2012 ME Update & 2011 ME Findings

1. 2012 ME Update & 2011 ME Findings Webcast 4/12/12 Presenter Terri Riemenschneider, MDCH/WIC ME PAL

2. Agenda • Update 2012 ME tools-2012 ME process • WIC “ACME” process for Cycle 5 • Short break • Questions and Answers • Review 2011 ME findings • Reasons Not Met • Recommendations for Improvement • Short break • Questions and Answers

3. Questions???Click on ASK

4. 2012 ME-ReviewersReviewers will contact agency to arrange dates • Berrien-Peg • BHSJ-Joyce • CAA-Terri/Heather • Central Michigan- Peg • Chippewa-Eileen • Delta-Menominee-Nancy • Detroit Urban League-Nancy • Downriver Community-Peg/Heather • Family Health Center-Nancy • Genesee-Terri • Grand Traverse-Amy • Huron-Amy • InterCare-Cheryl • Jackson-Nancy • Kalamazoo-Cheryl • Lapeer-Peg • LMAS-Eileen • Marquette-Joyce • Mid-Michigan DHD-Amy • Muskegon-Peg • Oakland-Nancy/Heather • Saginaw-Regina • Sanilac-Regina • St. Clair-Amy • Tuscola-Amy

5. 2011 ME Follow upReviewers will contact agency to arrange dates • Barry-Eaton- Eileen/Diane • Bay-Joyce • Benzie-Leelanau-Terri • Calhoun-Cheryl • Detroit-Regina • DHD #2-Peg • DHD #4-Regina • Dickinson-Iron-Eileen • HDI-Amy/Diane • HDNWM-Terri • Ingham-Heather • Ionia-Nancy/Heather • Keweenaw Bay-Nancy/Diane • Kent-Nancy • Livingston-Peg/Heather • Macomb-Joyce • Mid-Michigan CAA-Diane • Monroe-Nancy/Kevin • Shiawassee-Amy/Kevin • Washtenaw-Cheryl • Wayne- Terri/Kevin • Western UP-Eileen

6. 2012 ME Changes • Updated … • Updated policy citations • Clarified wording • Reduce duplication • Summary of changes in attached document • WIC ME Changes 2012 ME Tools will be posted on WIC Provider website when completed. E-Notice will be sent to notify you of final documents.

7. 2012 ME Changes • Record Review • Nutrition Education review • Single certifier audit review • Class III- diagnosis/high risk • Certification/Admin • New lab manual requirements • Voter registration-cert, recert, change of address • Outreach • Include homeless families • Nutrition Education • Re-arranged existing indicators/criterion to clarify and avoid duplication • Client centered • NE meets policy requirements • Recordkeeping • Updated list of documents to be verified (includes single certifier audits)

8. Comprehensive Plans of Action • After the ME letter is sent, you will be EMAILED a copy of the CPA form. The citations and ‘reason not met’ will be filled in. • Please complete the Plan for each citation noted. • Each step necessary to address the problem • Timeframe for completion • Who will be responsible for step/who will be trained, observed, monitored • Return CPA (hardcopy) within 30 days of ME letter date with cover letter signed by Health Officer or Agency Director. • Email completed CPA to Sheryl Darling, cc to Local Agency Consultant • You will receive feedback from your Consultant within 10 days

9. Sample CPA Agency completes CPA portion. Submit with letter signed by Health Officer/Agency Director

10. ACME ProcessWIC & Cycle 5

11. ACME ProcessWIC & Cycle 5 • Agency completes ME • CPA process NOT COMPLETED • Agency Accreditation-NOT MET • CPA must be fully completed to Meet accreditation. • Agency completes ME • Agency completes CPA process, if needed • Agency ready for Accreditation-MET

12. Cycle 5 Accreditation Schedule

13. Accreditation Report

14. Questions???Click on ASK

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20. Questions & Answers 2012 ME Tools will be posted on WIC Provider website when completed. E-Notice will be sent to notify you of final documents.

