WIC Supplemental Nutrition

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"6.7.5.1 Women, Infants, and Children (WIC) Supplemental Food Program:
General Requirement

The Contractor, as part of its initial assessment of Members, and as part of the initial evaluation of newly pregnant women, will provide and document the referral of pregnant, breast feeding, or postpartum women or a parent/guardian of a child under the age of five, as indicated, to the WIC program as mandated by Title 42, CFR 431.635(c).

6.7.5.2 WIC Supplemental Food Program: Medical Records
The Contractor will conduct the hemoglobin or hematocrit test and use the CHDP program Form PM160 to document the laboratory values for eligible children and/or a prescription pad written by a Physician to document laboratory values for eligible women for referral to the WIC program. The Contractor will document such referrals in the Members' Medical Records." California Contract, page 124.

"IV. COVERED SERVICES.
C. Fee for Service Benefits
1. The Contractor shall also advise post partum or breast feeding or pregnant women of the special supplemental food program (WIC), state's special assistance program for substance abusing pregnant women, and enhanced prenatal care services." Colorado Contract, pages 18, 20.

"3.17 Children's Issues and EPSDT Compliance
In order to meet the requirements of the Early and Periodic Screening, Diagnosis and Treatment program as set forth in §§1902(a)(43) and 1905(r) of the Social Security Act, the MCO shall: ...
g. Coordinate and enhance the services provided to Members under 21 through the development and execution of memorandums of understanding (MOUs) with the following programs: ...
* The Special Supplemental Food Program for Women, Infants, and Children (WIC)." Connecticut Contract, pages 26-28.

"3.19 Prenatal Care
a. In order to promote healthy birth outcomes, the MCO shall: ...
3. Refer enrolled pregnant women to the WIC program;
4. Offer individualized assistance with obtaining .WIC." Connecticut Contract, page 33.

"Appendix L: Bulletins, Memos and Policy Transmittals...
Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)...
In order to promote high quality coordinated health care, Medicaid providers are required to refer potentially eligible clients to the WIC program with a Certification Form. Coordination with public health agencies and systems, including WIC, was included as part of the Request for Application for participation in the Connecticut Access program." Connecticut Contract Appendix L, page 4.

"9. Public Health-Related Information...
c. Provider is responsible for referring pregnant and post-partum women and children up to age 5 who have or are at risk for nutritional deficiencies or have nutrition related medical conditions to the Special Supplemental Food Program for Women, Infants and Children (WIC) and for furnishing the WIC agency with the results of tests conducted to ascertain nutritional status." District of Columbia Contract, page 11.

"4. Physician Services...
k. The plan shall refer all pregnant, breastfeeding and postpartum women, infants and children up to age 5 to the local Women, Infants and Children (WIC) office by completing the Florida WIC program Medical Referral Form with the current height, weight (taken within 60 days), hemoglobin, or hematocrit (taken within 90 days for members over six months of age), and any identified medical/nutritional problems for the initial WIC referral and for all subsequent certifications. The plan shall ensure the provider provides a copy of the WIC referral to the member and shall retain a copy in the member's medical record." Florida Contract, pages 77-79.

"8. Case Management/Continuity of Care. The plan shall be for the management of medical care and continuity of care for all enrolled Medicaid recipients. The plan shall maintain written case management continuity of care protocol(s) that include the following minimal functions: ...
f. Determining the need for non-covered services and referring the member for assessment and referral to the appropriate service setting (to include referral to the Women, Infants and Children program (WIC))..." Florida Contract, pages 18-19.

"SECTION 3
SCOPE OF SERVICES...
3.010 Offeror Responsibilities
The following identify the responsibilities to be performed by the Offeror.4. Using DMA approved record review instrument, perform a review of recipient medical records using appropriately trained RNs and/or MDs and a statistically valid sampling methodology. to evaluate documentation regarding overall patient care management, including appropriateness and timeliness of care. Factors to be considered include: ...
f. Coordination, referrals for other health and social services such as WIC." Georgia RFP, page 7-8.

"33.100 Other Services to be Provided...
* WIC Coordination
The health plan shall coordinate the referral of potentially eligible women, infants, and children to the Supplemental Nutrition Program for Women, Infants, and Children (WIC) program and the provision of health data within the time frame required by WIC, from their providers." Hawaii RFP, pages 31-32.

"(5) Linkages to Other Services
(A) The Contractor shall use reasonable efforts to encourage the Plan Providers and subcontractors to cooperate with and communicate with other service providers who serve Beneficiaries. Such other service providers may include Women-Infant and Children (WIC) programs...Such cooperation may include performing annual physical examinations for school and the sharing of information (with the consent of the Beneficiary)." Illinois HMO Contract, page 44.

