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REGULATIONS
Vol. 29 Iss. 12 - February 11, 2013TITLE 12. HEALTHSTATE BOARD OF HEALTHChapter 195Final RegulationREGISTRAR'S NOTICE: The State Board of Health is claiming an exemption from the Administrative Process Act pursuant to Item 295 B of Chapter 3 of Special Session I of the 2012 Acts of Assembly, which exempts the Special Supplemental Nutrition Program for Women, Infants, and Children from the requirements of the Administrative Process Act.
Title of Regulation: 12VAC5-195. Virginia WIC Program (amending 12VAC5-195-10, 12VAC5-195-20, 12VAC5-195-30, 12VAC5-195-70, 12VAC5-195-110, 12VAC5-195-140, 12VAC5-195-150, 12VAC5-195-200, 12VAC5-195-210, 12VAC5-195-230, 12VAC5-195-280 through 12VAC5-195-370, 12VAC5-195-390 through 12VAC5-195-670; adding 12VAC5-195-680).
Statutory Authority: § 32.1-12 of the Code of Virginia; 7 CFR Part 246.
Effective Date: March 13, 2013.
Agency Contact: Anne Massey, Policy Analyst, Department of Health, 109 Governor Street, Richmond, VA 23219, telephone (804) 864-7797, or email anne.massey@vdh.virginia.gov.
Summary:
Amendments were made to the Virginia WIC Program state regulations, the majority of which were made to Part III pertaining to vendor requirements. Many of the amendments reflect the Virginia WIC Program's change in the retailer peer group structure, which was the result of an independent analysis of the existing peer group structure conducted by Mikelson and Associates. The analysis included a recommendation to change the structure to define geographic areas based on a rural or urban designation according to the Isserman model instead of Business Economic Areas, the criteria in use at the time of the report. The Isserman model includes a definition of rural and urban that integrates the 2000 census tract population into the U.S. Office of Management and Budget (OMB) county based definition and the census rural/urban continuum codes.
In addition, the retailer slotting system, which had been the basis for retailer selection decisions and was tied into the peer group structure, was eliminated. The Virginia WIC Program had committed to this change during discussions with the Joint Commission on Administrative Rules. The following sections were amended due to these changes in the peer group structure and retailer slotting system: 12VAC5-195-330, Adequate Participant Access; 12VAC5-195-340, Competitive Pricing; 12VAC5-195-360, Selection Decisions; and 12VAC5-195-370, Authorization Exception Decisions.
A new section, 12VAC5-195-680, Food Application Process, was added to formalize the process used by the Virginia WIC Program to solicit, evaluate, and select products for inclusion in the WIC Approved Food List. The content of this section details the application process in which prospective manufacturers, distributors, and suppliers participate to have their products considered for the WIC Approved Food List as well as the process to implement any changes to the list.
Additional amendments were made to remain consistent with current WIC Program policies including:
1. 12VAC5-195-30, Definitions. Removes terms that were no longer used such as "Business Economic Areas," adds terms from new sections including "formula flyer," and adds terms that had been in use but needed clarification including "WIC sales" and "relative." The term "vendor" was removed and replaced solely with "retailer" for consistency.
2. 12VAC5-195-110, Caretaker. Reflects policy changes that make the caretaker option more accessible to those caring for WIC eligible infants and children in the absence of a parent or legal guardian.
3. 12VAC5-195-150, Alternative office hours. Adds the requirement of local agencies to offer a minimum of 16 alternative office hours a month.
4. 12VAC5-195-350, Price verification. Reduces the number of retailers negatively affected by rejected food instruments due to noncompetitive prices; the variance of the peer group pricing average was increased by 10%.
5. 12VAC5-195-460, Conflict of interest. Adds clarification regarding conflict of interest requirements for WIC authorized retail management and employees.
6. 12VAC5-195-600, Sanctions and administrative actions. Updated to reflect the most current sanction descriptions and related administrative actions.
General language and wording changes were also made for consistency and clarity.
Part I
General Provisions12VAC5-195-10. General authority.
The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) was authorized as part of the Child Nutrition Act of 1966, Section 17 (42 USC § 1786), to provide supplemental foods and nutrition education to pregnant, postpartum and breastfeeding women, infants and young children from families with inadequate income. The Virginia WIC Program is regulated by federal regulations published in the Code of Federal Regulations, 7 CFR Part 246, Special Supplemental Nutrition Program for Women, Infants and Children. The state regulations shall serve as a supplement to 7 CFR Part 246.
The WIC Farmers' Market Nutrition Program was established in 1992 as P. L. 102-314 to provide resources in the form of fresh, nutritious, unprepared foods (fruits, vegetables and cut herbs) from farmers' markets to WIC participants and to expand the awareness, use of and sales at farmers' markets. The Virginia WIC Farmers' Market Nutrition Program is regulated by federal regulations published in the Code of Federal Regulations, 7 CFR Part 248.12VAC5-195-20. Purpose.
A. The Virginia WIC Program serves women who are breastfeeding, pregnant, or have just given birth; infants less than one year old; and children less than five years old. WIC participants must be Virginia residents and meet the financial and nutritional requirements.
B. The Virginia WIC Program provides special supplemental foods to eligible participants through a retailer delivery system (7 CFR 246.12). Food benefits are issued by local agencies to eligible participants using food instruments (7 CFR 246.10). Participants redeem their food instruments at any authorized retailer or entity. The state agency enters into an agreement with authorized
storesretailers (7 CFR 246.12). This agreement identifies the obligations, rights and responsibilities of both the authorizedretail storeretailers and the state agency. Retailers deposit these food instruments into their bank account. The state agency pays authorized retailers a reasonable dollar amount for the foods purchased, as listed on the deposited food instruments (7 CFR 246.12).C. The state agency shall promulgate policies, guidelines, manuals and training resources to facilitate operations of the Virginia WIC Program in accordance with its contractual agreement with Food Nutrition Service (FNS) (7 CFR 246.3); the guidelines and instructions issued by FNS in policy letters; and management evaluations and audits and the WIC Program State Plan of Operations.
12VAC5-195-30. Definitions.
The following words and terms when used in this chapter shall have the following meanings, unless the context clearly indicates otherwise:
"Administrative
appealreview" means the procedure through which applicants and/orretail storesretailers may appeal a state agency's administrative action, including program disqualification, denied authorization and othertermination reasonsadverse actions."Agency representative" means staff from the state agency, a local agency, a contractor, or other designated individuals trained to conduct WIC functions and monitor retailers.
"Approved food list" means a brochure or method used by the WIC Program to communicate to eligible participants, retailers, local agencies and other interested parties which authorized supplemental foods may be purchased using WIC food instruments. The approved food list is a guide and must be used with the printed food instrument, which may identify specific brands or additional products not stated on the approved food list that may be purchased by participants.
"Authorization" means the process by which the state agency assesses, selects and enters into an agreement with
storesretailers that apply or subsequently reapply to be authorized."Automated clearinghouse" or "ACH credit" or "direct deposit" means a method used to reimburse stores for certain types of processed food instruments (i.e., "Over FI Max."). A credit is made to the store's designated bank account and routing number using the automated clearinghouse process."Business economic areas" or "BEAs" mean a categorization method established by the United States Department of Commerce – Bureau of Economic Analysis and used by the state agency to identify geographically similar trade and economic communities. Some more populated BEAs are further broken down into smaller subsets or peer groupings, based upon number of unique participants served by authorized stores."Caretaker" means a person 18 years of age or older, unless approved at the discretion of a competent professional authority, designated by a parent or legal guardian to certify an infant/child, obtain and redeem food instruments and attend nutrition education. A caretaker may be any person who has detailed knowledge of the nutritional needs and eating habits of the infant/child. A parent or legal guardian may designate one caretaker per family ID number.
"Caseload" means the number of WIC participants assigned to a local agency by the state agency."Cash value food benefits" means a special food instrument that has been issued to eligible participants for a specific dollar amount that must be used to purchase fruits and vegetables. Unless stated otherwise, all references to food instruments include cash value food benefits, as well as food and formula food instruments.
"Civil monetary penalty" or "CMP" means an administrative fine offered to a retailer in lieu of disqualification if inadequate participant access exists as determined by the state agency.
"Direct deposit ACH" means a method used to reimburse retailers for certain types of processed food instruments (i.e., "Over FI Max"). A credit is made to the retailer's designated bank account and routing number using the automated clearinghouse process.
"Enrollment" means the process all applicants and authorized
storesretailers must complete in order for astoreretailer to be eligible to accept WIC food instruments."Food instrument" means a voucher, check, electronic benefits transfer card (EBT), coupon, or other document that is used by a participant to obtain supplemental foods.
"Formula flyer" means a handout or method used by the state agency to communicate to eligible participants, retailers, local agencies, and other interested parties that formulas may be purchased at authorized retailers.
"Image replacement document" or "IRD" means a legal copy of a deposited food instrument that is created and transmitted by a
store'sretailer's depository bank to the WIC Program's backend processor for payment consideration."Informal settlement meeting" means a meeting held with an authorized
storeretailer or applicant representative and the state WIC director whose purpose is to review and clarify outstanding WIC Program administrative issues."Legal guardian" means an individual who has been appointed by a court of law or the Department of Social Services, or other legal means, to have primary, physical custody of a minor. A legal guardian shall be authorized to provide eligibility information for an applicant, consent to medical treatment of the applicant, and shall be held legally bound if sanctions are imposed.
"Peer group" means a classification of applicants and authorized
storesretailers into groups based on common characteristics or criteria that affect food prices for the purpose of applying appropriate competitive price criteria tostoresretailers at authorization and limiting payments for foods at competitive pricing levels. A retailer's peer group is used to determine competitive pricing levels at initial authorization and establish the reimbursement maximums paid by the state agency."Postpayment review" means an analysis of paid food instruments redeemed by authorized retailers in order to determine if pricing and redemption discrepancies exist. Based upon this analysis, a
vendorretailer claim against theretail storeretailer may be established by the state agency."Prepayment edit" means a price adjustment made to the reimbursement level given to retailers. This editing process can be either automated or a manual screening of deposited food instruments done by an independent banking contractor, prior to releasing payment to authorized
retail storesretailers."Relatives" means spouses, parents, children, brothers, sisters, aunts, uncles, nephews, nieces, grandparents, and grandchildren.
"Retailer" means a vendor, retail store, commissary, or entity authorized by the Virginia WIC Program to accept WIC food instruments for the various types of foods listed on food instruments. The term "retailer" is equivalent to the term "vendor" used in federal regulations (7 CFR 246.12).
"Retailer agreement" means a written agreement that establishes the respective roles and responsibilities of the
programstate agency and authorized retailers in complying with federal and state requirements."Retailer claim" means the state agency has determined an authorized retailer committed a violation of the retailer agreement that affects the payment status of one or several food instruments.
"Retailer manual" means a series of written documents that communicate administrative procedures for the Virginia WIC Program that regulate both authorized retailers and applicants. The Retailer Manual is part of the WIC Program State Plan that must be submitted and approved by USDA.
"Sanctions" mean a penalty imposed by the state agency upon an authorized retailer for a specific violation outlined in the
vendorretailer manual or retailer agreement."State agency" means the Virginia Department of Health and the delegated authority to the Division of
WIC and Community Nutrition Services thatCommunity Nutrition, which has the administrative responsibility for managing the Virginia WIC Program."Termination" means the act of ending a
retail store'sretailer's WIC Program authorization for administrative reasons that includebut are not limited toa change of ownership, closedstoreretailer location, voluntary withdrawal, and noncompetitive prices."Unique participant" means the number of unduplicated individuals who have redeemed one or more food instruments at a retail store during a specific period.
"United States Department of Agriculture" or "USDA" means the federal agency that provides funding for the WIC Program on behalf of Congress.