21. Most frequent ‘Not Met’ for 2011 • Collated ME citations for 2011 agencies reviewed • Show most commonly ‘not met’ citations for 2011 • Reasons not met • Recommendations for improvement

22. 4.3 a Health and Diet Assessment59 % Met • Health and Diet Assessment: The WIC Program determines if a person is at nutritional risk through health and diet screening at each certification, recertification, and infant health evaluation. (7 CFR 246.7(e)(1), 246.7(g)(1)(iv), WIC Policy 2.04, 4.02, MI-WIC Policy 2.14) Reasons Not Met: • CAR (Client Assessment Reference) tool not being used, client not assessed for all possible risks • Infant Evaluation not completed Recommendations for Improvement: • Use CAR Tool to assess for all possible risks • Complete Infant Evaluations for all infants

23. Assign ALL Applicable Risks • Review the CAR tools with clients to assess for • medical conditions • other risks that must be manually assigned

24. 4.3 b Anthropometric Assessment68.2% Met • The WIC Program requires or obtains a height or length, head circumference and weight measurement documented in the applicant’s file at the time of certification, recertification and infant health evaluation in accordance with the Anthropometric Measurement Procedures Manual. (7 CFR 246.7(e)(1), 246.7(g)(1)(iv), MI-WIC Policy 2.15) Reason Not Met • Inaccurate height boards • Measurements not confirmed • Dry diaper not verified • Woman not measured Recommendations for Improvement • Check measurement equipment accuracy • Confirm all measurements • Make sure of dry diaper • Measure women

25. 4.3c Hematological Assessment 68.2% Met • The WIC Program requires or obtains a hematological test as a screening tool to assess for low serum iron levels, as a part of the assessment for nutritional risk. The WIC Program requires screening for lead testing and referral if they have not been tested. Hematological testing shall be performed according to the standard procedures established in the WIC Laboratory Procedure Manual. (7 CFR 246.7(e)(1), 246.7(g)(1)(iv), MI-WIC Policy 2.16, 6.04) Reasons Not Met • Hands not washed before gloving • Clients not asking about bleeding disorders • Choking risk not monitored • Expired control solutions • No “open date” on microcuvettes Recommendations for Improvement • Follow Lab procedures • Monitor bandaids/choking risk

26. 4.3d Assignment of Risk 63.6% Met • The WIC Program’s Competent Professional Authority (CPA) determines an individual’s nutritional risk by considering dietary, anthropometric, hematological, and health history assessments and assigns all applicable risks. (7 CFR 246.7(e)(2), WIC Policy 2.04, 4.02, MI-WIC Policy 2.13 A, 2.15, 2.16) Reason Not Met: • Not using CAR tool to assess and assign manual risks Recommendations for improvement: • Use CAR tool to identify all applicable risks

27. 5.1a Medicaid Referrals50% Met • The WIC Program provides written information and referrals regarding Medicaid to potentially eligible clients. (7 CFR 246.7(b)(2), MI-WIC Policy 6.02) Reason Not Met • No referral to Medicaid-current Medicaid (MA) & Food Stamps/SNAP (FS) not documented Recommendations for Improvement: • Refer all clients who don’t have Medicaid

28. 5.1b Referrals to MIHP45.5% Met • The WIC Program advises and refers each client, parent or caretaker of the types of health and community services that may benefit the client. (7 CFR 246.7(b)(2), MI-WIC Policy 6.02) Reason Not Met: • No referral of women & infants to MIHP Recommendations for improvements • Refer all women and infants to MIHP (if available in community)

29. 5.1c List of Local Substance Abuse Treatment Resources 63.6% Met • The WIC Program makes available a list of local resources for drug and other harmful substance abuse counseling, prevention and treatment, where they are located, how they may be obtained, and why they may be useful at the first WIC visit and thereafter as appropriate. (Public Law 101-147, MI-WIC Policy 6.02) Reason Not Met • No list of substance abuse services given to newly enrolled client Recommendations for improvement • Provide list of local substance abuse treatment services to all new clients