"4.7 Coordination and Continuation of Care
The HMO shall ensure that the Enrollee's care is coordinated and continuous, including at a minimum the following: ...
- Integration of Women, Infant, and Children (WIC) services for eligible Enrollees." Iowa Contract, page 26-27.

"4.10 Public health Issues...
The HMO shall refer all pregnant women, infants, and children (WIC) in the HMO service area, and inform the Enrollee of eligibility for this program. The WIC Program provides most special formulas necessary for special medical conditions.

The HMO shall sign, and provide a copy to the Department upon request, a memorandum of understanding with the Women, Infants and Children Supplemental Nutrition Program(s) (WIC) in the HMO service area. The HMO shall use the WIC referral form identified in Addendum XIII to refer women, infants and children to the WIC program. With theEnrollee's consent, the HMO shall forward to the local WIC agency basic medical data required for WIC certification. Upon request by the HMO the local WIC agency will provide pediatric nutrition surveillance system data and pregnancy nutrition surveillance system data specific to the HMO service area." Iowa Contract, page 28.

"D. LOCAL HEALTH DEPARTMENTS...
HCFA has recently mandated the following of all Medicaid Managed Care Providers:
Section 1902(a)(11)(C) of the Social Security Act provides for the coordination of Medicaid and the Special Supplemental Food Program for Women, Infants and Children (WIC). Public Law 103-448, §204(e) expands this provision to say that States using managed care arrangements to serve their Medicaid beneficiaries must assure that coordination exists between the WIC and Medicaid Managed Care Programs. This coordination should include the referral of potentially eligible women, infants, and children to the WIC Program and the provision of medical information by providers working within Medicaid managed care plans to the WIC Program.

The WIC Program in the State of Kansas is coordinated through the Local Health Departments. HMOs are expected to subcontract or coordinate with the Local Health Departments in their areas. The form provided in Appendix G may be used as a means of referring potentially eligible members to the Local Health Department WIC Program." Kansas General Service, pages 10-11.

"WIC REFERRAL FORM
PL 103-448, §204(e) requires States using managed care arrangements to serve their Medicaid beneficiaries to coordinate their WIC and Medicaid Programs. This coordination should include the referral of potentially eligible women, infants, and children and the provision of medical information to the WIC program." Kansas General Service, Appendix G, page 1.

"The Member Services staff shall be responsible for the following services and tasks: ...
* Making referrals for relevant non-Program provider services such as the Women, Infants and Children (WIC) supplemental nutrition program and Social Services..." Kentucky RFA, page 53.

"The Partnership member services function is responsible for ensuring that members are informed of how to access the health education and prevention opportunities available to them which shall also include information related to support services offered outside The Partnership-such as WIC, child nutrition." Kentucky RFA, page 59.

"The Partnership shall establish referral relationships with various human service agencies whose services are outside The Partnership's scope of covered services.these services shall include the WIC supplemental Nutrition Program." Kentucky RFA, page 71.

"Coordination procedures shall also be established for other services needed by eligible Members which are outside the usual scope of Partnership services Examples include.WIC." Kentucky RFA, page 74.

"10.09.65.08...
G. An MCO shall refer pregnant and postpartum women, infants, and children younger than 5 years old to the WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) Program, and shall provide to WIC necessary medical information to determine WIC nutritional eligibility." Maryland COMAR 10.09.65.08.

"10.09.67.20...
C. An MCO shall provide referrals for services not covered by Medicaid, but which are furnished at little or no cost to recipients, including appropriate referrals to: ...
(2) The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)." Maryland COMAR 10.09.67.20.

".21 Benefits-Pregnancy-Related Services.
A. An MCO shall provide to its pregnant and postpartum enrollees medically necessary and appropriate pregnancy-related services, including: ...
(d) Appropriate referrals to services that may improve the pregnancy outcome, including:
(i) Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)." Maryland COMAR 10.09.67.21.

"Section 6.1.19. Obstetrics and Gynecological Services. Such services include nurse-midwife services and prenatal care services as described below.
B. Prenatal Care Services. The HEALTH PLAN must perform the following tasks:
1) All pregnant Enrollees must be screened during their initial prenatal care office visit. A referral to the Women, Infants, Children Supplemental Food and Nutrition Program (WIC) must be made when WIC assessment standards are met." Minnesota Contract, page 57.

"f. Women, Infants and Children (WIC) Supplemental Food Program -Title 42, CFR 431.6358 and Missouri Public Law 103-448 require coordination between Medicaid and the WIC program. While WIC services are not the responsibility of the health plan, the health plan provider is required to document and refer eligible members for WIC services. As part of the initial assessment of members, and as part of the initial evaluation of newly pregnant women, the health plan's providers will provide and document the referral of pregnant, breast-feeding, or postpartum women or a arent/guardian of a child under the age of five, as indicated, to the WIC program. The Missouri Department of Health shall provide health plans with WIC program eligibility and referral criteria upon award of contract or at any time upon request." Missouri RFP, page 60.

