 3.3.2                                                                       reported lost/stolen.) (Explanation: Any "Yes" would be a "U". LWP
                                         issuance status in MOWINS.                                                     3.06200
                                                                                                                                                                                  reviews Void/Lost/Stolen report to assure this is not happening and
                                                                                                                                                                                  responds to state staff monthly.
                           D. Food instrument issuance to participants:
                                    1. Food instruments are issued even when client                                                                                               (Statement) Food Instruments should be given even if the participant
  164                               refuses                                                           3.4.1             2.06100                                                   does not attend Nutrition Education Classes. Asked, "Did you find all foods
                                        nutrition education.                                                                                                                      available and did you have any difficulty obtaining WIC foods?"
                                    2. Food instruments are properly issued to clients.

                                                                                                                        3.01800                                                   (Clinic Observation) Only participant, authorized representative or
                                                 a. FI's are issued to eligible participants or                         3.04000                                                   alternate authorized representative, or authorized proxy are issued Fis
   50                                                                                                  3.2
                                                    appropriate proxies.                                                3.03800                                                   after identity is proven. Scan notes updating proxy from participant into
                                                                                                                        3.04800                                                   MOWINS. Was participant shown FI numbers prior to signing for checks?


                                                                                                                                                                                  (Clinic Observation or statement) Ask agency to explain what their
                                                                                                                                                                                  process is. FI reported stolen shall not be replaced for current month, or
                                                 b. Lost/Stolen FI's are replaced according
  167                                                                                                  3.2              3.06200                                                   exception is documented. Seven-day waiting period is enforced.
                                                 to policy.
                                                                                                                                                                                  Participant signs lost/stolen form and it is scanned. Replaced FI's are
                                                                                                                                                                                  picked up only by the participant, not proxy. Ask to see agency's form.

                                                                                                                                                                                  (Desk Audit or statement) Generate report of FIs mailed. Ask agency
                                                                                                                                                                                  what their process is. Do they document the reason for mailing in
                                                                                                                                                                                  MOWINS for: equipment not working, inclement weather, power out, fire,
                                                                                                                        3.04800
  320                                            c. FI's are mailed according to policy.               3.3                                                                        flood, and unable to reschedule? They should checkmark "mailing check"
                                                                                                                        3.05500
                                                                                                                                                                                  in the Issue Check screen, and sign for checks as "mailed by" with their
                                                                                                                                                                                  initials. They should send instructions to participant with the checks if
                                                                                                                                                                                  exception to the policy.

                                                                                                                        1.01250
                           E. Separation of duties - Certifier or Health professional staff                             2.01400                                                   (Desk Audit) Certifier or Health professional staff that certifies a
  170                         assigning risk factors will not print all the food instruments           3.3              2.01500                                                   participant should not, on a regular basis, issue food instruments for the
                              for a participant during the certification period.                                        3.04000                                                   same participant throughout the entire certification period.
                                                                                                                        3.04800
                           VI. MANAGEMENT
                           A. Voter Registration

                                                                                                                                                                                  (Clinic Observation) At each cert/recert or when notified of address
                                                                                                                                                                                  change, LWP staff must ask participant/guardian “if you are not registered
                                                                                                                                                                                  to vote where you live now, would you like to register here today?” LWP
  220                                 1. Clinic provides voter registration services.                 3.5.6             3.02700                                                   staff will update MOWINS after asking. LWP staff will record declination on
                                                                                                                                                                                  back of Voter Registration Application and keep on file. Will assist
                                                                                                                                                                                  participant in completing the form if needed. Will send forms to local
                                                                                                                                                                                  election authority at least weekly, and keep on file a tally of forms sent.

                                                                                                                                                                                  Review two months of files. In Comments note months reviewed, if tally
                                      2. Voter registration declination forms and weekly
                                                                                                                                                                                  sheet was present and complete, and if number of declinations and "yes"
  178                                 tally                                                                             3.02700
                                                                                                                                                                                  copies seem appropriate. Are refusals to sign declination forms
                                          sheets are kept on file for 24 months.                                                                                                  documented appropriately?