"Vendor claim" means the state agency has determined an authorized store committed a violation of the retailer agreement that affects the payment status of one or several food instruments. The state agency may delay payment or establish a claim in the amount of the full purchase price of each food instrument that contained the overcharge or other error. The state agency will bill and recoup the funds paid against these improperly redeemed food instruments."Vendor manual" means a series of written documents that communicate administrative policies and procedures for the Virginia WIC Program that affect both authorized retailers and applicants. The Vendor Manual is part of the WIC Program State Plan that must be submitted and approved by USDA."Virginia Department of Health" or "VDH" means the state agency that oversees the Virginia WIC Program."Waiting list" means a list implemented by the state agency for individual participants when the maximum caseload is reached.
"Warning" means one or more incidents of noncompliance with program requirements were documented. The state agency sends a written warning letter to the owner or store manager to advise him of any documented violations. A warning letter is not sent to the owner or store manager for selective documented violations that affect the integrity of the investigative process, including but not limited to overcharges, fraud, and forgery."WIC sales" means annual sales based on WIC redemption paid by the state agency to an authorized retailer.
Part II
Participant Requirements12VAC5-195-70. Eligibility requirements.
A. Adjunctive financial eligibility requirements. Adjunctive, or automatic
incomefinancial eligibility is determined pursuant to 7 CFR 246.7. Documentation is required as proof of participation in programs that qualify an applicant for adjunctive financial eligibility. The state agency also allowsthe following state-administered programsFamily Access to Medical Insurance Security Plan (FAMIS) and a $2.00 co-pay level to be used in determining adjunctiveincomefinancial eligibility:.1. Family Access to Medical Insurance Security Plan (FAMIS) and a $2.00 co-pay level; and.2. FAMIS MOMS program.B. Local agencies shall serve institutionalized applicants if they meet all eligibility requirements.
C. For determining income eligibility, local agency personnel shall use the applicant's current or annualized income, whichever is the best indication of circumstances.
D. In determining income eligibility, the state agency
utilizesshall utilize all income exclusions listed in 7 CFR 246.7.E. Applicants who are not adjunctively financially eligible shall have financial eligibility determined using income guidelines equaling the income guidelines established under § 9 of the National School Lunch Act for reduced price school meals per 7 CFR 246.7.
F. An applicant claiming multiple fetuses shall have the stated number used at the time of certification, but
is required toshall be required to provide written verification by a physician or nurse practitioner working under the supervision of a physician within 90 days of certification.12VAC5-195-110. Caretaker.
A. A parent or legal guardian may have the privilege, but not the right, to designate one caretaker per family ID number to certify an infant or child
, towho may obtain and redeem food instruments,andtoattend nutrition education. The caretaker assumes all of the rights and responsibilities of the parent or legal guardian who designatesthemhim. A caretaker shall be designated only when the local agency cannot accommodate the needs of the parent to attend the local agency to obtain WIC benefits. In the absence of a parent or legal guardian, a caregiver shall provide reasonable documentation of his status as a primary caregiver. Reasons supporting the designation of a caretaker shall be documented and become part of the participant's record. The authority to implement the caretaker policy will be granted individually to local agencies by the state WIC director. The parent is always encouraged to be the primary recipient of all WIC benefits.B. A caretaker may be designated in two situations:
1. A parent or legal guardian's declaration of hardship or
2. The caretaker providing reasonable documentation of his role in the absence of a parent or legal guardian.
B.C. Local agency personnel shallonlydiscuss the option of designating a caretaker if the participant, parent, or legal guardianindicates one of the following situationsdeclares hardship that prevents him from coming to the local agency during established regular and alternative hours due to:1.
The participant, parent or legal guardian expresses difficulty with attending the local agency for nutrition education WIC benefitsConflict of schedules due to work, school, or some other valid reason;2.
The local agency determines difficulty with the participant, parent or legal guardian attending the local agency through objective methods such as the no show reports, missed appointments, or frequently rescheduled appointmentsLack of transportation; or3.
The local agency determines difficulty with the participant, parent or legal guardian attending the local agency during established alternative hoursAn infant or child residing with a family member or caretaker.D. The caretaker shall provide reasonable documentation to substantiate his relationship with the infant or child and his role as primary caretaker. Reasonable documentation may include:
1. Signed caretaker designation form, WIC-311, indicating the designation of caretaker that may be obtained prior to the first local agency visit;
2. Signed and witnessed letter from the legal guardian or parent designating a caretaker and reason for the legal guardian's or parent's inability to certify an infant or child, obtain and redeem food instruments, and attend nutrition education; and
3. Documentation of the parent or legal guardian's enrollment, residence, or confinement in a hospital treatment program, shelter, penal institution, or other institution.
12VAC5-195-140. Food instruments.
A. Food instrument issuance. All food instruments shall be issued through the automated system only after eligibility has been documented and
onlywhen the participant, parent or legal guardian, caretaker, or proxy is physically present at the local agency to pick uptheirthe food instrument. Failure by the participant, parent, legal guardian, caretaker, or proxy to attend the initial nutrition education appointment may result in reduced WIC benefits for that month.B. Lost food instruments. Replacement of lost, valid, not redeemed food instruments shall only occur once within the entire duration of the participant, parent, caretaker, or legal guardian's receipt of WIC services, unless approval is obtained from the state agency. Lost food instruments shall only be replaced for one of the following situations:
1. A participant leaving home because of
familydomestic violence;2. A change in full legal custody, including when infants/children are removed from home and placed in foster care or parental custody is changed; or
3. An event out of the control of participant, such as a fire or natural disaster that is publicly documented.
C. Stolen food instruments. Food instruments reported as stolen shall only be replaced when a police report is provided that states that the valid, not redeemed, WIC food instruments were
thestolenitems. Stolen food instruments shall not be replaced without a police report, unless costs are associated with the police report and a waiver is granted by the state agency. Stolen food instruments shall only be replaced once within the entire duration of the participant, parent, caretaker, or legal guardian's receipt of WIC services, unless approval is obtained from the state agency.D. Mailing WIC food instruments. Food instruments shall only be mailed with prior approval from the competent professional authority for individual participants if the participant has already received the required secondary nutrition education contact or if the participant will be able to receive nutrition education at the next visit within the certification period. Justification for mailing food instruments to individuals, families and groups includes:
1. Illness or disability resulting in the participant being physically unable to be present as documented by medical records
and meeting the Americans with Disabilities Act criteria (28 CFR Part 35) for physically unable to be present;2. Imminent childbirth as documented by medical records;
3. Distance to travel, especially in rural areas with a minimum 60-mile roundtrip travel distance between home and the local WIC clinic, as
approvedconfirmed by the local WIC coordinator;4. Other travel distance for participants with unique transportation challenges;
5. Computer failure at the local agency site;
6. Natural disasters;
7. Complete systemwide failure of automated system; and
8. Difficulty obtaining complete prescription for a special formula
asthat has been approved by a local WIC coordinator.Food instruments shall only be mailed for a
one-monththree-month period. Requests beyond theone-monththree-month period shall require approval by the state agency.12VAC5-195-150. Alternative office hours.
Alternative office hours shall be offered outside of the regular operating hours of Monday through Friday, between 8 a.m. and
54:30 p.m. to address barriers in accessing WIC services for current and potential applicants and participants. The local agency shall offer a minimum of 16 alternative office hours per month and provide documentation to the state agency that the alternative hours accommodate the needs of the current client caseload.12VAC5-195-200. Program abuse and sanctions.
A. The state agency determines program abuse and sanctions that may be issued to applicants and participants. When more than one abuse is involved at a time, the sanction shall be based on the more serious abuse.
B. If an abuse occurs more than 12 months after the last abuse, the local agency shall process the abuse as a first offense.
C. When more than three abuses in a 12-month period occur, the local agency shall issue a three-month temporary disqualification.
D. Program abuses and assigned sanctions are as follows:
Abuse
Number of Offenses
Sanction
Class I
Any deliberate misrepresentation of income, name, residence, family size, medical data, or date of birth to obtain WIC benefits
All
Three-month disqualification
Dual participation – redeeming food instruments from two programs/agencies in same month
All
One-year disqualification
Assessed claim for $100 or more
All
One-year disqualification
Assessed second or subsequent claim for any amount
2nd or subsequent
One-year disqualification
Attempting to steal or actually stealing food instruments from the local agency or another participant, if under $100
All
Three-month disqualification
Selling, exchanging or giving away food instruments, food, or formula
All
Three-month disqualification
Redeeming WIC food instruments reported as lost or stolen, if under $100
All
Three-month disqualification
Attempting to redeem or redeeming WIC food instruments for nonfood items (i.e., diapers, wine, cigarettes)
All
Three-month disqualification
Physically abusing the WIC or store retailer staff (An incidence of physical abuse of WIC or store retailer staff/property should be reported to the police)
All
Three-month disqualification
Accepting cash or credit from a store retailer in connection with a WIC transaction
1st
One-month disqualification
2nd
Two-month disqualification
3rd
Three-month disqualification
Alteration of WIC food instruments (includes date, quantities, types of food)
1st
One-month disqualification
2nd
Two-month disqualification
3rd
Three-month disqualification
Class II
Creating a public nuisance at the local agency or the store retailer (i.e., verbally abusing, harassing, or threatening WIC or store retailer staff, destroying store retailer merchandise, or disrupting normal local agency or store retailer activities)
1st
Warning letter
2nd
Two-month disqualification
3rd
Three-month disqualification
Attempting to redeem or redeeming WIC food instruments for unauthorized food, formula or food amounts
1st
Warning letter
2nd
Two-month disqualification
3rd
Three-month disqualification
Allowing unauthorized person(s) to use the WIC ID Folder to pick-up and/or redeem WIC food instruments
1st
Warning letter
2nd
Two-month disqualification
3rd
Three-month disqualification
Deliberately damaging or destroying WIC food instruments
1st
Warning letter
2nd
Two-month disqualification
3rd
Three-month disqualification
Redeeming WIC food instruments before or after valid spend dates
1st
Warning letter
2nd
One-month disqualification
3rd
Two-month disqualification
Attempting to redeem or redeeming food instruments at unauthorized stores retailers
1st
Warning letter
2nd
One-month disqualification
3rd
Two-month disqualification
12VAC5-195-210. Collection of improperly issued instruments/claims against participants.
The state agency
mayshall establish a claim against a participant for the full value of benefits improperly obtained or disposed ofand any fees or additional expenses incurredas a result of a participant violation.These improper acts include, but are not limited to:Participant violations include:1. Inaccurate certification information;
2. Dual participation violations;
3.
Proxy abusesViolation of the WIC guidelines or rules by the proxy or caretaker; or4. Retention of future food instruments after disqualification.
12VAC5-195-230. Conflict of interest.
A. Individuals involved in administering the WIC Program may not, without prior written approval from the WIC Director or his designee or the director of the local health district:
1. Act as a proxy for a participant;
or2. Have a direct financial interest in an authorized WIC
retail store.retailer; or3. Complete an onsite stocking visit of an authorized retailer at which they or a relative is employed.
B. Individuals involved in administering the WIC Program shall not certify or issue food instruments to themselves or relatives.
Relatives include spouses, parents, children, brothers, sisters, aunts, uncles, nephews, nieces, grandparents and grandchildren.C. Additional conflict of interest regulation may be found in 12VAC5-195-460.
D. This section is not meant to replace or abrogate the Virginia State and Local Government Conflict of Interests Act, Chapter 31 (§ 2.2-3100 et seq.) of Title 2.2 of the Code of Virginia.
Part III
VendorRetailer Requirements12VAC5-195-280. Enrollment procedures.
A. The state agency
acceptsshall accept applications from newstoreretailer applicants year round.B.
