Nutrition Risk Determination, Documentation, and Priority Assignment


  1. 1. Nutrition Risk Determination and Documentation
  2. 2. Documentation
  3. 3. Priority Assignments

1. Nutrition Risk Determination and Documentation

  1. Professionals authorized by the State agency as Competent Professional Authorities (CPAs) to determine nutritional risk include (check all that apply):
    • Qualification Can certify for
      Priorities I-III All Priorities
      RD or Master's Level Nutritionist X X
      Bachelor's Level Nutritionist X X
      Physician
      Physician Assistant
      Registered Nurse X X
      Licensed Practical Nurse
      Home Economist X X
      Paraprofessional
      Other (Specify):
      Other (Specify):
  2. The State agency authorizes local agencies to (check all that apply):
    • (Checked) conduct (Checked) anthropometric and (Checked)hematological measurements (Checked) use medical referral data for (Checked) anthropometric and (Checked) hematological measurements (Not Checked) conduct measurements only when medical referral data are unavailable
  3. The State agency uses only FNS-approved nutrition risk criteria, as issued in Policy Memorandum 98-9, WIC Nutrition Risk Criteria, to document nutrition risk. (Note: The implementation date for Policy Memorandum 98-9, Revision 8, has been extended until 10/1/07).
    • Yes - Checked
    • No

    Please append a copy of the revised nutrition risk criteria in its entirety to this State Plan.

  4. The State agency modifies nutrition risk criteria such that criteria definitions are more restrictive than nationally established definitions.
    • Yes (list criteria):
    • No - Checked
  5. Hematological risk determination:
    • The State agency requires (check one of the following):
      • Bloodwork data to be collected at the time of certification (Statewide).
      • Bloodwork data to be collected within 90 days of certification, so long as the participant is determined to have at least one qualifying nutritional risk at the time of certification (Statewide), and the State has implemented procedures to ensure receipt of data. - Checked
    • The State agency ensures that hematological assessment data are current and reflective of participant status, to include a bloodwork periodicity schedule that conforms to the requirements as described in 246.7(e)(1)(ii)(B).
      • Yes - Checked
      • No
    • The State agency allows local agencies the option of obtaining bloodwork on children ages 2-5 annually if prior certification results were normal.
      • Yes - Checked
      • No
  6. Anthropometric risk determination:
    • The State agency allows (check one):
      • anthropometric data for certification to be no older than 60 days (Statewide) - Checked
      • a shorter (less than 60 days) limit on age of anthropometric data for certification
  7. Dietary risk assessment:
    • Note: It is unadvisable for State agencies to implement major changes to their diet assessment protocols until FNS issues Value Enhanced Nutrition Assessment (VENA) Policy and Guidance
      1. Local agencies are required at a minimum to assess and document dietary intake for:
        • all participants - Checked
        • only those participants who do not have a medical risk factor
        • only those participants at risk for inadequate diet or other dietary risk
        • only specific participant categories (specify which categories):
        • other (specify):
      2. The State agency policy requires that dietary intake information be collected through (check all that apply):
        • no intake protocol is specified
        • 24-hour recall
        • food frequency/food item checklist
        • dietary record/diary
        • other (specify): MIS Assessment questions
        • If yes, attach mandated forms or specify location in the procedure manual and reference below. WIC PPM Certification Standards, Sect 6.
        • If no, the State agency assures quality diet assessment by:
          • requiring local agencies to submit forms for approval
          • annually monitoring the locally developed forms during local agency reviews
          • other (specify):
      3. Analysis of diet is based on professionally recognized guidelines (e.g., RDI, AAP, Dietary Guidelines for Americans - MyPyramid Food Guide)
        • Yes (specify):
        • No (explain): based on Rev 8 guidance including presumptive eligibility risks.

ADDITIONAL DETAIL: Certification and Eligibility Appendix and/or Procedure Manual (cite): WIC PPM, Certification Standards, Sect 6

2. Documentation

  1. The State agency requires documentation in the applicant's case file for all nutrition risk criteria used to establish WIC eligibility (check one):
    • Yes, supported by a written "exceptions" policy (e.g., policies to direct clinic staff in situations in which documentation is unavailable) - Checked
    • Yes, with CPA discretion when to waive documentation requirement (no written policy)
    • No (explain):
  2. As a matter of policy, the State agency requires the documentation of nutritional risk criteria on a participant's certification form in the following manner:
    • the single most important criterion is recorded
    • all identified risk criteria are recorded - Checked
    • a set number of criteria is recorded (maximum number is criteria)
    • local agency personnel decide how many and which criteria are recorded
    • other (specify):
  3. The State agency requires verification for all nutrition risk criteria that contain a statement requiring a physician's diagnosis.
    • Yes - Checked
    • No

ADDITIONAL DETAIL: Certification and Eligibility Appendix and/or Procedure Manual (cite): WIC PPM, Part 3

3. Priority Assignments

  1. Participants certified for regression
    • remain in the same priority in which they were previously assigned
    • are assigned to Priority VII, regardless of their initial priority at first certification
    • other (specify): no longer in use
  2. Participants may be certified for regression (check all that apply):
    • a single six-month period
    • multiple consecutive certifications (maximum)
    • multiple non-consecutive certifications
    • no policy, local agency discretion
  3. High risk postpartum women are assigned to the following priority:
    • Priority III - Checked
    • Priority IV
    • Priority V
    • Priority VI
  4. Participants certified solely due to homelessness/migrancy are assigned to the following priority :
    • IV V VI VII
      Pregnant Women X
      Breastfeeding Women X
      Postpartum Women X
      Infants X
      Children X
  5. Attach a copy of any nutrition risk criteria that will be added, modified or deleted during the coming fiscal year. For each criterion, indicate:
    • applicable participant category
    • applicable priority level(s)
    • whether health care provider diagnosis is required
    • SA code number which conforms to list of codes provided by USDA for Participant Characteristics data collection

ADDITIONAL DETAIL: Certification and Eligibility Appendix and/or Procedure Manual (citation):