"13.42 HEALTH CHECK (EPSDT): The plan shall develop a program to ensure the delivery of HEALTH CHECK (i.e., Early and Periodic Screening, Diagnosis and Treatment or EPSDT services)...
(a) HEALTH CHECK (EPSDT) Screening: ...
(6) Coordinating with other services, e.g., WIC...as appropriate.

(f) Throughout the contract term, the plan shall participate in the NHC Quality Assurance Plan's ongoing maternal and child health-related activities...Cooperate with the Department's Title V, Maternal Child Health Program (MCHP), to include: ...
(7) Cooperating with public health agencies who have identified children with abnormal lead levels. The plan will provide lead screening and blood lead testing according to the Center for Disease Control (CDC) and Health Care Financing Administration (HCFA) requirements; provide information to PCPs regarding the provision of blood lead screening and testing." Nebraska Contract, pages 90-91.

"K. Coordination with Other Services. Contractors will be responsible for coordinating services with non-Medicaid programs such as the Special Supplemental Food Program for Women, Infants, and Children (WIC). This coordination includes referral of potentially eligible women, infants and children and the provision of pertinent medical information to the WIC program. Coordination with other agencies and programs such as State or Local Education Agencies, and Head start programs, may also be necessary." Nevada Contract, page 27.

"II. Covered Services-Specialty Areas

B. Proactive Prenatal Care: The Contractor shall promote early initiation and appropriate frequency of prenatal care. Such efforts shall include: ...
5. coordination with services in support of good prenatal care including services available in the community such as Women, Infants and Children Program, (WIC)...

E. The Contractor shall develop a referral procedure to assure that coordination exists with Supplemental Nutrition Program for Women, Infants and Children (WIC) as required under Public Law 103-448, 204.(e), utilizing State required documentation." New Hampshire General Service Agreement, Exhibit A.3., pages 5-6.

"2.C.10.C...
(E) Referral and coordination to ensure maximum participation in the Supplemental Food Program for Women, Infants, and Children (WIC)." New Mexico Contract, page 31.

"10. BENEFIT PACKAGE, COVERED AND NON-COVERED SERVICES...
10.26 Women, Infants, and Children (WIC)
The Contractor shall develop linkage agreements or other mechanisms to ensure women and children enrollees are referred to WIC services if qualified to receive such services. The Contractor shall refer pregnant women and children, five (5) years of age or younger, to WIC local agencies for nutritional assessments and supplements...

"10.27 Coordination of Services
The Contractor shall coordinate care for Enrollees with: ...
d) WIC
Coordination may involve contracts or linkage agreements (if entities are willing to enter into such agreement), or other mechanisms to ensure coordinated care for Enrollees." New York Contract, pages 10-1-10-16.

"COMMUNITY RESOURCES
Child Service Coordination...
Women, Infants, and Children (WIC) Program: ...Currently, WIC operates through State health departments. The supplemental foods provided by WIC contain nutrients often lacking in diets of the target population. The WIC program provides information and education emphasizing the relationship between nutrition and good health. In addition, WIC offices make referrals to health and social services to help clients access Health Check Screenings, drug and alcohol use counseling, family planning, Food Stamps, migrant services, Head Start, Even Start, and child abuse counseling." North Carolina Contract, Appendix VI, pages 1-2.

"F. IN-PLAN SERVICES...
5. Special Needs Population Staffing
The HMO will be required to develop, train, and maintain a 'special' dedicated unit with in its organizational structure to deal with issues relating to MA members with special needs.These staff members will be responsible to assist recipients in accessing services and benefits of the HMO and to act as liaisons with various government offices, providers, public entities, county entities which shall include but not limited to: ...
* WIC Agencies." Pennsylvania RFP, pages 37-48.

"2.07.04.04 Special Supplemental Nutrition Program for Women, Infants And Children (WIC Program) The State operates a WIC Nutrition program through the Department of Health for pregnant, postpartum and breast-feeding women and children, birth to age five who are at risk for nutritionally related health and developmental conditions. For its part, Contractor shall have written policies and procedures for referring pregnant women and children to the WIC program." Rhode Island RFP, page 32.

"4.7.5 Women, Infant, and Children (WIC) Program Referral
The Contractor shall be responsible for ensuring that coordination exists between the WIC Program and network providers. Coordination shall include referral of potentially eligible women, infants and children and reporting of appropriate medical information to the WIC Program. The WIC Program is administered by the South Carolina Department of Health & Environmental Control (DHEC)." South Carolina Contract, page 20.