StoresRetailers seeking authorization shall comply with 7 CFR 246.12 and sell a range and variety of staple foods and WIC-approved formulas at a permanent fixed location, as specified in the retailer agreement and application package. Only one authorization approval will be granted by the state agency to each eligible location selected for program authorization. Stand-alone pharmacies and any other types of entities that cannot meet all of the general requirements outlined in this sectionwillshall be denied WIC Program authorization.C.
StoreRetailer applicants shall complete the following requirements to become authorized for WIC Program participation:1. Submit all applications, including pricing updates, using an electronic, Internet-based method that has been approved by the WIC Program;
2. Submit prices for all mandatory food and formula items, a signed retailer agreement, supplemental informational form, direct deposit ACH form, and other required forms as deemed necessary to evaluate
a retailer's oran applicant's qualifications;3. Pass a competitiveness price assessment completed by the WIC Program. The state agency shall determine
thatwhether the prices submitted as part of the newstoreretailer application process are price competitive when compared to otherstoresretailers located in thestore'sretailer's assigned peer group;4. Provide documentation to the state agency, upon request, that a satisfactory business integrity record exists. None of the
store'sretailer's current owners, officers, or managers shall have been convicted of or had a civil judgment entered against them for conduct demonstrating a lack of business integrity, within the past six years;5. Pass an unannounced onsite visit to determine if the
storeretailer has met the minimum stocking requirement, has available for sale the variety and selection of foods as stated on the supplemental informational form, and has posted prices that are not higher than prices submitted as part of the application process. The visit shall also verify that thestore'sretailer's hours of operation and number of cash registers were accurately reported;6. Pass an onsite visit to determine if the type and variety of foods sold would qualify the
storeretailer to earn more than 50% of its annual sales solely from the WIC Program. If thestoreretailer is likely to be an above 50%vendorretailer, then it shall be denied authorization;7. Attend a mandatory new
storeretailer training session conducted by either state agency staff or a certified corporate trainer within 30 calendar days after theretail storeretailer passesaan unannounced stocking and price verification visit. Provide documentation to the state agencythat this mandatory training has been completed. Store applicants shall provide to the state agency this documentationwithin 30 calendar days after meeting all other enrollment requirements that this mandatory training has been completed;8. Provide training to
storeretailer personnel and cashiers on proper WIC food instrument handling procedures;9. Return to the state agency all required paperwork within 14 days after receipt including
, but not limited to,a signed retailer agreement, if applicable; supplemental informational form; direct deposit ACH form; and other information deemed necessary to evaluate a retailer's or applicant's qualifications; and10. Receive from the state agency a packet containing an authorization acknowledgement letter granting WIC Program authorization, a
VendorRetailer Manual for the Virginia WIC Program, a WIC window decal, and an authorization stamp.D. Newly authorized
storesretailers shall begin accepting WIC food instruments within 15 calendar days after receiving their program authorization stamp and final acknowledgment letter. Authorizedstoresretailers are required to contact the state agency in writing if thestore will beretailer is unable to meet this program requirement. Failure to begin accepting WIC food instruments within the established time frame may lead to the state agency withdrawing its authorization decision.E.
StoreRetailer applicants that fail to meet any of the enrollment requirements outlined in this sectionwillshall be denied authorization unless the state agency determines that inadequate participant access would exist if the authorization were terminated.12VAC5-195-290. Communications.
A. Authorized
storesretailers shall contact the state agency or their assigned agency representative rather than local WIC agency staff for all questions related to WIC Program participation including,but not limited to, retail storeretailer selection and authorization requirements and decisions, reimbursement questions, participant's food instrument prescriptions, and complaints.B. Authorized
storesretailers shall provide at least 15 calendar days written notice if the retailerdesiresdecides to terminate its participation in the WIC Program orwhenif the retailer ceases operation, changes ownership, or for any other circumstances that impacts service delivery including, but not limited to,relocations, renovations,permanentor temporary closures.C. The state agency shall regularly
communicatescommunicate policy and procedural changes, training issues, WIC food instrument processing tips, cashier reminders and alerts affectingretail storesretailers in an informational newsletter.Annually, aA newsletterisshall be published annually and sent to all authorizedretail storesretailers to updatestoreretailer personnel on major program changes. Theprogram posts, if applicable,state agency shall post approved policy changes, if applicable, on its external webpage. Authorizedstoresretailers shallbe held accountable for complyingcomply with all policy changes communicated in writing by the state agency.D. Written correspondence retained in the state agency's centralized files located in Richmond, Virginia, pertaining to
, but not limited to,astore'sretailer's authorization status, application documentation, or WIC andfood stampsSupplemental Nutrition Assistance Program compliance history is confidential and is protectedunderby federal regulations (7 CFR 246.26). The state agency shall maintainstores'retailers' compliance history and background information for at least a three-year period or the contract period, whichever is longer. For civil judgments andfood stampSupplemental Nutrition Assistance Program administrative documentation issued against a specific authorized retailer, the state agencywillshall retain this documentation for six years.E. In order to utilize the WIC-approved, Internet-based application for submission of prices,
storesretailers shallgiveconsent to be monitored by thestate agencyVirginia Department of Health or its information technology agency to ensure that this application isbeingused for its intended purpose. Ifsuchmonitoring reveals possible evidence of unauthorized or criminal activity, this evidence may be provided toappropriatelocal, state, or federal authorities for disciplinary action and prosecution to the fullest extent permitted by law.12VAC5-195-300. General requirements and conditions for authorization.
A. Once enrolled, a
storeretailer or applicant shall obtain authorization from the state agency to operate as a WIC-authorizedstore from the state agencyretailer before accepting or redeeming food instruments.B. To obtain and retain authorization
and remain authorized, retailers shall:1. Be
food stampSupplemental Nutrition Assistance Program authorized at the time of application or reauthorization and remain in good standing;2.
Be currently WIC-authorized or eligible for authorization after meeting aIf applicable, fulfill the WIC disqualification requirement, if applicable;3. Be in operation as a business at the time of application or within 45 calendar days of application;
4.
MeetComply with all local, state and federalrequirementsstatutes, regulations, and rules, including sanitation and building code regulations;5. Be necessary as determined by the state agency to ensure adequate participant access;6.5. Submit pricesto the WIC Programusing an electronic, Internet-based method at least twice a yearor asand when requested by the state agency;7.6. Remain price competitive when compared to other authorizedstoresretailers that are located in the same peer group;8.7. Meet the mandatory minimum stocking requirement at all times and keep such stock immediately available in the customer shopping area orimmediately availableonsite;9.8.Be locatedOperate at thestoreretailer address indicated in the state agency's application or authorization record; this address shall be the sole location at which WIC customers purchase supplemental foods and formulas;10.9. Be open for business at least 50 hours per week;11.10. Meet all business integrity criteria as defined in 7 CFR 246.12;12.11. Provide supporting documentation to the state agency including, but not limited to,annual food sales information or tax records that will be used to ensure thatnotno more than 50% of thestore'sretailer's total food sales were derived from WIC sales;13.12. Comply with allfinancial andcorrective actions identifiedfromduring prior WICauthorizationauthorizations and pay all civil monetary penalties, if applicable;14.13. Purchase contract and special formula from a distributor, supplier, wholesaler, orretail storewhose nameretailer who islistedapproved by the Virginia WIC Programas approvedto sell formula; and15.14. Participate in the WIC Program's direct deposit(ACH)ACH process used for reimbursement purposes.C.
StoresRetailers shall not offer drive-through window or home delivery services formakingWIC purchases. The participant must take physical possession of purchased food and formula items at the time of transaction when the WIC food instrument is signed.12VAC5-195-310. Above 50%
vendorretailer screening.A. The state agency shall not authorize any applicant or
retail storeretailer that is likely to derive 50% or more of its annual food sales from the sale of supplemental foods to WIC participants.StoresRetailers already authorized by the program whose annual WIC food sales rise to 50% or more of their total food sales will have their authorization status terminated.StoresRetailers must submit documentation that permits the state agency to complete its evaluation and identification of above 50%vendorsretailers. Failure to submit the requested documentation may lead to thestore'sretailer's authorization being terminated.B. Newly authorized
storesretailers with six months of redemption history shall have their status reviewed to determine if they qualify as an above 50%vendorretailer (7 CFR 246.12). If the state agency's assessment determines thestoreretailer qualifies as an above 50%vendorretailer, thestore'sretailer's WIC Program authorization status shall be terminated.12VAC5-195-320. Retailer agreement.
A. The retailer agreement does not constitute a license or a property right. If an authorized
storeretailer wishes to continue to be authorized beyond the current agreement period, thestoreretailer must reapply for authorization. Allstoresretailers must be selected under the current selection and authorization criteria being used by the state agency (7 CFR 246.12).B. Authorized
retail stores and military commissariesretailers shall use a single uniform retailer agreement. The maximum duration of the retailer agreement shall not exceed three years. The duration of the retailer agreement may be for a period that is less than three years, depending uponwhenwhether a county or location is selected to undergo the regional authorization and selection process.C. A fully executed retailer agreement
shallmust be signed by bothanthe authorizedstoreretailer representative andstate agencya WIC program management representative to be enforceable. The state agency shall provide thestoreretailer or its designated contact person a copy ofitsthe signed retailer agreement or authorization acknowledgement letteronceafter all selection and authorization requirements have been met.D.
AAn authorized retailer must have a signed copy of the retailer agreementmust be on filefor anystoreretailer to be paid for a redeemed WIC food instrument.E. Revisions, amendments, or modifications to the provisions of the retailer agreement shall be made in writing. The retailer agreement shall be automatically amended upon written notice from the state agency
shouldif federal,or state laws,or regulations require amendments.F. Authorized
storesretailers shall keep a copy of the updatedVendorRetailer Manual, including a copy of the WIC ApprovedFoodfood list, formula flyer, and Cashier Training Guide, at thestoreauthorized retailer locationauthorized to accept WIC food instruments.G. The state agency reserves the right to extend the current retailer agreement up to six months during the reauthorization evaluation process. If the state agency uses this option, it shall provide written notice to authorized stores affected by this administrative decision.H.G. If thestate agency takesretailer appeals an administrative action by the state agency against a retailerand the retailer appealsand the retailer agreement would otherwise expire during the appeal process, then the state agency shall grant an extension of thatstore'sretailer's retailer agreement during the pendency of the appeal processif the retailer agreement would otherwise expire during that time. Once an appeal decision has been made, the state agency will proceed with either terminating the existing agreement or issuing a new agreement.12VAC5-195-330. Adequate participant access.
A.The state agency shall ensure that adequate participant access exists so that eligible participants may redeem the food instruments issued to them.The state agency uses a retailer limiting criteria to determine adequate participant access (7 CFR 246.12).The state agency has the sole authority todefineestablish adequate participant access criteria, which are described in 12VAC5-195-370.B. The number of authorized stores or retailer slots available is based on two factors:1. Number of WIC participants living in a specific city or county in which the retail store is physically located; and2. Population density of the community where the store is physically located.C. Population density is calculated by identifying the population that resides in a specific city or county. Population density serves as a proxy indicator used by the program to project how close together retailers and participants are located next to each other. Thus densely populated areas where stores are located closer together require fewer stores to provide adequate participant access.D. In sparsely populated areas, both population and stores are dispersed over a wider geographical area that directly impacts participant access. More sparsely populated areas require more authorized stores to adequately serve eligible participants.E. Participation is managed and monitored by the WIC Program on a monthly basis. For this reason the number of available slots for authorized stores may change frequently. This change will not impact stores already authorized, but may impact a new store applying for authorization in a given area.F. The number of authorized retailers or retailer slots available is calculated by a store to participant ratio, which is higher for densely populated communities, and lower for sparsely populated counties. Population density data is updated annually by the state agency and is obtained from the United States Census Bureau. The WIC Program uses a single population density indicator to identify which communities have the higher retailer to participant ratio.G. A specific number of retailer slots will be allocated to each city/county. A listing of retailer slots available and allocated to each city and county will not be published and distributed to authorized stores, since this figure may change frequently.12VAC5-195-340. Competitive pricing.