                           B. Clinic shall investigate alleged or suspected participant                                                                                           (Statement) Ask if there has been any sanctions given since last monitor
                                                                                                                                                                                  and what the procedure was for handling. Alleged violations must have
                                violations, and handle appropriately. This includes State
                                                                                                                                                                                  been investigated and documented in MOWINS, and State WIC Office
  180                          WIC office being contacted and giving authority prior to a            6.2.10             1.06200
                                                                                                                                                                                  should have been notified before any sanctions are given to a participant.
                               client being sanctioned, and appropriate documentation                                                                                             What is their process in handling difficult clients. Have they ever told a
                              being maintained in MOWINS.                                                                                                                         participant not to come back?
                           C. Public notification done as required:
                                                                                                                                                                                  Does agency have a file where a copy of the ad or PSA documentation is
                                      1. Done annually (during first quarter of fiscal year)
  182                                                                                                 3.7.6             1.05700                                                   kept? Is it for the right FY? Does it announce that they have a contract to
                                         regarding availability of services.                                                                                                      provide WIC and times open?
                                                                                                                                                                                  Used when state makes significant program changes (ex: if a priority has
  184                                 2. Done to announce significant program changes                 3.7.6             1.05700                                                   been taken off the WIC program) or when LWP makes changes like
                                                                                                                                                                                  closing satellite or drastically reducing hours.
                                                                                                                        1.01600
  558 D. Volunteers are appropriately trained and supervised.                                         3.9.1                                                                       Volunteers must have trainings for their equivalent positions.
                                                                                                                        1.01700

      E. All contracted LWP staff who provides WIC services and
         benefits to eligible participants must complete required
         trainings (Civil Rights, Breastfeeding Promotion Orientation,                                                  1.01550,                                                  Check training record. New employees must take training within six
  201                                                                                                 3.9.1
         Voter Registration, Immunizations, Computer Security).                                                         3.02700                                                   months of hire. All employees must take annually.
         Training is completed within required timeframes, and
         documentation of training is available.
                                                                                                                                                                                  Check training record for MOWINS and Self-Paced Clerical Module.
  202 F. WIC clerks are appropriately trained.                                                        3.9.1             1.01550
                                                                                                                                                                                  Clerical staff trained 2004 or later must have a certificate in the file.


                                                                                                                     BFPC Program
      G. Breastfeeding Peer Counselor has a signed
  583                                                                                              BFPC 1.6          Policy Manual,
         Confidentiality Agreement on file.                                                                             6.00200


                                                                                                                                                                                  SOW states it should be installed on each computer used for WIC.
                           H. The online WOM is easily accessible to all staff. All staff
  194                                                                                             6.8.1,     6.8.2      1.02300                                                   (Statement) Question WIC staff for how they receive new information on
                              also have WIC Update information available to them.                                                                                                 WIC (for example, WIC Updates, meetings, etc.)
      I. Data Security:
               1. Each individual using the system has, and only                                                                                                                  Using a copy of state’s listing of user ID’s, does each of the agency’s WIC
  197          uses,                                                                                                    3.01400                                                   staff have a user ID? Does each person using the system enter their own
                  own user ID.                                                                                                                                                    user ID?
                                                                                                                                                                                  At clinic observation, watch to see if staff shares user ID’s. Especially if
                                                                                                                                                                                  teamwork is prevalent. Each person using their own ID must sign off
                                      2. Each individual signs on & off appropriately so no
                                                                                                                                                                                  before leaving the machine. If staff can't see their computer, it should be
  198                                 one                                                                               3.01400
                                                                                                                                                                                  "locked" or logged out of MOWINS. Watch if someone goes on break and
                                         else uses their user ID.                                                                                                                 does not sign off or use password-protected screensaver and someone
                                                                                                                                                                                  else uses their computer to issue FIs.
                                    3. Local Agency immediately completes an ASAP to
                                                                                                                                                                                  LWP needs to go to ASAP to delete user IDs of staff who have left the
  200                                   delete the user ID of individuals who terminate                                 3.01400
                                                                                                                                                                                  agency or no longer work with WIC.
                                        employment.
                           VII. ASSESSMENT, PLANNING, AND EVALUATION
                                                                                                                                                                                  Review documentation maintained of outreach activities and dates
  210 A. Outreach plan has been implemented.                                                          3.7.2             1.02100
                                                                                                                                                                                  implemented to ensure activities undertaken follow plan.
      VIII. CLINIC ENVIRONMENT, ACCESSIBILITY OF SERVICES, CUSTOMER SERVICE
      A. Clinic prohibits smoking. "No Smoking" sign is posted in
  222                                                                     3.5.7 1.02600                                                                                           Check for sign.
          a visible location.
      B. Contractor identifies in a highly visible manner where
  224                                                                     3.5.9                                                                                                   Check for sign visible from street.
          WIC services are located at each site.
      C. Availability of Appropriate Health Services:
                  1. Clinic has a plan for continued efforts to make
                                                                                                                                                                                  LWP has written agreements on file or has documented their
                  health
                                                                                                                                                                                  communication with health care providers to make sure they will accept
  226                 services available to participants at the clinic or  3.6  1.01800
                                                                                                                                                                                  referrals made. Documentation of contact should be revised at least
                      through written agreement with health care                                                                                                                  annually, or as needed. Ask for copy of most recent documentation.
                  providers

