Food Industry Alliance Government Relations Committee May 15, 2013 Loretta A. Santilli, M.P.H. Director, Division of Nutrition Roberta Hayward NYS WIC Program Director Offers nutrition education, breastfeeding support, referrals and individualized nutritious food packages to low-income pregnant, breastfeeding or postpartum women, infants and children up to age five to promote and support good health. Foods provided as part of a package include: ◦ ◦ ◦ ◦ ◦ Low or fat free milk Fruits and vegetables Peanut butter Beans, peas and lentils Whole grains – cereal, bread, Infant formula 100% Juice Canned fish brown rice Average monthly WIC caseload is 512,294: ◦ 125,810 (25%) women (pregnant/lactating) ◦ 121,220 (24%) infants (<1 yr) ◦ 265,265 (51%) children (2-4 yrs) 75% of caseload is located in the greater NYC Metropolitan region WIC serves ~50% of all infants born in NYS Federal grant program (USDA) ◦ $6.6 billion in 2012 ◦ NYS $550M Eligibility: gross income limit of 185% of federal poverty level ($2,944/mo/family of 3) and presence of nutritional risk as assessed by a WIC health care provider. The results of multiple studies conducted by governmental and other non-government entities prove that WIC is one of the nation’s most successful and cost-effective nutrition intervention programs. Federal sequestration has impacted the WIC Program nationally. The NYS WIC Program’s federal funding was reduced in FFY 2013. Food funding was reduced by $17M. NYS DOH provided additional state funding to help mitigate the shortfall. USDA will entertain requests for additional funds. In order to apply for additional federal funds, NYS must review current practices and take steps to contain food costs. There are many initiatives that NYS is currently considering. The recent elimination of canned beans as a substitute for dried beans, peas and lentils is a first step. Eliminating the dangling quart of milk resulting from the substitution of cheese. Requiring the purchase of least expensive brand for milk and eggs. Review of the issuance of special formulas: medical documentation, quantities, brands, etc. Elimination of soy beverage and tofu as substitutes. Staffing changes at NYSDOH. Taking a fresh look and policies and procedures. Committed to ensuring program integrity. A WIC vendor is a sole proprietorship, partnership, cooperative association, corporation, or other business entity operating one or more stores authorized by the State agency to provide authorized supplemental foods to participants under a retail food delivery system. Each store operated by a business entity constitutes a separate vendor and must be authorized separately from other stores operated by the business entity. Currently there are 4,400 WIC authorized vendors in NYS. ◦ Pharmacies may be authorized as a WIC vendor to issue formula. There are 5 Vendor Management Agencies (VMAs) contracted by NYSDOH to receive and process all vendor applications, perform mandatory store monitoring and training, and enter into contracts with the individual stores. 575 new vendor apps per year are processed through the VMAs. In addition, the VMAs also reauthorize 1,450 current vendors annually. Vendors are reauthorized every 3 years. USDA is reviewing their vendor management policies, monitoring and oversight of state programs. Significant changes are expected. Due to breaches in vendor management oversight in California and Georgia WIC Programs, an increase in SNAP (food stamp fraud), and an Office of Inspector General audit of USDA’s oversight of vendor enrollment and monitoring; USDA is conducting a comprehensive review of each state’s vendor enrollment and monitoring polices and procedures in FY 2013 and 2014. New York’s review will be in 2014. The Office of Inspector General (OIG) found that the Food and Nutrition Service’s (FNS) management evaluations (MEs) did not identify and correct significant issues in the vendor management processes at two State agencies operating WIC. These agencies lacked sufficient controls to track vendor violations and ensure timely and appropriate sanctions. ◦ As a result, vendors were not disqualified as required, and could redeem WIC benefits during their required periods of disqualification. Also, the State agency did not conduct compliance investigations on high-risk vendors, and did not treat smaller vendors in an equitable manner with large chain stores. ◦ These deficiencies could allow vendor violations, including excessive charges and the sale of unauthorized food items, to go undetected. Women, Infants and Children (WIC) Program Vendor Moratorium Announcement Effective March 18, 2013 The United States Department of Agriculture (USDA) has formally notified the Department of Public Health (DPH) that effective March 18, 2013 the USDA will not allow the Georgia Women, Infants and Children (WIC) program to authorize any new vendors to participate in the program regardless of size, peer group, or application status. This moratorium shall apply to all new vendor applications and additions of new stores to current agreements. Any applications received after March 18, 2013 will be returned to the applicant unprocessed. In addition, any application not processed by March 18, 2013 will not be approved as directed by the USDA. Some areas of review have already been shared with states: ◦ Limiting the authorization of vendors with known history of program violations. ◦ Review of vendor to participant ratios. ◦ Small vendors: ensuring food costs are reasonable. In accordance with federal regulations, NYS WIC is required to consider the business integrity of vendors (includes owners, officers, managers). NYS is committed to program integrity and uses formal background checks to screen WIC vendor applicants. Vendor background checks are the most effective method of front end detection to keep individuals from participating in the NYS WIC Program who lack business integrity and/or who have abused other government programs. Background checks for WIC authorization are necessary for each store operated by the business entity because management personnel and officers differ from store to store. Approx. 10% of new apps have findings requiring additional follow up. The Bureau of Special Investigations (BSI) uncovers issues in about 25% (300-350 vendors) of vendors they review. ◦ Further follow up and potential action (sanctions, CMP, DQs). BSI manages information sharing with SNAP/USDA for approximately 300 SNAP vendors to determine reciprocal actions needed from the WIC side (as required by federal reg). USDA has reviewed NYS’s revisions to the vendor enrollment policy and has asked a few clarifying questions. NYS will respond to USDA with an approval expected shortly thereafter. NYS has proactively taken steps to improve processing time for vendor applications. Vendor Authorizations Average Number of Days to Process Complete Application* 70 60 57 47 50 Days 61 51 49 40 40 31 30 24 20 10 0 VMA 802 VMA 803 Downstate VMA 806 VMA 807 VMA 808 Upstate Statewide Improve training and communication with the VMAs. Instead of using “snail mail” to send the vendor application packets from the VMA to the State, document scanning has been implemented to transmit the information electronically. The vendor application is sent forward for processing as long as the SNAP application is in process. (No longer need to wait for the actual SNAP approval.) The WIC app will not be formally approved until the SNAP authorization is officially received. VMAs are conducting the required onsite store monitoring concurrently with State business integrity review. Vendor Authorizations Average Number of Days to Process Complete Application* 50 45 44 40 37.5 35 31 31 Days 30 28 25 25 21 20 15 10 5 0 0 VMA 802 VMA 803 Downstate VMA 806 VMA 807 VMA 808 Upstate Statewide WICSIS2 and EBT ◦ USDA has approved NYS’s selection of a new webbased MIS system. ◦ NYS is developing an implementation plan. ◦ EBT implementation is expected in early 2017. New Foods Card ◦ Staff are compiling results. ◦ Results to be made public mid-summer. ◦ New WIC Acceptable Foods List expected early fall. USDA held a debriefing meeting with at a WIC clinic that was affected by Hurricane Sandy in Far Rockaway. Lessons learned: ◦ Communication is key. ◦ Take storm warnings seriously and prepare. ◦ Post storm conduct reviews of vendors who remained open/opened quickly post storm to ensure food supply is safe.