A. Authorized
storesretailers and applicants shall submit pricing information to the state agency. Item pricing data is obtained from authorizedstoresretailers and applicantsfromusing prices that have been entered into a WIC-approved Internet-based application.B. The state agency
collectsshall collect pricing information for specific food items at least twice a year (7 CFR 246.12). Prices may be collected more frequently from authorizedstores including, but not limited to, the followingretailers for reasons including:1. A
store'sretailer's prices are determined to be noncompetitive;2. A
storeretailer is designated a high risk retailer;3. A competitive pricing analysis is needed in order to consider an applicant's qualifications;4.3. An administrative review is being conducted as part of a compliance investigation, onsite monitoring visit, participant access analysis, inventory audit, or post payment analysis; or5.4. Other operational considerations that may occur including, but not limited to,a changeinof contract formula company, a changeinof infant food company, food industry price fluctuations, and manufacturer's price increases for selected WIC-approved products, such as baby foods, contract formula, and infant cereal.C.
StoresRetailers and applicants must submit the highest shelf price for all mandatory foods and formula brands, unless stated otherwise, that are available and eligible to be sold to participants. For milk items only,storesretailers must submit the price for theirstoreWIC designated brandor least expensive brand available.Prices for optional foods approved for purchase submitted via the Internet-based applicationAll prices submitted via the Internet-based application shall be used for calculating the reimbursement maximums. Retailers must use the approved food list and the minimum stocking requirement to identify all eligible brands and foods.D.
StoresRetailers failing to submit their prices within 14 days of thestateddue date stated in theVendorRetailer Manualwillshall receive one warning letter. After receiving this letter,storesretailers that fail to respond within the time period stated in the letter may have their WIC Program authorization terminated unless the state agency determines that inadequate participant access would exist if the retailer's authorization were terminated.E. Applicants whose prices are determined to be noncompetitive when compared with other authorized
stores assigned toretailers in the same peer group shall be denied WIC Program authorization. These applicants shall not be given a second opportunity to resubmit their prices,unless the state agency determines that inadequate participant access would exist if the application was not considered.F. Authorized
storesretailers whose prices are determined to be noncompetitive when compared with otherstoresretailers assigned to the same peer group shall be given one opportunity to resubmit their prices. After analyzing the prices submitted from this second submission, the state agency shall determine if thestoreretailer qualifies to remain authorized. The state agency shall terminate thestore'sretailer's authorization if its prices are noncompetitive unless the state agency determines that inadequate participant access would exist if the retailer's authorization were terminated.G.
The state agency uses nine business economic areas (BEAs) to initially define peer groups based on location and economic variations. For more densely populated BEAs, a second criterion used to further define peer groups is the number of unique participants served (7 CFR 246.12). Each authorized store or applicant is assigned to a single peer group.The applicant's physical retailer address shall be classified as being located either in an urban or rural location based on the county or city where the retailer is located. Retailer applicants located outside of Virginia shall be assigned to the rural category.Business Economic Areas (ID)
(# of Unique Participants Served, if applicable)Peer GroupCities & Counties Located in each BEA4910Accomack & Northampton Counties6611Cities: Danville, Galax City, & Martinsville and Counties: Carroll, Grayson, Henry, Patrick & Pittsylvania7112Cities: Buena Vista, Harrisonburg, Lexington, Staunton & Waynesboro and Counties: Augusta, Bath, Highland, Page, Rockbridge & Rockingham8113Cities: Bristol & Norton and Counties: Buchanan, Dickerson, Lee, Russell, Scott, Smyth, Tazewell, Washington & Wise13314Halifax County137
(0 – 100 participants)15Cities: Charlottesville, Colonial Heights, Emporia, Hopewell, Petersburg, & Richmond and Counties: Albemarle, Amelia, Brunswick, Buckingham, Caroline, Charles City, Charlotte, Chesterfield, Cumberland, Dinwiddie, Essex, Fluvanna, Goochland, Greene, Greensville, Hanover, Henrico, King and Queen, King William, Lancaster, Louisa, Lunenburg, Mecklenburg, Middlesex, Nelson, New Kent, Northumberland, Nottoway, Powhatan, Prince Edward, Prince George, Richmond & Sussex137
(101 – 250 participants)16137
(251 and up participants)17138
(0 – 100 participants)25Cities: Bedford, Clifton Forge, Covington, Lynchburg, Radford, Roanoke & Salem and Counties: Alleghany, Amherst, Appomattox, Bedford, Bland, Botetourt, Campbell, Craig, Floyd, Franklin, Giles, Montgomery, Pulaski, Roanoke & Wythe138
(101 – 250 participants)26138
(251 and up participants)27173
(0 – 100 participants)35Cities: Chesapeake, Franklin, Hampton, Newport News, Norfolk, Poquoson, Portsmouth, Suffolk, Virginia Beach & Williamsburg and Counties: Gloucester, Isle of Wight, James City, Mathews, Southampton, Surry & York173
(101 – 250 participants)36173
(251 and up participants)37174
(0 – 100 participants)45Cities: Alexandria, Fairfax, Falls Church, Fredericksburg, Manassas, Manassas Park & Winchester and Counties: Arlington, Clarke, Culpeper, Fairfax, Fauquier, Frederick, King George, Loudoun, Madison, Orange, Prince William, Rappahannock, Shenandoah, Spotsylvania, Stafford, Warren & Westmoreland174
(101 – 250 participants)46174
(251 and up participants)47Rural Areas1
Cities:
Norton, SuffolkCounties:
Accomack, Albemarle, Alleghany, Amelia, Amherst, Appomattox, Augusta, Bath, Bedford, Bland, Botetourt, Brunswick, Buchanan, Buckingham, Campbell, Caroline, Carroll, Charles City, Charlotte, Clarke, Craig, Culpeper, Cumberland, Dickenson, Dinwiddie, Essex, Fauquier, Floyd, Fluvanna, Franklin, Frederick, Giles, Gloucester, Goochland, Grayson, Greene, Greensville, Halifax, Hanover, Henry, Highland, Isle of Wight, King and Queen, King George, King William, Lancaster, Lee, Louisa, Lunenburg, Madison, Mathews, Mecklenburg, Middlesex, Montgomery, Nelson, New Kent, Northampton, Northumberland, Nottoway, Orange, Page, Patrick, Powhatan, Pittsylvania, Prince Edward, Prince George, Pulaski, Rappahannock, Richmond, Rockbridge, Rockingham, Russell, Scott, Shenandoah, Smyth, Southampton, Spotsylvania, Surry, Sussex, Tazewell, Warren, Washington, Westmoreland, Wise, WytheUrban Areas1
Cities:
Alexandria, Bedford, Bristol, Buena Vista, Charlottesville, Chesapeake, Clifton Forge, Colonial Heights, Covington, Danville, Emporia, Fairfax, Falls Church, Franklin, Fredericksburg, Galax, Hampton, Harrisonburg, Hopewell, Lexington, Lynchburg, Manassas, Manassas Park, Martinsville, Newport News, Norfolk, Petersburg, Poquoson, Portsmouth, Radford, Richmond, Roanoke, Salem, Staunton, Virginia Beach, Waynesboro, Williamsburg, WinchesterCounties:
Arlington, Chesterfield, Fairfax, Henrico, James City, Loudoun, Prince William, Roanoke, Stafford, York1The state agency uses the Isserman model for determining what cities and counties are considered urban and rural settings. This model was created for the United States Department of Agriculture and was published in "In the National Interest: Defining Rural and Urban Correctly in Public Policy" (International Regional Science Review, 28, 4:465 - 499 (2005))
Authorized retailers are assigned to a peer group based on their designation of rural or urban and the number of cash registers located in the retailer. Peer groups are defined as follows:
Peer Group
Description
Location
06
Special formula contractor
Other
50
One to four cash registers
Rural
51
Five to nine cash registers
Rural and under $100,000 in annual WIC sales
52
Five to nine cash registers
Rural and over $100,000 in annual WIC sales
53
10 and above cash registers
Rural
60
One to four cash registers
Urban
61
Five to nine cash registers
Urban and under $100,000 in annual WIC sales
62
Five to nine cash registers
Urban and over $100,000 in annual WIC sales
63
10 and above cash registers
Urban
H. For newly authorized
storesretailers and applicants the peer group designation assigned during the first three monthsisshall be determined by thefirst criterion only; specifically the store's BEA default locationretailer's location and number of cash registers.This default location, if applicable, is the peer group that services 0-100 unique participants. Authorized stores' peer group designation may change, based upon increases or decreases in the monthly average number of unique WIC participants being served by the store.For the peer group designation of newly authorized retailers that have five to nine cash registers, the state agency shall assume the retailer had less than $100,000 in annual WIC sales.I. All retailers that have five to nine cash registers shall have their WIC sales data calculated by the state agency every six months to determine if the retailer's annual WIC sales are projected to be under or over $100,000. If the retailer's WIC sales have changed, then the retailer's assigned peer group shall change to reflect its redemption status.
J. Retailers that increase or decrease their number of cash registers must notify the state agency in writing within 15 calendar days. An onsite visit may be conducted by the state agency to confirm the number of operational cash registers. Retailers that knowingly misrepresent their number of cash registers may have their authorization status terminated unless the state agency determines that inadequate participant access would exist if the retailer's authorization were terminated.
12VAC5-195-350. Price verification.
A. Authorized
storesretailers and applicants must submit prices for all mandatory foods and formulas as defined by the state agency. Once prices have been submitted to the WIC Program, they must remainvalidin effect for at least a 30-day period and are subject to random onsite verification by the state agency. Posted prices that are significantlyabove what washigher than the prices submitted to the state agency may affect thestore'sretailer's or applicant's authorization selection status.B. A
storeretailer or applicant's submitted price shall be compared by the state agency to other authorizedstores assigned toretailer in the same peer groupin orderto determine if the prices submitted are competitive. Prices shall be submitted and validated as competitive for specific food items and formulaseligible for payment to the authorized store locationas specified in the Retailer Manual.C. Authorized
storesretailers and applicants shall have a pricing point value that is 40 or higher in order to remain eligible for program authorization.Description
Price Comparison Range
Pricing Point Value
Best Pricing
Peer Group Average, minus 10% or more
100
Highly Competitive
Peer Group Average, minus 5.1 - 9.9%
80
More Competitive Pricing
Peer Group Pricing Average, plus or minus 5.0%
60
Competitive
Peer Group Pricing Average, plus 5.1 –
9.9%19.9%40
Noncompetitive
Peer Group Pricing Average, plus
10.020% or higher20
D. Authorized
storesretailers whose prices are identified as noncompetitive when compared with other authorizedstoresassigned toretailers in the same peer groupwithin a BEAmay have their WIC Program authorization terminated,unless the state agency determines that inadequate participant access would exist if the retailer's authorization were terminated.E. Authorized
storesretailers that fail to submit a price for optional food and formula items may have redeemed food instruments selected as ineligible for payment as part of the postpayment review process. These improperly redeemed food instruments may be identified as avendorretailer claim and be subject to repayment of the full amount paid for all of the items prescribed on the food instrument.12VAC5-195-360. Selection decisions.
A.