"WIC - The Supplemental Food Program for Women, Infants, and Children which provides nutrition counseling, nutrition education, and nutritious foods to pregnant and postpartum women, infants, and children up to the age of two or children deemed nutritional deficient are covered up to age five who have a low income and who are determined to be at nutritional risk." South Carolina Contract, Appendix A, page 10.

"BEST PRACTICE EXAMPLES
FOR HEALTH MAINTENANCE ORGANIZATIONS...
ENHANCED PRENATAL CARE.
Other Services:
Each Medicaid eligible pregnant woman should be assessed to assure that the patient receives all appropriate services available either through the local county Health department or other providers. Such services may include Women Infants and Children (WIC)." South Carolina Contract, Appendix B, page 2.

"6.11 SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS, AND CHILDREN (WIC) - SPECIFIC REQUIREMENTS
6.11.1 HMO must coordinate with WIC to provide certain medical information which is necessary to determine WIC eligibility, such as height, weight, hematocrit or hemoglobin (see Article 7.16.3.2).
6.11.2 HMO must direct all eligible Members to the WIC program (Medicaid recipients are automatically income-eligible for WIC).
6.11.3 HMO must coordinate with existing WIC providers to ensure Members have access to the Special Supplemental Nutrition Program for Women, Infants and Children; or HMO must provide these services.
6.11.4 HMO may use the nutrition education provided by WIC to satisfy health education requirements described in this contract." Texas Contract, pages 46-47.

"34. Medallion II Contractor Referral Responsibilities...
b. Contractor shall advise the recipients of the availability of services offered by the following programs, if appropriate to address the needs of the recipient. The Contractor may coordinate with and refer recipients to the following programs...

(2) WIC Programs
Section 1902(a)(11)(C) of the Social Security Act, as amended, requires the State plan to provide for the coordination of Medicaid and the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) and is administered by the Virginia Department of Health. The Contractor shall provide for the referral of potentially eligible women, infants, and children to the WIC Program and the provision of medical information by providers working within Medicaid managed care plans to the WIC Program." Virginia Contract, pages 56-57.

"5.1.2.5 Coordination With the WIC Programs
The MCP must work with DHHR to provide for the coordination between the Medicaid program and the Special Supplemental Food Program for Women, Infants and Children (WIC) and must provide timely notice and referral to WIC in accordance with section 1902 (a) (53) of the Social Security Act. Referrals to WIC must be accomplished through the WIC PROGRAM REFERRAL FORM, SOR-20 WIC/Medicaid Referral Form." West Virginia RFA, page 38.

"S. HEALTH EDUCATION AND PREVENTION...
8. Systematic referrals of potentially eligible women, infants, and children to the Special Supplemental Food Program for Women, Infants, and Children (WIC) and relevant medical information to the WIC program. General information about recipient eligibility requirements for the WIC program, a Statewide list of WIC agencies, as well as a sample WIC Referral Form that can be used by HMOs, can be found in Addendum XV." Wisconsin Contract, pages 17-18.

"TT. SUBCONTRACTS WITH COMMUNITY-BASED HEALTH ORGANIZATIONS - The Department encourages the HMO to contract withcommunity-based health organizations for the provision of care to Medicaid recipients in order to assure continuity and culturally appropriate care and services...

Community-based health organizations may also provide services, such as WIC services, that HMOs are required by Federal law to coordinate with and refer to, as appropriate." Wisconsin Contract, page 41.

"ADDENDUM XV
GENERAL INFORMATION ABOUT THE WIC PROGRAM, SAMPLE HMO-TO-WIC REFERRAL FORM, AND STATEWIDE LIST OF WIC AGENCIES

General Information About the WIC Program and its Relationship to Medicaid HMOs

The Special Supplemental Food Program for Women, Infants, and Children (WIC) program is a program funded through Title V of the Social Security Act to assess women, infants, and children for nutritional risk and to provide food and food supplements in order to raise the nutritional level of these recipients up to a normal healthy range...

The State Division of Health contracts with numerous local agencies to provide WIC benefits. In Wisconsin, most local WIC agencies are local health departments, but other community based organizations are contracted with to provide WIC benefits, including Community Action Programs and other non-profit agencies.

Section 1902(a)(11)(C) of the Social Security Act requires coordination between Medicaid HMOs and WIC. This coordination includes the referral of potentially eligible women, infants, and children to the WIC program and the provision of medical information by providers working within Medicaid Managed care plans to the WIC program if requested by WIC agencies. Typical types of medical information requested by WIC agencies include information on nutrition related metabolic disease, diabetes, low birth weight, failure to thrive, prematurely, infants of alcoholic, mentally retarded, or drug addicted mothers, AIDS, allergy or intolerance that affects nutritional status, and anemia." Wisconsin Contract, Addendum XV, page 127.