30. 5.4a Client Agreement72.7% Met • At the time of initial entry, out of state transfer or Authorized Person change, the WIC Client Agreement is read by or read to the WIC applicant, client or authorized person, in a language which is understandable to that client, the client signs the Agreement and is given a signed copy. At recertification the client reviews and signs the WIC Client Agreement and is provided a copy upon request. (7 CFR 246.7(i)(8), 246.7(j), MI-WIC Policy 2.18) Reason Not Met • Client agreement not signed or read at recert Recommendations for improvement • Read and sign the Client Agreement at each cert/recert

31. 5.4c Notifications77.3% Met • The WIC Program provides notices of ineligibility, mid-certification termination, short certification and expiration/termination of certification to applicants and clients as required. (7 CFR 246.7(j), MI-WIC Policy 2.19, 2.20) Reason Not Met: • Not providing copies of short cert, ineligibility or term notices Recommendations for improvement: • Provide required notifications when termination, short cert or ineligible

32. 5.4d Voter Registration72.7% Met • At each certification, the client is offered an opportunity to register to vote and the local agency sends the completed registration forms to county or township officials (forms may be sent as a batch) and declination forms are retained for 24 months. (National Voter Registration Act of 1993, MI-WIC Policy 1.10) Reason Not Met: • Not offering/signing voter declination forms Recommendations for Improvement: • Offering/signing voter registration or declination at each cert, recert, address change

33. 6.1a Nutrition Ed Contacts50% Met • The WIC Program ensures that at least the required nutrition education contacts are made available during each certification period to all clients (through individual or group sessions) (7 CFR 246.11(e)(2), MI-WIC Policy 5.01, 5.03) Reason Not Met: • Did not document offer of required number of NE contacts Recommendations for improvement • Offer and document required number of nutrition education contacts

34. 6.1b NE Plan77.3% Met • The WIC Program documents that nutrition education has been offered in the NE Plan section of each client’s record. (7 CFR 246.11(e)(4), MI-WIC Policy 5.01, 5.03) Reason Not Met: • NE Plan not completed Recommendations for Improvement • Complete NE Plan at each cert/recert/infant evaluation • Provide copy of NE Plan to client

35. 6.1c NE Documentation68.2% Met • The WIC Program documents each nutrition education contact that has been provided in the MI-WIC nutrition education/pop-up section of all client records. (7 CFR 246.11, MI-WIC Policy 5.01, 5.03) Reason Not Met • Did not complete NE grid on NE pop-upscreen Recommendations for improvement • Document NE provided on NE pop up grid

36. 6.2a Client Centered Nutrition Ed54.5% Met • The WIC Program ensures that nutrition education stresses the relationship between proper nutrition and good health based on the client’s individual concerns, nutritional needs, socio and economic factors, food preferences, language/literacy needs, and cultural values. (7 CFR 246.11(b)(1-2), 246.11(e)(6), MI-WIC Policy 5.01) Reason Not Met: • Client's concerns not honored in NE provided • Provided NE during assessment • VENA techniques not observed • NE materials not evaluated for appropriateness • NE not provided during cert Recommendations for improvement: • Provide client centered NE during cert/recert/infant evaluation • Evaluate NE materials

37. 6.4a NE Plan-Develop50% Met • The WIC Program’s Competent Professional Authority (CPA) and the client will develop and document a nutrition education plan that prioritizes client health concerns to be discussed during the certification period and plans for follow up (e.g. NE Plan). (WIC Policy Exhibit 6.02B, MI-WIC Policy 5.01) Reason Not Met: • Client concerns not addressed in NE Plan Recommendations for Improvement: • Address client concerns in NE plan • Offer NE that targets client needs

38. 6.4b Nutrition Ed Plan Copy50% Met • The WIC Program shall provide to the client at the time of the certification and recertification a copy of the Nutrition Education Plan that lists the broad categories of the health concerns identified at the time of the visit. (7 CFR 246.11(b)(2), MI-WIC Policy 5.01) Reason Not Met: • Client not provided NE plan • NE Plan not documented Recommendations for Improvement: • Document and provide NE plan at each cert/recert/infant evaluation