                                                                                                                                                                                  (Clinic Observation and Statement) The LWP restricts use/disclosure
                                                                                                                                                                                  of program participant information to persons/programs listed per
  228 D. Client confidentiality is protected.                                                     3.1.5,     6.4.1      1.01700                                                   referenced WOM policy. If request received from another entity, LWP staff
                                                                                                                                                                                  contacts state WIC office for guidance. Ask the LWP if they share info with
                                                                                                                                                                                  other entities. Clinic set-up should be conducive to confidentiality.

                           IX. EQUIPMENT
                           A. Hematological/hemoglobin equipment & condition:
                                                                                                                        2.04350,
  245                                 1. Hemoglobin meter is in working order.                        12.3                                                                        It should be cleaned. Check to assure no blood on instrument.
                                                                                                                         HNAH
                                                                                                                                                                                  Check on box or container of microcuvettes for expiration date (list exp.
                                      2. Microcuvettes are within expiration date and used                              2.04350,
  247                                                                                                 12.3                                                                        Date). Check date opened and ensure not more than 90 days old (or
                                         within open shelf life.                                                         HNAH
                                                                                                                                                                                  whatever timeframe is given by the manufacturer).




(Rev. Date 09-12)
                                                                                                                                                                                                                                                                 Page 3 of 20
                                                         WIC




   State Office Use Only
                                                     Operations
                                                       Manual
                                                       (WOM),
                                                      Health &
                                                      Nutrition                                      Repeat
                                                      Handbook                                       Finding
                                                                          RATING                                                   REVIEWER TIPS
                                          Scope of     (HNAH)                                           ?
                                                                        Not Applicable, Meets
                           DESCRIPTION      Work      Reference           Standards, Needs
                                                     No. or Other   Improvement, or Unsatisfactory   Indicate   *For all findings, statement can be used for assessment when
                                           (SOW)
                                                                                                     Yes with                   other methods cannot be used
                                         Reference
                                             No.                    NA MS NI                  U         X




(Rev. Date 09-12)
                                                                                                                                                                               Page 4 of 20
                                                         WIC




   State Office Use Only
                                                     Operations
                                                       Manual
                                                       (WOM),
                                                      Health &
                                                      Nutrition                                      Repeat
                                                      Handbook                                       Finding
                                                                          RATING                                                   REVIEWER TIPS
                                          Scope of     (HNAH)                                           ?
                                                                        Not Applicable, Meets
                           DESCRIPTION      Work      Reference           Standards, Needs
                                                     No. or Other   Improvement, or Unsatisfactory   Indicate   *For all findings, statement can be used for assessment when
                                           (SOW)
                                                                                                     Yes with                   other methods cannot be used
                                         Reference
                                             No.                    NA MS NI                  U         X




(Rev. Date 09-12)
                                                                                                                                                                               Page 5 of 20
                                                         WIC




   State Office Use Only
                                                     Operations
                                                       Manual
                                                       (WOM),
                                                      Health &
                                                      Nutrition                                      Repeat
                                                      Handbook                                       Finding
                                                                          RATING                                                   REVIEWER TIPS
                                          Scope of     (HNAH)                                           ?
                                                                        Not Applicable, Meets
                           DESCRIPTION      Work      Reference           Standards, Needs
                                                     No. or Other   Improvement, or Unsatisfactory   Indicate   *For all findings, statement can be used for assessment when
                                           (SOW)
                                                                                                     Yes with                   other methods cannot be used
                                         Reference
                                             No.                    NA MS NI                  U         X