All retailers and applicants will compete equally for available slots located within a specific city/county or zip code, if applicable. The state agency reviews the qualifications of authorized stores and applicants located in a specific BEA or city/county within a BEAto make authorization selection decisions. Retail stores' and applicants' mandatory women and infant food and formula items used for pricing analysis purposes must qualify under the price competitive category of 40 or higher in order to be selected for authorization (7 CFR 246.12).The state agency shall rank all stores that have a pricing point value of 40 or higher in ascending order, or lowest price to highest price. The stores that have the lowest total prices are considered the best qualified stores. Applicant's and store's ranking will be used to select applicants and stores for all available slots located within a specific BEA or city/county within a BEA.Every three years, currently authorized retailers shall reapply for WIC program authorization. Retailers must meet all general requirements for authorization as established in 12VAC5-195-300.
B.
When multiple stores have equal rankings and there are not enough slots to authorize all such stores, rankings will be further differentiated based on the following criteria in order of their application:1. When equal rankings occur, stores with the lowest prices for selective special formulas that are eligible to be sold to WIC participants will be offered any available slots.2. If rankings continue to be equal, the state agency shall offer available slots to the authorized store or applicant with the highest number of unique participants who reside in the zip code where the store is located.3. If rankings continue to be equal, the state agency shall offer available slots to the authorized store or applicant with the highest square footage, excluding storage space, to determine which stores will be offered available slots.4. If rankings continue to be equal and the stores or applicants are owned by the same corporate entity, then the corporate representative will be allowed to decide which corporate-sponsored store shall be offered the available slot.5. If rankings continue to be equal and the stores or applicants are not owned by the same corporate entity, then the store or applicant that has the highest food stamp sales for the previous six months will be offered the available slot.The state agency shall review the qualifications of retailer applicants before making authorization selection decisions. Mandatory women and infant food and formula items sold at authorized retailers and retailer applicants shall be used for pricing analysis purposes. Authorized retailers and applicants must qualify under the price competitive category of 40 or higher in order to be selected for authorization.
C. If a
retail storeretailer or applicant is notcompetitivelyselected for program authorization, then thestoreretailer may not apply againno sooner thanduring the six months after being denied authorization.Any exception to the six-month requirement shall be determined at the discretion of the state WIC director.The state WIC director or designee may grant exceptions to the six month requirement if inadequate participation would exist if the retailer's authorization was not considered.D. If a newly opened store is considered to be a best qualified store and is offered a slot, then the previously authorized store in that slot will be offered an extension to its retailer agreement to remain authorized for one year from the start of the new authorization period.E.D. The state agency shall send all authorizedstoresretailers and applicants a written noticepertaining toof their selection status. Allstoresretailers and applicantsbeingdenied WIC Program authorization shall also receive information that explains their right to appeal the state agency's administrative decision.F.E. The state agencydoesshall not maintain an applicant waiting list.12VAC5-195-370. Authorization exception decisions.
The state agency may adjust the number of retail stores authorized to ensure that adequate participant access exists. Only the state agency shall determine what constitutes adequate participant access.The state agency may make authorization exceptions to ensure that adequate access exists based onone or several ofat least one of the following criteria:1. Provide reasonable access;
2. Provide safe access due to a physical barrier or impediment including
, but not limited to,a multilane highway, river, bridge; physical terrain (i.e., mountains);3. Provide a best pricing or highly competitive alternative
storeretailer location to eligible participants to purchase WIC-approvedfoodfoods, when compared to other availablestoresretailers located within a given city and/or county;4. Promote competition in a trade area previously identified as not having a price competitive authorized
retail storeretailer location available;5. Improve customer service or remove an existing service barrier, i.e., language, cultural;
6. Improve WIC customer access
due to the fact thatbecause thestoreretailer is within a safe and reasonable walking distance and is located in close proximity to one or several low income housing units where WIC participants reside;7.
Provide supporting documentation that the store'sThe retailer's draw area is broader than thestore'sretailer's immediate trade area. Thestore'sretailer's draw area includes cities and counties that cross geographical boundaries; or8.
Provide supporting documentation that the specific BEA or city/county within a BEA in which the store is located is experiencing, or based on recognized projected economic indicators, is likely to experience disproportionate economic hardship.Expand access to WIC eligible foods that are purchased by a specific ethnic population.12VAC5-195-390. Approved food list.
A. A copy of the current Virginia WIC Program's Approved Food List
(effective January 1, 2007)and formula flyer must be stored at each cash register where WIC transactions are handled. A copy of the approved food list and formula flyer must also be stored in theVendorRetailer Manualthat shall bekept onsite at the authorizedstoreretailer location.B. The approved food list
isshall be used in conjunction with the WIC food instrument to identify foods that are eligible for purchaseby WIC participantsusing WIC food instruments. The food instrument may state specific manufacturers or brandsthat must be purchased by program participantsthat are not covered by the general description used in the approved food list that must be purchased by program participants.C. The formula flyer shall be used in conjunction with the WIC food instrument to identify formula and medical foods that are eligible for purchase using WIC food instruments. The food instrument shall state the specific manufacturer, type, and quantity of formula that must be purchased by program participants.
C.D. Authorized retailers shall sell WIC-designated brands for food categories identified in the approved food list. Authorized retailers shall use shelf labels approved by the state agency to identify the WIC-designated brands thatthey select and declareare declared using the state agency's Internet-based application.12VAC5-195-400. Authorization stamp – assignment and usage.
A. The state agency
assignsshall assign a unique stamp number tostores that are authorized and eligible to receive reimbursement for deposited food instrumentseach authorized retailer. Thestore'sretailer's authorization numberisshall be imprinted on a rubber stamp, which shall be used on every food instrument deposited by the authorizedstoreretailer location. Failure by theretail storeretailer to use the issued authorization stamp may result indeniedpayment being denied for redeemed WIC food instruments ora store's disqualification, if a pattern of noncompliance is documented, the termination of a retailer's authorization unless the state agency determines that inadequate participant access would exist if the authorization were terminated.B. Authorized
storesretailers must obtain any needed replacement stamps from the stamp supplier approved by the state agency. The state agencywillshall provide a maximum of three stamps to an authorizedstoreretailer per contract period at no charge. Failure to purchase an approved stamp from the designated stamp supplier may lead to deposited food instruments being rejected and returned unpaid by the state agency.C. If a stamp overlay process is requested by an authorized retailer, the state agency may waive the requirement to use a rubber stamp on deposited food instruments. The stamp overlay process shall result in the assignment of a unique identification number that must be tested and approved by all affected parties. Retailers must submit a written request to the state agency at least 60 days prior to implementing the stamp overlay. If the request is approved, the state agency shall send written approval to the corporate office of the retailer requesting the stamp overlay. Failure to obtain written approval may lead to food instruments being returned unpaid by the banking contractor.
12VAC5-195-410. Change of ownership.
A. Authorized
retail storesretailers shall provide the state agency with advance written noticeofat least 15 calendar days prior to any change of ownership as outlined in 7 CFR 246.12.B. A change of ownership occurs
for reasons including, but not limited to,when the principal owner,orowners, or corporate officers of the business or corporationhaveare legally or permanently changed.C. A
store'sretailer's authorizationwill become null and voidshall be terminated by the state agency upon a change of ownership. The rights and obligations established under a signed retailer's agreement with the WIC Program may not be transferred or assigned by theretail storeretailer or corporate owner to any other third party.D. The new owner or
storeretailer manager of thebusiness/corporationbusiness or corporation shall apply for WIC Program authorization and submittheirhis qualifications and a new application for evaluation based on the most current retailer selection and authorization criteria.E. The state agency shall terminate the authorization status of any
storeretailer that has undergone a change of ownership and failed to notify the state agency in accordance with the requirements outlined in the signed Retailer Agreement, effective July 1, 2008.12VAC5-195-420. Change of location.
A. Authorized WIC
retail storesretailers shall provide the state agency with written notice of astore'sretailer's relocation plans within 15 calendar days prior to scheduled move date. Failure to notify the state agency in writing of such actions may result in the state agency taking administrative action, including terminating for cause thestore'sretailer's program authorization, unless the state agency determines that inadequate participant access would exist if the authorization were terminated.B. Relocation of a
retail storeretailer is defined as:1. The
store'sretailer's physical location changes within the same geographical area or county/city and there is no change in ownership or pricing structure. Thestore meetsretailer must meet one of the following criteria:a. New
storeretailer location is two miles or less from the former location; orb. Majority of management and
storeretailer personnel will move to the new location. If the new location is greater than two miles, the WIC Program will evaluate on a case-by-case basis to determine whether the new location is an alternative location and qualifies as a relocation versus a newstoreretailer authorization;2. The
store willretailer shall be open for business within 15 calendar days or less after moving to a different physical location; and3. The former
storeretailer locationwillunder the existing owner shall be permanently closed for business.C. The state agency shall ensure that the new location still meets the selection criteria as outlined in 12VAC5-195-340 and 12VAC5-195-360 including being price competitive. Failure to meet all selection criteria may lead to the
store'sretailer's authorization being terminated,unless the state agency determines that inadequate participant accessexistswould exist if the authorization were terminated. Authorizedstoresretailers that meet all selection criteria will be permitted by the state agency to continue their authorization without experiencing any disruption in their authorization status. The state agency must assign a new WIC authorization ID to the newstoreretailer location if a newfood stampSupplemental Nutrition Assistance Program ID has been issued to thestoreretailer.12VAC5-195-430. Change due to closure.
A. Authorized
retail storesretailers shall give the state agency written notice of astore'sretailer's permanent or temporary closure within 15 calendar days before the actual closing date. A temporary closure is defined as astoreretailer location being closed to the public for more than 15 consecutive calendar days.StoresRetailers closed to the public for any reason greater than 30 consecutive calendar days will have their WIC Program authorization terminated.B. Failure to notify the state agency in writing of either permanent or temporary closure may result in the state agency taking administrative action, including terminating for cause the
store'sretailer's WIC authorization status.12VAC5-195-440. Voluntary withdrawal.
Authorized
retail storesretailers shall give the state agency at least 15 calendar days written notice if thestoreretailer owner or manager decides to discontinue participation in the Virginia WIC Program.12VAC5-195-450. Complaints.
A. The state agency shall maintain a system of receiving, documenting and investigating all complaints submitted by
retail storesretailers, participants, proxies, caretakers, parents, and the general public.From submitted complaints, theOn the basis of a written complaint, the state agency mayissue a written warning totake action against participants andretail storesretailers that abuse or misuse program benefits as outlined in the State Plan andVendorRetailer Manual(effective August 1, 2008).B. The state agency shall forward complaints of both alleged discrimination and civil rights violations to the Secretary of Agriculture as required by federal regulations.
12VAC5-195-460. Conflict of interest.
A. Authorized
retail storeretailer management shall seek to ensure that no conflict of interest exists between anystoreretailer personnel employed by the retailer and any local, state, or federal WIC agency.This includes, but may not be limited to, storeThe prohibition against conflict of interest applies to retailer employeesor spouses of store owners, retailer owners, or relatives of retail employees or owners who are also employees of a local, state, or federal WIC agency.B. Retail stores shall identify and report any member of the store's ownership, management, or operations staff who are directly associated with the WIC Program to the state agency. To ensure that all potential conflicts of interest are identified and reported, the retail store must complete and submit a potential conflict of interest reporting form to the state agency upon request or as deemed necessary by the state agency. Failure by the store to submit this form in the time frame designated by the state agency may result in the store's authorization status being terminated unless inadequate participant access would exist.C.B. WIC participants, caretakers, or proxies who are employed at an authorizedretail store mayretailer shall not accept or transact food instruments issued to themselves ora member of their immediate familyrelatives as a function of their duties at the retail location. Authorizedretail storeretailer management shall ensure allstoreretailer employees adhere to this integrity requirement.C. Authorized retailer management shall notify the state agency in writing when a conflict of interest exists.