39. 6.5e Breastfeeding68.25% Met • The WIC Program has a plan to ensure that women have access to breastfeeding promotion and support activities during the prenatal and postpartum periods. (7 CFR 246.11(c)(8)(iv), MI-WIC Policy 1.07, MI-WIC Policy 4.01, 4.02, 4.03) Reason Not Met: • BF assessment screens not completed during PG, BF, Infant enrollment and Infant evaluation Recommendations for Improvement: • Complete breastfeeding assessments at cert/recert and infant evaluation for women and infants

40. 6.5f BF Education and Support50% Met • The Local Agency provides ongoing education and support to Pregnant and Breastfeeding mothers and infants. (MI-WIC Policy 4.01, 4.03) Reason Not Met: • BF education and support not documented Recommendations for improvement • Document breastfeeding education provided (clients and staff)

41. 6.6b High Risk Services40.9% Met • The WIC Program ensures that a Registered Dietitian is accessible to see nutrition high-risk clients, completes the nutrition assessments and develops nutrition care plans or documents that a care plan is not needed. (USDA WIC Nutrition Services Standards, WIC Policy 1.11, 6.03, 6.07, Exhibit 6.07A) Reason Not Met: • Not documenting referral to RD • Incomplete documentation of care plans/NE pop-up screen • LA not monitoring High Risk referrals, care plan documentation Recommendations for improvement: • Offer and document referral to RD • Fully document Care Plan and NE provided (CP (Care Plan) & NE pop up screens) • Monitor High Risk services

42. 7.3a, b Special Formula Approval50% /54.5% Met • The WIC Program CPA/RD approves and provides special dietary formula and food packages as indicated for clients with special dietary needs, based on complete medical documentation received for: • Class I formulas after 1 year of age. • Class II formulas. • Class III • Other special food packages as indicated per policy. (7 CFR 246.10(c)(1), MI-WIC Policy 7.03) Reasons Not Met: • Medical Documentation Form not completed • Food pkg. given did not reflect MDF prescription • Prescription periods did not reflect MDF • Unauthorized diagnosis Recommendations for Improvement: • Complete Medical Documentation Form • Verify food package & period prescribed • Authorize allowed diagnosis only

43. 9.1a Recordkeeping36.4% Met • The WIC Program maintains complete and accurate records including, but not be limited to, information pertaining to financial operations, equipment purchases and inventory, training, quality assurance/audits/record reviews. (7 CFR 246.7, 246.17(b)(2), 246.19(b)(6), 246.25(a)(1), WIC Policy 1.09, 1.10, 6.03, 6.08, MI-WIC Policy 1.03, 6.03) Reason Not Met: • Breastpump issuance not according to policy • Clinics not reviewed annually Recommendations for Improvement: • Issue breastpumps per policy • Review all clinics annually

44. 9.2b EBT Issuance77.3% Met • The WIC Program follows procedures issuance of WIC Bridge Cards. (7 CFR 246.25(a)(1), MI-WIC Policy 8.08, 8.09 Reason Not Met: • Failed to conduct monthly EBT card inventory • Did not store EBT cards securely • Not recording cards immediately upon receipt Recommendations for Improvement: • Inventory monthly • Store cards securely with limited access • Record into inventory upon receipt

45. Upcoming WIC trainings….Register at https://mphi-web.ungerboeck.com/wri/wri_p1_display.aspx?oc=10&cc=WIC • April 16-20 Certified Lactation Specialist Course Mt. Pleasant • April 24-25 WIC CPA Clare • April 26 Preventing Birth Defect Webcast • May 8-9 WIC Conference Grand Rapids • May 10 Anthropometric Grand Rapids • May 10 Laboratory Grand Rapids • June 6 Anthropometric Mt. Pleasant • June 7 Laboratory Mt. Pleasant • June 12-13 Breastfeeding Basics Kalamazoo • June 14 Growth Chart/Risk Revision Webcast • June 19 CPA Advanced Dearborn • June 21 CPA Advanced Clare

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