(Rev. Date 09-12)
                                                                                                                                                                               Page 6 of 20
                                                         WIC




   State Office Use Only
                                                     Operations
                                                       Manual
                                                       (WOM),
                                                      Health &
                                                      Nutrition                                      Repeat
                                                      Handbook                                       Finding
                                                                          RATING                                                   REVIEWER TIPS
                                          Scope of     (HNAH)                                           ?
                                                                        Not Applicable, Meets
                           DESCRIPTION      Work      Reference           Standards, Needs
                                                     No. or Other   Improvement, or Unsatisfactory   Indicate   *For all findings, statement can be used for assessment when
                                           (SOW)
                                                                                                     Yes with                   other methods cannot be used
                                         Reference
                                             No.                    NA MS NI                  U         X




(Rev. Date 09-12)
                                                                                                                                                                               Page 7 of 20
                                                         WIC




   State Office Use Only
                                                     Operations
                                                       Manual
                                                       (WOM),
                                                      Health &
                                                      Nutrition                                      Repeat
                                                      Handbook                                       Finding
                                                                          RATING                                                   REVIEWER TIPS
                                          Scope of     (HNAH)                                           ?
                                                                        Not Applicable, Meets
                           DESCRIPTION      Work      Reference           Standards, Needs
                                                     No. or Other   Improvement, or Unsatisfactory   Indicate   *For all findings, statement can be used for assessment when
                                           (SOW)
                                                                                                     Yes with                   other methods cannot be used
                                         Reference
                                             No.                    NA MS NI                  U         X




(Rev. Date 09-12)
                                                                                                                                                                               Page 8 of 20
                                                         WIC




   State Office Use Only
                                                     Operations
                                                       Manual
                                                       (WOM),
                                                      Health &
                                                      Nutrition                                      Repeat
                                                      Handbook                                       Finding
                                                                          RATING                                                   REVIEWER TIPS
                                          Scope of     (HNAH)                                           ?
                                                                        Not Applicable, Meets
                           DESCRIPTION      Work      Reference           Standards, Needs
                                                     No. or Other   Improvement, or Unsatisfactory   Indicate   *For all findings, statement can be used for assessment when
                                           (SOW)
                                                                                                     Yes with                   other methods cannot be used
                                         Reference
                                             No.                    NA MS NI                  U         X




(Rev. Date 09-12)
                                                                                                                                                                               Page 9 of 20
                                                         WIC




   State Office Use Only
                                                     Operations
                                                       Manual
                                                       (WOM),
                                                      Health &
                                                      Nutrition                                      Repeat
                                                      Handbook                                       Finding
                                                                          RATING                                                   REVIEWER TIPS
                                          Scope of     (HNAH)                                           ?
                                                                        Not Applicable, Meets
                           DESCRIPTION      Work      Reference           Standards, Needs
                                                     No. or Other   Improvement, or Unsatisfactory   Indicate   *For all findings, statement can be used for assessment when
                                           (SOW)
                                                                                                     Yes with                   other methods cannot be used
                                         Reference
                                             No.                    NA MS NI                  U         X




(Rev. Date 09-12)
                                                                                                                                                                               Page 10 of 20
                                                         WIC




   State Office Use Only
                                                     Operations
                                                       Manual
                                                       (WOM),
                                                      Health &
                                                      Nutrition                                      Repeat
                                                      Handbook                                       Finding
                                                                          RATING                                                   REVIEWER TIPS
                                          Scope of     (HNAH)                                           ?
                                                                        Not Applicable, Meets
                           DESCRIPTION      Work      Reference           Standards, Needs
                                                     No. or Other   Improvement, or Unsatisfactory   Indicate   *For all findings, statement can be used for assessment when
                                           (SOW)
                                                                                                     Yes with                   other methods cannot be used
                                         Reference
                                             No.                    NA MS NI                  U         X