D. When an employee of an authorized retailer or an employee's relative is employed by a local, state, or federal WIC agency, the employee shall:
1. Notify retailer ownership or management of his or his relative's employment; and
2. Not show favoritism towards any authorized retailer including the retailer where he is employed.
E. Employees of an authorized retailer shall not in their professional capacity provide any gratuities, including cash, food, coupons, or gift cards, to employees of local, state, or federal WIC agencies.
F. Authorized retailer management shall seek to ensure its employees comply with the conflict of interest requirements listed in this section and review them with retailer personnel annually.
G. Additional conflict of interest regulations may be found in 12VAC5-195-230.
H. This section is not meant to replace or abrogate the Virginia State and Local Government Conflict of Interests Act, Chapter 31 (§ 2.2-3100 et seq.) of Title 2.2 of the Code of Virginia.
12VAC5-195-470. Incentives.
Authorized
storesretailers may not provide incentives to local agency staff or participants to entice or promote shopping at a specificstoreretailer location, unless approved in writing by the state agency.12VAC5-195-480. Participant confidentiality.
A. Participant information shall remain confidential to ensure compliance with federal regulations and to protect the right to privacy of WIC participants (7 CFR 246.26).
B. Confidentiality requirements apply to information provided by a participant and that is based on direct observation by
storeretailer personnel. Confidentiality requirements include, but are not limited to:1. The prohibition of retailers from collecting personal information from WIC participants;
2. Making personal contacts with WIC participants after the WIC transaction has occurred; or
3. Sharing information on participant identification with third parties. Third parties do not include WIC Program state, local and federal agency representatives who have a legitimate business interest in the services provided to participants.
12VAC5-195-490. Retailer confidentiality.
A. Background and pricing information collected by the state agency related to evaluating the authorization status of a
storeretailer or collected from food instruments redeemed by an authorizedstore isretailer are confidential(7 CFR 246.26)andcanmay be released onlyto:as provided in 7 CFR 246.26.1. The store retailer itself;2. The parent corporation; or3. Other governmental agencies responsible for ensuring program integrity, i.e., Food Stamp SNAP Program, Office of Inspector General, United States Department of Agriculture.B. In accordance with federal regulations, 7 CFR 246.26, confidential
vendorretailer information is any information about avendorretailer, whether it is obtained from thevendorretailer or another source, that individually identifies thevendorretailer, except for the following:storeretailer name, physical mailing address, telephone number, website, email address,storeretailer type,orand authorization status. All othervendorretailer specific information is restricted from disclosureto the publicby the state agency.C. Upon receiving a written request from a
storeretailer ortheirits parent corporation, the state agency shall only release background and pricing information that has been provided by or that pertains to the requestor. Under no circumstanceswillmay the state agency release confidential information about the redemption revenue paid tostoresretailers owned by other corporations.D. Authorized
stores'retailers' peer group designation is confidential and is restricted from disclosure to persons and entities not directly associated with the authorizedstoreretailer location.E. The state agency's inadequate participant access results completed for administrative purposes are considered confidential and not subject to review by the
retail storeretailer or its agent, since this profile contains information protected by WIC Program regulations. Upon request, a copy of this work documentcanmay be released withanyall confidential information removed. This document in its entiretywillshall be made available to appropriate governmental bodies that are responsible to ensure that the state agency has fully complied with any mandated WIC Program requirements.12VAC5-195-500. Sales tax and coupons.
A. Authorized
retail storesretailers shall ensure that no sales tax is charged to the WIC Program.StoreRetailer coupons, manufacturer coupons and loyalty card discounts may be used for WIC-approved purchases. When a WIC participant uses a coupon or discount card in conjunction with a food instrument and an item is provided free, then sales tax shall be collected directly from the participant.B. No sales tax can be applied to the printed value of cash value food benefits. Any tax associated with the dollar amount purchased above the printed value of the cash value food benefit must be collected directly from the participant.
12VAC5-195-510. Solicitation.
A. Authorized
storesretailers shall not:1. Initiate behavior that may be deemed aggressive or intimidating by a reasonable person in approaching potential WIC participants in order to promote that participant's shop at a specific
storeretailer location; or2. Use any state or local agency facilities and property to post or distribute materials advertising their
storeretailer location.B. If the state agency documents that an authorized
storeretailer violates either of these prohibitions, then thestore'sretailer's authorization may be subject to termination by the program.C. Authorized
storesretailers shall not use any advertisement practices or procedures that may give the public or participants the impression that a special or exclusive business relationship exists between the state agency and any authorizedstoreretailer.D. It is the
storeretailer owner's or designated agent's responsibility to ensure all employees understand and adhere to all prohibitions and restrictions related to solicitation.12VAC5-195-520. Training and education.
A. Training of applicants or authorized
storesretailers may be conducted by state agency staff. The state agency may also delegatefullauthority to trained individuals who have been certified as corporate trainers. Certified corporate trainers shall attend at least one mandatory WIC training class annually in order to remain certified.B. The state agency shall provide mandatory annual training for previously authorized
storesretailers. The annual training requirement may be met by the previously authorized retailers:1. Submitting a newsletter training acknowledgement form;
2. Successfully completing an agency-sponsored Internet training course offered by the WIC Program; or
3. Attending an approved instructor-led, interactive training class.
C. Reauthorization training shall be required for previously authorized
storesretailers that have been selected under a new contract period.D. Authorized
stores canretailers may request remedial training at any time by contacting the state agency.E. All authorized
storesretailers are required to have at least onestorerepresentative participate in annual training provided by either the state agency or a certified corporate trainer (7 CFR 246.12).F. Failure of an authorized
storeretailer to meetanythe mandatory trainingrequirementrequirements shall result in sanctions being imposed and the possible termination of thestore'sretailer's program authorization, unless the state agency determines that inadequate participant access would exist if the authorization were terminated.12VAC5-195-530. Use of acronym and logo.
A. Authorized
storesretailers shall post a state-issued "WIC Accepted Here" window decal in thestore'sretailer's front entrance or in a conspicuously visible location that identifies to the general public that thestoreretailer location participates in the WIC Program. Authorizedstoresretailers may use alternative signage if approved by the state agency prior to being used.B.
Retail storesRetailers, food manufacturers, distributors and suppliers shall receive written approval from the state agency prior to producing or distributing window decals, channel strips, shelf talkers, or other promotional items that use either the WIC acronym or logo.StoresRetailers that elect to use point-of-sale channel strips, shelf labels, or other promotional materials for a specific food category must ensure that all eligible items are consistently promoted as WIC approved.StoresRetailers are prohibited from promoting a specific manufacturer's product over another eligible WIC-approved product within the same food category (USDA Memo SFP 09-020).C.
Retail storesRetailers or applicants shall not use either the acronym "WIC," "W.I.C." or the WIC logo, including close facsimiles thereof, in total or in part, either in their official name in which thestoreretailer is registered or in the name under which it does business, if different (USDA Memo SFP 09-020).D.
Retail storesRetailers, food manufacturers, distributors and suppliers shall not use the WIC acronym or logo in the packaging of their products.Retail storesRetailers, food manufacturers, distributors and suppliers shall receive written approval from the state agency before using either the WIC acronym or logo for any business or public relations purpose (USDA Memo SFP 09-020).12VAC5-195-540.
VendorRetailer manual for the Virginia WIC Program.All authorized stores must keep a current copy of the Vendor Manual for the Virginia WIC Program, Cashier Training Guide, and an Approved Food List at the store location authorized to participate in the program. A current copy of the Virginia Approved Food List must be kept at each cash register used to process WIC transactions.Periodically, individual sections of theVendorRetailer Manual may be updated to reflect federally mandated regulatory changes and other WIC Program requirements. The most current version of theVendorRetailer Manual is located on the state agency's website, whichstoresretailers must access to obtain updated copies of procedures and forms.12VAC5-195-550. High risk
storesretailers.A. The state agency
classifiesshall classify each authorizedstoreretailer as either high risk, probationary, or nonhigh risk. In accordance with federal regulations (7 CFR 246.12), high riskstoresretailers have demonstrated from prior authorization history a pattern of noncompliance with documentedvendorretailer management policies or violations documented from covert, undercover buys. The state agency may also change astore'sretailer's designation to high risk based upon noncompliance documented from onsite monitoring visits or inventory audits. All of these overt and covert visits shall be conducted during hours the retailer is open to the general public, including weekdays, weekends, and holidays.The state agency may select
storesretailers for compliance monitoring based on statistical trends documented froma retail store'sretailers' redemptionpatternpatterns. Astore'sretailer's designationbeingwill only be changed to high riskwill only occuras result of documented violations identifiedfromby compliance investigations or other types of objective monitoring practices used by the state agency.StoresRetailers shall also be changed to high risk if:1. The
storeretailer has been the subject of a compliance investigation by the state agency and has been cited for five or more chargeable violations within 12 consecutive months;2. The
storeretailer has received aFood Stamp ProgramSupplemental Nutrition Assistance Program civil monetary penalty or WIC program civil monetary penalty and is being retained in lieu of disqualification;or3. The
store'sretailer's authorization status is under consideration for possible disqualification during the administrative review or appeal process.; or4. The retailer has been the subject of an inventory audit and the documented results identify a significant discrepancy between the retailer's inventory, purchasing records, and WIC redemption sales.
All
storesretailers classified as high riskwillshall receive written notification from the state WIC Program to advise them of thestore'sretailer's status change prior to the change becoming effective.StoresRetailers shall be designated high risk for a minimum one-year period and will have their status periodically evaluated by the state agency.B. If a retailer is retained in lieu of disqualification or its status is changed to high risk, a written assurance letter must be submitted to the state agency within 30 calendar days after being notified of this requirement. The retailer's assurance letter must
identify specific steps detailingdetail the actions thestoreretailer will take to improve its performance.C. Authorized
storesretailers designated as high riskwillshall be selected for more frequent onsite and covert monitoring investigations.12VAC5-195-560. Nonhigh risk
storesretailers.Authorized
storesretailers that have participated in the WIC Program for more than one continuous year and have demonstrated an acceptable level of compliance in meeting program requirements are considered nonhigh riskstoresretailers.12VAC5-195-570. Probationary
storesretailers.Newly authorized
storesretailers with less than one year of continuous program authorization shall be designated a probationary retailer. During a probationarystore'sretailer's first year it will be more frequently monitored through both unannounced and onsite monitoring visits, as well as being selected for at least one compliance investigation.12VAC5-195-580. Performance and administrative monitoring.
A. All applicants must successfully pass an unannounced stocking visit prior to being authorized. Applicants
willshall receive a written letter from the state agency advising themthe storethat their retailer has been selected for further authorization consideration. The applicantwillshall receive a copy of the minimum stocking requirement and the letter sent to thestore willretailer shall identify the consequencesassociated withof failing to meet this program standard.B. The state agency
monitorsshall monitor authorizedstore'sretailers' performance throughout the contract period in order to ensure the best qualifiedstoresretailers are authorized. The type and level of monitoring conducted by the state agencydependsshall depend upon thestore'sretailer's authorization status. Trained local agency staff, state agency staff, and other specially trained contractors may conduct onsite visits to ensure compliance with basic stocking requirements and administrative program requirements.StoresRetailers designated ashigh volume retailers,high risk retailers,and probationarystoresretailers are more likely to be selected for unannounced monitoring visits by the WIC Program.C. Authorized
storesretailers that fail to consistentlymeetcomply with any of the general requirements and conditions for authorization may be terminated.Specific areas theThe state agencymonitors include, but are not limited toshall monitor:1. Number of paid and rejected food instruments;
2. Prices charged for WIC-approved foods and formula;
3. Level of compliance
in followingwith program requirements;and4. Use of approved wholesalers and suppliers
infor purchasing WIC-approved foods and formulas.; and5. Compliance with retaining purchasing records for WIC-approved foods and formulas.
