Nutrition Services Updates Training

WIC & Nutrition ServicesImplementation April 1, 2015

Training Overview

• Part I– Final food rule changes– USDA Management Evaluation

• Part II– Nutrition Services Documentation

• Missouri FY14 top nutrition findings

Part IAfter completing this training, staff will be able to:•Identify the changes to WIC approved food items. •Understand your role related to food packages changes.•Identify dairy alternatives (yogurt) and the exchange. •Understand direct shipment and the formula process. •Apply their critical thinking skills when reviewing the nutrition assessment for risk factors. •Understand the documentation needed for assessment and assigning of risk factors.

Non-fat Goat Milk

Standard Milk PackageWIC Certifier

• Women and children (24-59 months)– Standard food packages which can be issued

are:• All milk and the supplemental foods

OR

• One pound of cheese/fat-free evaporated milk and the remaining supplemental food

Standard Formula PackageWIC Certifier

• Infants fully formula fed

• Standard contract formulas which can be issued are: – Enfamil Infant / Enfamil Premium Infant

• Powder or concentrate

– Enfamil Gentlease • Powder

– Enfamil ProSobee• Powder or concentrate

Lactose Free Milk

Cultured Buttermilk

April 1st Changes

• Fruits and Vegetables – Participants will be able to pay the difference

when their fruit and vegetable purchase exceeds the CVV value

Fruit & Vegetable Check

• Participant can choose to pay the difference by any of these methods– Cash– Check– Credit/debit card– SNAP EBT card

Fat-Free Refried Beans

• Bush’s Best – 16 oz. – Fat free

Low-fat Yogurt

• Approved brands and varieties

• Size: 32 oz.

• Approved: plain, vanilla and blended flavors– Not approved: fruit on the bottom, Greek

and whole (fat) yogurt

• Approved for women and children 2 years of age and older– Not authorized for children 12-23 months

Low-fat Yogurt

• Approved for: – Children 2 years of age and older– Women

• Milk substitute – For participants who might not otherwise drink

sufficient amounts of fluid milk due to lactose intolerance or other reasons

Yogurt Nutritional Profile

• Compared to milk, yogurt is – Similar in calcium– Similar in protein– Similar in vitamins and minerals– Low in fat– Widely available (low-fat)

Dairy Substitutions

Low-fat Yogurt

• Maximum monthly allowance of yogurt– One quart

• Additional amount above the one quart is not authorized

– Exchange rate• 1 quart of yogurt = 1 quart of milk

Cheese Exchange

• Total amounts which can be issued• One pound - Food Packages IV, V & VI• Two pounds - Food Package VII

• Substitution exchange – One pound of cheese = 3 quarts of milk

Tofu Exchange Children (12 – 59 months of age)

CPA is authorized to determine the need. Reason for issuance (e.g. milk allergy, lactose intolerance, vegan diet, etc.) Must document the reason for issuance

Women - No CPA documentation needed

Four pound max can be issued

Maximum substitution for a combination of cheese, yogurt

or tofu:

• No more than 4 quarts

– Children Food Package IV

– Women Food Package V & VI

• No more than 6 quarts

– Women Food Package VII

• Complete the case studies (Sophia, Joe and Rosa)

Allowance of Standard Infant Formula for Infants

• Infants 6 – 12 months of age may receive additional standard contract infant formula in lieu of infant foods – Same maximum monthly allowance as infants

4-6 months of age

• WIC-27 required

• Refer to the reference sheet, “Issuing Standard Contract Formula”

Approved Food List

• Changes:– Page 2 – Page 4 – Page 8– Page 16

This will depend on the final proof

MOWINS Update

March 31st

Management Evaluation (ME)

Management Evaluation Over Issuance of Formula

• Finding #11

• Definition of Direct Ship– Special formula is sent to your agency from

the manufacturer– Formula issued from the LWP’s storage

cabinet– Formula from another LWP’s storage cabinet

Management Evaluation Over Issuance of Formula

(Cont.)• LWP shall accept return of non-expired

– Standard formula – Exempt formulas – WIC eligible nutritionals

• Established check in process when receiving returned formulas

Management Evaluation Over Issuance of Formula

(Cont.)• From your storage cabinet:

– Formula used before it expires– Check stored cans routinely for dents and

bulges– Rotate the stored cans

• older formulas used first

– Discard formula in a way that no one can retrieve the cans for use

Management Evaluation Over Issuance of Formula

(Cont.)• No replacement formula issued after the

benefit expiration date

• Document in the record the return formula and the reason for issuance of a different formula

• Returned formula may be issued to other WIC participants

Management Evaluation Over Issuance of Formula

(Cont.)• Proration of formula when shorter benefit

period remains– CPA may determine when proration for

shorter benefit period is needed– Document in the record the reason for the

proration

Agency Resources

• ER# 2.07400 Return and Replacement of Standard Formula, Exempt Formula or WIC Eligible Nutritionals rev 10/14

• MOWINS December 2013 - Direct Shipments & Extra Formula Documentation Hot topics

• Food & Formula Reference Guide: Guidelines• Food & Formula Reference Guide: Formula Listing

Critical Thinking - Critical Thinking - AppliedApplied to to Assessment & Assignment Assessment & Assignment

1. What is the purpose of meeting with this participant?

2. What data or information do I need? Evaluate what you know about the participant Past history Paper work submitted about participant Data gained from discussion

3. How am I going to get the needed information?Create questions to gain the information needed.

4. Ask the questions you have developed.

Risk Factor Assessment & Assignment

• Finding #19 – Staff shall identify and assign risk criteria

based on nutrition assessment • Prematurity (RF 142) was not assigned

– Auto and manually assigned

• One of the top ten FY14 nutrition monitoring findings was; manually assigned risk factors (RF) are not appropriately assigned

• Complete the case studies (Peggy Sue Jones and Casey Smith)

Agency Resources

• Risk Factors Policies– USDA Justifications

• Risk Factor Definitions Table – web or MOWINS

• Nutrition Assessment and MCA Training– Training portal > LWP staff > Program

Updates