(Rev. Date 09-12)
                                                                                                                                                                               Page 11 of 20
2010 WOM Policy ER#
       1.01250
       1.01400
       1.01550
       1.01600
       1.01700
       1.01800
       1.02100
       1.02200
       1.02300
       1.02600
       1.02700
       1.03300
       1.03400
       1.03500
       1.03600
       1.03700
       1.03800
       1.03900
       1.04000
       1.04100
       1.04200
       1.04300
       1.04400
       1.04500
       1.04600
       1.04700
       1.04900
       1.05100
       1.05600
       1.05700
       1.05900
       1.06000
       1.06200
       1.07000
       2.01400
       2.01500
       2.02700
       2.02800
       2.03200
       3.01100
       3.01400
       3.01500
       3.01700
       3.01800
       3.02000
       3.02700
       3.02900
       3.03300
       3.03500
       3.03800
       3.03850
       3.03950
       3.04000
       3.04800
3.05500
3.06200
Policy Name
LA Personnel: WIC Coordinator
Appropriate Tasks: Administrative/Clerical
Training Local WIC Providers
Using Volunteers
Participant Confidentiality
Participant Referrals
Outreach
Public Notification
WIC Operations Manual (WOM)
No-Smoking Policy
Local Agency Plan
Monthly Administrative Cost Invoice
Line Item: Personnel Compensation
Line Item: Personnel Benefits
Line Item: Contract Services
Line Item: Conference and Training
Line Item: Travel
Line Item: Equipment Purchases
Line Item: Nutrition and Breastfeeding Materials
Line Item: Administrative Office Costs
Line Item: Medical Materials
Line Item: Computer Hardware/Software
Line Item: Facilities Costs
Line Item: Indirect Costs
Line Item: Special Funds
In-Kind Costs
Equipment and Resource Inventory
WIC Equipment: Temporary Loan, Repair, and Replacement
State Responsibility: Civil Rights Compliance
Local Responsibility: Civil Rights Compliance
Audit
Local WIC Provider Record Retention and Destruction/Audit Letter
Participant Violations
WIC Services to Local WIC Provider Employees and Relatives of Employees
Local Agency Nutrition Personnel: Nutrition Coordinator/Nutritionist
Agency Nutrition Personnel: Competent Professional Authority(CPA)
Physical Presence at Certification or Recertification
Certification, Recertification and Infant Follow-Up Components
Program Explanation to the Participant
Local WIC Provider Administrative Management Responsibilities
WIC Data and Reports Access
Civil Rights Impact Analysis-Change in Clinic- Closure, Reducing Hours or Moving
Applicants Processing
Residence Requirements for Participants
Income Assessment and Documentation
Voter Registration
Transfer of Certification and Verification of Certification
Written Notification of Ineligibility
Schedule of Certification Periods
Proxies and Authorized Representatives
Proof of Identity
Participant Identification Folder
Food Instrument Accountability and Liability
Food Instrument Issuance
Food Instrument Issuance - Mailing
Food Instruments (FI) Replacement - Lost or Stolen Reported by Participant
CFR/Regulatory Reference
2008 7 CFR 246.3(f), 246.4(a)(25) & 426.6(b)
2008 7 CFR 246.3(f) & 246.4(a)(25)
2005 7 CFR 246.11; Missouri Senate Bill 1122, sections 324.200 to 324.225
2008 7 CFR 246.2(d)(1) & MPSF-1:WC-93-15-P