D. The state agency shall establish and communicate the minimum stocking requirement to all authorized
storesretailers and applicantsthe minimum stocking requirement.E. Each federal fiscal year, a sample of authorized
storesretailers shall be selected for one or more unannounced onsite monitoring visits.F.
State agency personnelAgency representatives may conduct an unannounced monitoring visit to ensure that authorizedstoresretailers or applicants meet all program requirements. Authorizedstoresretailers and applicants shall haveavailable onsitethe minimum stocking requirement available onsite at all timesas established by the state agency. The required specific foods, contract formulas, and administrative proceduresassociated with meeting this requirementare outlined in the Minimum Stocking Requirement, which is includedin theVendorRetailer Manual.G. Agency representatives shall conduct unannounced monitoring visits during hours the retailer is open to the public. Authorized retailers must submit any changes to their normal hours of operation to the state agency in writing.
G.H. Authorizedstoresretailers with more than one year of continuous participation in the program may request in writing to the state agency that a waiver be granted for one or more items that are part of the minimum stocking requirement. The state agency shall provide a written decisiontoregarding thestore'sretailer's waiver request within 30 calendar days after receipt. The waiver to the minimum stocking requirement for a required item shall expire upon the presentation to thestoreretailer, on behalf of a participant, of a WIC food instrument for the purchase of that required food item. The authorizedstoreretailer shall provide the food item within 48 hours, excluding weekends and holidays, after presentation of the WIC food instrument.H.I. The state agency may conduct other types of unannounced onsite monitoring visits to aretail store'sretailer's location including, but not limited to,random, price verification,high volume,formula audits, purchased formula records review, and high risk.I.J. Duringthean unannounced onsite monitoring visit, the state agency representative mayperform, but not be limited, to the following:1. Observe and document the level of compliance with general program requirements;
2. Validate if the minimum stocking requirement has been met;
3. Collect and confirm prices submitted by
retail storesretailers;4. Confirm prices are posted on or in close proximity to WIC-approved foods;
5. Review purchase or invoice records;
6. Conduct formula inventory analysis;
7. Educate the retailer about program changes;
8. Provide educational materials and supplies;
9. Provide technical consultation;
and10. Confirm WIC-approved shelf labels are being used correctly to
correctlyidentify WIC-designated brands; and11. Confirm the number of reported cash registers.
J.K. During the unannounced onsite monitoring visits,storeretailer management may receivethe following:1. Answers to technical or procedural questions;
2. Updated program information;
3. Additional training materials and supplies;
4. Opportunity to correct documented deficiencies, if needed;
5. Opportunity to provide shelf prices of WIC-approved items, if applicable; and
6. Opportunity to confirm results documented by the state agency representative during the monitoring visit.
K.L. The results from these onsite visits are documented and kept on file at theRichmond, Virginia,state agency office in Richmond, Virginia.L.M. Each federal fiscal year, a sample of authorizedstoresretailers shall be selected for one or more announced onsite formula monitoring visits. The state agency shall ensure that authorizedstoresretailers sell formulas that have been purchased from a WIC-approved supplier, distributor, wholesaler, oranauthorized resource. A listing of WIC-approved suppliers, distributors, wholesalers, and authorized resources is located on the state agency's website.This outcome is accomplished by stateState agency personnelreviewingshall review formula purchasing records and invoices,comparingcompare formula redemption data from WIC sales, andcompletingcomplete apre-prephysical and postphysical inventory of formula available at thestoreretailer location during a specific analysis period.StoresRetailers whose purchase records do not support the quantity of WIC sales volume for a selective formula item based upon redeemed food instruments may be issued sanctions, fined, or disqualified from the WIC Program. The results from a formula monitoring visitareshall be documented and a written assessmentisshall be sent to thestoreretailer once the state agency has completed its analysis.M.N. Authorizedstoresretailers that do not remain price competitive, fail to maintain the minimum stocking requirement, or fail to adhere to the retailer agreement may be fined or have their authorization terminated unless the state agency determines that inadequate participant accessexistswould exist if the authorization were terminated. Depending upon the service delivery impact, the state agency may temporarily waive terminating astoreretailer that fails to comply with any of these requirements until an alternativestoreretailer located in the same area can be authorized. The state agencywill evaluate andshall document the reasons for making any authorization exception decisions.12VAC5-195-590. Reimbursement and payments.
A. The state agency shall use a prepayment edit process to screen all deposited food instruments. For each processed food instrument, the state agency shall either:
1. Pay as submitted;
2. Make a price adjustment, if applicable; or
3. Deny payment of the deposited food instrument.
B. The state agency's reimbursement responsibilities in making payments against deposited and undeposited food instruments include, but are not limited to:
1. Ensuring payments are made to authorized
storesretailers that have a signed retailer agreement with the Virginia WIC Program. Unauthorizedstoresretailers will not be paid for any mistakenly accepted and deposited food instruments;2. Ensuring the maximum reimbursement levels used by its banking contractor, based upon peer groups, are reasonable for the food and formula items prescribed for purchase by participants;
3. Reconsidering for payment WIC food instruments not paid or partially paid provided the food instruments are submitted to the state agency within 50 calendar days of the first date printed on the food instrument;
4. Making price adjustments to the reimbursement amount paid to
retail storesretailers in order to ensure individualstore'sretailer's reimbursement levels remain eligible for authorization, based upon competitive prices charged by similarstoresretailers;5. Collecting bank account and routing numbers from applicants and authorized
storesretailers in order to process direct deposit ACH paymentsusing an Automated Clearinghouse (ACH);6. Ensuring prompt ACH credits are made to the retailer's bank account when appropriate;
7. Collecting retailer's prices using an electronic, Internet-based application;
8. Identifying retailers whose prices are noncompetitive and take administrative actions including possible termination of the retailer's authorization;
9. Complying with all federal regulations and guidelines that require administrative approval by USDA prior to making payments, as applicable;
10. Providing written communications to all authorized
storesretailers containing the procedures used by the program to pay or deny payments for all deposited food instruments; and11. Recouping overpayments due to banking or procedural errors, if applicable, from authorized
storesretailers.C. Authorized
storesretailers must deposit food instruments within 14 calendar days of the last date printed on the food instrument.D. Food instruments or image replacement documents (IRDs) rejected for payment due to "unreadable
vendorauthorization stamp" or "novendorauthorization stamp" error messages must be corrected and redeposited within 30 calendar days of the last date printed on the food instrument.E. All food instruments or IRDs rejected for payment or undeposited food instruments require WIC Program review for exception payment consideration and must be submitted by the authorized
storeretailer to the state agency. The state agency reserves the right to deny a submitted request for payment depending on the explanation provided by thestoreretailer or bank of first deposit. Approved exception payments will only be made to an authorizedretail storeretailer.1.
StoresRetailers must submit their undeposited or rejected food instruments or IRDs and justifications to the state agency within 30 calendar days of the last date printed on the food instrument. Astoreretailer must also simultaneously submit a written request and justification for payments on undeposited or rejected food instruments or IRDs.2. Undeposited or rejected food instruments or IRDs sent to the state agency that are greater than 30 calendar days from the last date printed on the food instrument may not be eligible for payment and may require USDA approval.
3. Food instruments or IRDs rejected for payment due to a processing error that originates either at the federal reserve or bank of first deposit may be considered for an exception payment. The food instruments or IRDs must be submitted to the state agency within 120 calendar days from the first date to spend printed on the food instrument. A bank representative must submit a written request with the unpaid food instruments or IRDs.
F. A maximum allowable reimbursement amount for each peer group and food item combination is established using pricing data (7 CFR 246.12). Each food item combination is identified by a unique food instrument type identifier. More than 4,000 unique food combinations exist with different reimbursement maximum amounts. Authorized
storesretailers that submit prices determined to be noncompetitive will not have their prices used when the state agency computes the maximum allowable reimbursement amount used for making price adjustments.G.
StoresRetailers may only get reimbursed for mandatory and optional foods and formula products they have submitted prices for prior to redeeming food instruments for those products. Redeemed food instruments may be subject to repayment as avendorretailer claim if they include optional items for which astoreretailer has failed to submit prices.StoresRetailers must ensure that the most current shelf prices have been submitted to the WIC Program for all mandatory items. Failure to submit prices or providing inaccurate prices for any mandatory food items may lead to astore'sretailer's authorization being terminated unless inadequate participant access would exist.H. Contract and special formulas where pricing information is collected via the Internet-based application by the state agency are eligible for payment to authorized
stores. Prices are purposely not collected by the state agency for formulas that should not be redeemed atretail storesretailers. Food instruments redeemed for these types of special formulas are subject to repayment by thestoreretailer.I. A maximum reimbursement amount will be established for cash value food benefits used by participants to purchase fruits and vegetables. The amount written on the food instrument must not exceed the maximum reimbursement amount printed on it. For cash value food benefits only, the
storeretailer must offer one of the following options to the participant if the total dollar amount being purchased exceeds the printed cash value:1. The participant shall be allowed to pay the amount over the printed cash value; or
2. The participant shall be allowed to reduce the quantity of eligible fruits and vegetables being purchased.
StoresRetailers must notify the state agency in writing which of these options they provide to WIC participants.J. The food instrument type/peer group pricing maximum amount may be adjusted monthly by the state agency, depending upon external factors including, but not limited to, wholesale price increases. The reimbursement maximum used for the various food instrument types peer group combinations are not distributed to authorized
storesretailers prior to being used by the banking contractor.K. Food instruments or IRDs that are ineligible for payment and are rejected will be returned to the
store'sretailer's depository bank by the state agency's banking contractor. These returned food instruments will be stamped with a descriptive error message.L. The state agency may make payment exceptions for food instruments that would normally be denied payment by its banking services contractor. The authorized
storeretailer shall submit all such requests in writing, including a justification, within 30 calendar days from the last date printed on the food instrument. The state agency will send a payment disposition decision to the requestor within 30 calendar days, after receipt.M. The state agency shall use a postpayment review process to prospectively evaluate the reimbursement amount paid against redeemed food instruments in order to identify excessive or improperly redeemed food instruments in accordance with federal regulations (7 CFR 246.12). From the postpayment review process, the state agency may determine that one or more payments already made to a
retail storeretailer were ineligible for payment as a result of astoreretailer failing to submit pricing data for the purchased item or items. The state agency reserves the right to bill and recoup payments of these ineligible payments, which will be referred to as avendorretailer claim (7 CFR 246.12). The state agency shall not bill an authorizedstoreretailer if thevendorretailer claim amount is less than $10.N. A
retail storeretailer that is not authorized to participate in the Virginia WIC Program that accepts a food instrument will not be reimbursed for any food instruments redeemed by a WIC participant.O. A
storeretailer must submit a direct deposit ACH form to the state agency that identifies any bank changes to its routing or account number. A direct deposit ACH form must be submitted at least 14 days prior to the change effective date. If the state agency's banking contractor identifies that thestore'sretailer's bank account or routing number is not valid, then thestoreretailer will receive one written notice from the state agency. Failure by thestoreretailer to resolve any reported discrepancies within 30 days after a written notice has been sent by the state agency may lead to thestoreretailer being ineligible to receive payments for rejectedFIsfood instruments.P.
Retail storesRetailers are responsible for all bank handling fees and charges associated with doing business with the WIC Program.12VAC5-195-600. Sanctions and administrative actions.