2008 7 CFR 246.21(b), 246.25(a)(4), and 246.26(d), 45 CFR 164.103 and 164.105; Missouri State Law, Chapter 210, RSMO - 1
2008 7 CFR 246.7(a) & (b)(1-3); Missouri Senate Bill 1122, sections 324.200 to 324.225
2008 7 CFR 246.4(a)(7,18,20,&21), CFR 246.14(c)(3)
2008 7 CFR 246.4(a)(7) & FNS Instruction 113-1
2008 7 CFR 246.4(a)(11) WIC Local Agency Nutrition Services Contract Scope of Work
2008 7 CFR 246.6(b)(4) MPSF-1:WC-94-12-P & WIC Local Agency Nutrition Services Contract Scope of Work
2008 7 CFR 246.5(b) & (f), 246.6(b), 246.11(c)(1) & (7), (d) & (e)
2008 7 CFR 246.13(j), 246.16(d) & 246.25(a)
2008 7 CFR 246.14(c)
2008 7 CFR 246.14(c)
2008 7 CFR 246.14(c)
2008 7 CFR 246.14(c)
2008 7 CFR 246.14(c)
2008 7 CFR 246.14(c) FNS Instruction 808-1, 815-1, & MPSF-1:WC-94-33-P
2008 7 CFR 246.14(c)(1)(ii) MPSF-1:WC-94-33-P, MPSF-1:WC-95-10-P
2008 7 CFR 246.14(c)(4) & MPSF-1:WC-94-33-P
2008 7 CFR 246.14(c)(2)(ii)
2008 7 CFR 246.14(d) & FNS Instruction 808-1, 815-1
2008 7 CFR 246.14(a)(1) & FNS Instruction 808-1
2008 7 CFR 246.14(a)(1)(ii) & FNS Instruction 808-1, DHSS Financial Policy Manual Section 1.1
2008 7 CFR 246.11(c)(1)&(2), MPSF-1:WC-91-16-P, Loving Support Breastfeeding Peer Counseling Grant Guidance
2008 7 CFR 246.16(d)(2) & WIC Local Agency Nutrition Contract Scope of Work
2008 7 CFR 246.24(d), 246.25(a)(1) & WIC Local Agency Nutrition Services Contract Scope of Work
2008 7 CFR 246.6(b)(1) and 246.16(d)(2)
2008 7 CFR 246.8; FNS Instruction 113-1
2008 7 CFR 246.8
CFR 246.13(f)(j), 246.20(b)(1-3), CFR 246(a)(1)(2)(4)(d)
2008 7 CFR 246.25(a) & Missouri State Statutes 516-105
2008 7 CFR 246.7(j)(6)(7), 246.9(a), 246.12(u), 246.23(c)
CFR 246.12(a)(1,2)(0) & CFR 246.3(f); 2007 CFR 246.4(a)(25)
2008 2006 7 CFR 246.11(d); 2004 Missouri Senate Bill 1122, sections 324.200 to 324.225; 2007 CFR 246.4(a)(25)
2004 2008 7 CFR 246.2 & CFR 246.6(b)(2); 2007 CFR 246.4(a)(25)
2008 CFR 246.7(p)(2)(i)(o)(1)(2), MPSF-1:WC-89-47-P & WC-01-07-P
2007 CFR 246.2, 246.7(e)(1)(g), 246.7(e)(2)(ii); WIC PM 98-9, Revision 3, WC-00-24-P, Revision 4; WC-01-18-P, Revision 5; M
2007 7 CFR 246.7(i), (j)(1-4)
2008 7 CFR 246.3(f), WIC Local Agency Nutrition Services Contract Scope of Work
2008 7 CFR 246.26(d), DHSS Administrative Manual 11.6 and WIC Local Agency Nutrition Services Scope of Work
2008 7 CFR 246.8(a), FNS Instruction 113-1 Civil Rights Compliance and Enforcement- Nutrition Programs and Activities Sectio
2008 7 CFR 246.7(b)(5) & 246.7(f)(2)
2008 7 CFR 246.7(c)(1)
2008 7 CFR 246.7(d) & (h), WC-03-18-P, WC-04-27-P, WC-06-02-P, WC-06-38-P, & PL 105-336
PL 103-01 (National Voter Registration Act of 1993(NVRA)), Section 115.162 RsMo, WC-94-22-P, and WC-95-01-P
2008 7 CFR 246.7(k)
2008 7 CFR 246.7(j)(5)&(6)
CFR 246.7(g)
2007 7 CFR 246.12(r)
2008 7 CFR 246.7(c)(2)(i), WC-99-16-P
2008 7 CFR 246.7(j)(1-4) & 246.12(r)(1-3
2008 7 CFR 246.12(p) & (q)
2008 7 CFR 246.4(a)(25), 2007 7 CFR 246.12(r)
2008 7 CFR 246.12(r)(4)
2008 7 CFR 246.12(q)
 Chapter 210, RSMO - 1988, USPL 104-191




ant Guidance




C-01-18-P, Revision 5; MPSF; WIC-02-22-P, Revision 6 corrections; WIC PM 98-9, Risk Revision 8, FMNP: WC-05-22-P; WIC Policy Memor



 ms and Activities Section XIII, D6



WC-95-01-P
5-22-P; WIC Policy Memorandum 98-9 Revision 9; MPSF: WC-07-25-P; MPSF: WC-92:10

								
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