A. Each federal fiscal year, the state agency shall conduct compliance investigations on a minimum of 5.0% of authorized
storesretailers (7 CFR 246.12), including completing investigations of all high riskstoresretailers, all probationarystoresretailers, and selective nonhigh riskstoresretailers. The state agency will conduct at least two compliance buys at eachstoreretailer selected for an investigation.B. The state agency
willshall provide written notification to the authorizedstoreretailer of the investigation results, including thestore'sretailer's violation of any statutes or regulations governing its participation in the WIC Programunless fraudulent activities have been documented. Once an investigation has been closed,storesretailers with documented violationswillshall receive a final written report of the agency's findings. The final report will identify what administrative actionwillshall be taken by the state agency against the authorizedstoreretailer.C. Violations
areshall be categorized as either state agency or federally mandated. For federally mandated violations, a pattern consisting of four documented incidents of the same violation must occur during a single investigation unless a pattern requirement is not required by federal regulations.D. For federally mandated violations
that include, but are not limited to,including overcharge, fraud, trafficking in food instruments, selling firearms, ammunition, explosives, controlled substances,sale ofalcohol or alcoholic beverages, or tobacco products, the state agencywillmay not provide thestoreretailer with prior written notice that a violation or violations were documented before imposing administrative sanctions. This notification decision will be made on a case-by-case basis, depending on the type of federally mandated violation documented and if it is determined that notification would compromise the investigation.E. For selective state agency violations, the state agency shall not provide prior written notice that the violation has occurred, in order to ensure the integrity of the investigative process.F.E. The type of documented violation dictates the administrative action taken including, but not limited to:1. Provision of a written warning;
2. Imposition of a technical penalty fine;
3. Assessment of a civil monetary penalty (CMP) in lieu of disqualification; or
4. Disqualification of an authorized
storeretailer.The total period of disqualification imposed for state agency violations identified as part of a single investigation may not exceed one year. The state agency reserves the right to waive a disqualification requirement if the state agency determines that inadequate participant access would exist if the authorization were terminated.
G.F. The state agencyusesshall use a multitier sanction schedule that consists of:Class:
Description:
Description:
Administrative Actions:
A
Technical program violations
Represents procedural and food instrument handling errors.
$100 fine assessed per documented incident, as outlined in the Sanction/Violation schedule
(effective March 9, 2009), including repeat incidents of the same violation, plus a written warning sent to thestoreretailer.B
Serious program violations
Represents noncompliance errors documented
either fromby compliance investigations, inventory audits, or noncompliance with provisions outlined in the retailer agreement.EightOne-year disqualification for eight or more technical program violations, as outlined in the Sanction/Violation schedule, within a consecutive 12-month period of time; orOne-year disqualification, if a pattern of noncompliance
is required and metexists, as outlined in the Sanction/Violation schedule; or.One-year disqualification if a pattern of noncompliance is not required and the violation has been documented as outlined in the Sanction/Violation schedule.C
Critical program violations
Represents mandatory federal sanctions that require a pattern of noncompliance, i.e., overcharging.
Four documented incidents during a single investigation as outlined in the Sanction/Violation schedule – Three-year disqualification; or
One documented incident as outlined in the Sanction/Violation schedule during a single investigation if a pattern is not required – Three year disqualification.
D
Major program violations
Represents mandatory federal sanctions, i.e., administrative finding of trafficking
Six-year disqualification – only one documented incident is required as outlined in the Sanction/Violation schedule; or
Permanent disqualification – only one documented incident is required, as outlined in the Sanction/Violation schedule.
E
Warning
Represents a documented violation, but does not warrant points being assessed and/or a fine being charged.
Written warning sent to the
retail storeretailer.The date on which violations become effective is determined by the
documenteddate indicated on the final compliance investigation letter. Class A, B, and E violations have an active life of one year, a Class C violation has an active life of three years, and a Class D violation has an active life of six years or permanent disqualification.H.G. If, within a 12-month period, a retailer hasa pattern ofthree documented incidentswithin a 12-month periodof failure to meet the minimum stocking requirement or failure to properly stamp 50 or more deposited food instruments, then thestore willretailer shall be disqualified for a one-year period unless the state agency determines that inadequate participant access would exist if the authorization were terminated.I.H. All documented overcharges or payments for ineligible food items identified during a compliance investigationwillshall be considered avendorretailer claim and be subject to repayment.J.I. Copies of any investigative evidence collected by the state agencyfrom an openduring a compliance investigationwillshall be available to the authorizedstoreretailer, upon request,onceafter the investigation has been closed and thestoreretailer is notified in writing of the final compliance investigation results.K.J. A retailer may apply for WIC authorization after thestoreretailer hasmet anyfinished the disqualification periodimposed upon it. There is no automatic reinstatement of a retailer once the disqualification period hasbeen metended.L.K. The state agency shall not issue sanctions solely as a result of complaints submitted by participants.12VAC5-195-610. Participant access.
A. Prior to taking disqualification actions against an authorized
storeretailer, the state agency shall complete a participant access assessment (7 CFR 246.12). This type of assessment is completed for denied authorizations if an informal settlement meeting or full administrative review is requested by astoreretailer applicant. Participant convenience is not a valid consideration for the state agencies in making any adequate access decisions.B. Participant access will be a factor considered by the state agency in deciding if a
storeretailer shall be assessed a civil monetary penalty in lieu of disqualification or when astoreretailer applicant is eligible as an authorization exception.C. The state agency shall use the same criteria established for making authorization exceptions in deciding if adequate participant access exists.
D. The participant access analysis completed by the state agency contains confidential information. A copy of this internal work document shall not be given to
retail storesretailers or their representatives.12VAC5-195-620. Participant impact.
Participant impact may be an additional factor considered by the state agency in deciding if a
storeretailer shall be assessed a civil monetary penalty in lieu of disqualification. Forstoresretailers whose average number of unique participants is deemed high may be retained in lieu of disqualification. The state agency will take into consideration customer service impact and competitive pricing issues in making any administrative exception decisions.12VAC5-195-630. Retained in lieu of disqualification.
A. An authorized
storeretailer with documented administrative findings that warrant WIC Program disqualification actions may be retained in lieu of disqualification if the state agency determines that inadequate participant access would exist. The state agency will evaluate the impact on participants and the preventive procedures thestoreretailer intends to take in order to decide if thestoreretailer will be allowed to pay a civil monetary penaltyfinerather than being disqualified.B. The state agency shall notify the authorized
storeretailer in writing if it will be retained in lieu of disqualification and the civil monetary penaltyfinethat has been assessed (7 CFR 246.12).C. If a retailer fails to pay a civil monetary penalty that has been assessed,
thenthe state agency shall disqualify the retailer for a period equal to the sanction for which the civil monetary penalty was originally assessed.12VAC5-195-640. Civil monetary
penalty (CMP) finespenalties.A. A
civil monetary penalty (CMP) fineCMP may be assessed for documented state agency and federally mandated violations (7 CFR 246.12).B. The state agency uses a federally mandated formula to calculate both state and federally mandated CMPs that are assessed. The maximum civil monetary penalty assessed shall comply with federal requirements as outlined in 7 CFR 246.12. The state agency
is unable tocannot make any reductionsinto the maximum CMP amount duesincefor federally mandated violations because this formula is defined in federal regulations.C. The same formula
isshall be used to calculate the civil monetary penaltyfineforstoresretailers retained in lieu of disqualification due to documented state agency sanctions.The state agencyFor state agency violations only, the state WIC director of his designee has the authority to reduce or waive thefinepenalty amount being assessed against thestore by no more than 50%retailer. The state agency must document in its records the specific factors supporting this administrative decision.D. A CMP
shallmay be paid infulla lump sum orbased uponthrough an agreed installment plan. Failure of the authorizedstoreretailer to pay any scheduled installments in a timely mannerwillshall lead to thestore'sretailer's disqualification for the original disqualification period.E. Payments shall be made by certified check, cashier check, or money order. Payments shall be made out to the Virginia WIC Program and mailed to the address identified on the penalty fine statement.
F. The state agency
willshall process all past due obligationsfor any of the followingincludingpenaltyadministrative fines,vendorretailer claims, civil monetarypenalty finespenalties, oroverchargesovercharge repayments assessed against authorizedstoresretailers in accordance with the Office of the Comptroller's Policies and Procedures, Section Number 205000 (Accounts Receivable), dated June 2004. The state agencywillshall also process all past due financial obligations in accordance with the Virginia Debt Collection Act (§ 2.2-4800 et seq. of the Code of Virginia).G. The state agency shall notify the
Food Stamp ProgramSupplemental Nutrition Assistance Program in writing within 15 calendar days after assessing a CMP against an authorizedstoreretailer being retained in lieu of disqualification.12VAC5-195-650. Disqualification administrative actions.
A. Voluntary withdrawal or nonrenewal in lieu of disqualification is not permitted for documented mandatory federal violations. The state agency may
useonly allow voluntary withdrawal or nonrenewal for state agency sanctionsonly.B. The state agency shall disqualify an authorized
storeretailer for any of the following reasons:1. Failure to comply with general requirements and conditions as established in the retailer agreement;
2. Failure to meet program requirements as documented
fromduring the compliance investigation process;3. Reciprocal administrative action due to the
storeretailer being disqualified from theFood Stamp Program (FSP)Supplemental Nutrition Assistance Program;4. Failure to pay a CMP or
vendorretailer claim within3020 calendar days afterbeing assessedit is due or failure to pay an installment plan payment when due;5. Provision of false, incomplete, inaccurate, or misleading information that affects the
store'sretailer's selection status;6. Repeated failure to maintain the minimum stocking requirement; or
7. Failure to take documented remedial corrective actions.
C. The state agency shall notify the
food stampSupplemental Nutrition Assistance Program office of any WIC Program disqualificationsand termination actionstaken against an authorizedstoreretailer location.D.
Authorized stores that are beingIf an authorized retailer is disqualified primarily dueprimarilyto documented overcharges,that have participatedparticipates in a full administrative review, and the adjudication officer's findings confirm that the disqualification actionsbeingtaken by the state agency are appropriate, then a finewillshall be assessed. A maximum administrative fine of $999 shall be assessed for two or more documented overcharges during a single investigation. If only one overcharge incident was documented during a single investigation, then a maximum fine of $500 shall be assessed. If the disqualification action does not involve any documented overcharges, then no finewillshall be assessed.12VAC5-195-660. Informal settlement meetings.
A. If an authorized
storeretailer is being considered for possible adverse action, including but not limited to authorization denial and program disqualification, the state agency shall offer an optional informal settlement meeting withstoreretailer management prior to taking administrative action. The state WIC director or designee shall be in attendance. The purpose of the informal settlement meeting is to:1. Identify areas of noncompliance;
2. Provide a forum for the
storeretailer to submit information about the impact of the adverse action on WIC participants;3. Review criteria for authorization exception decisions pursuant to 12VAC5-195-370;
4. Review the inadequate participant access results, if applicable;
5. Review the civil monetary penalty
fineforstoresretailers being retained in lieu of disqualification, if applicable; and6. Provide information to the
storeretailer regarding its appeal rights, if applicable.B. The
retail storeretailer or applicant has 15 calendar days from the date of receipt of the state agency correspondence to postmark a written request for an informal settlement meeting.C. The request for the informal settlement meeting can be hand delivered, mailed by US mail, UPS, or FedEx, sent by facsimile transmission or sent via email to the
vendor managerstate agency.D. Upon receipt of the
retail store'sretailer's or applicant's request for an informal settlement meeting, the state agency will confirm a date, time, place and method for the informal settlement meeting.E. All requests to reschedule the meeting must be submitted in writing at least 24 hours before the scheduled meeting date, unless an emergency occurs, as determined at the discretion of the state WIC director or designee.
F. If the
retail storeretailer representative is more than 45 minutes late from the agreed upon meeting start time, then this will be considered a "no show" unless he can provide documentation that the state WIC director or designee determines justifies his tardiness or failure to appear. The state agency will proceed with administrative decisions without the input of theretail storeretailer should the representative either fail to schedule, fail to appear, or fail to reschedule the informal settlement meeting.G. Informal settlement meetings are either conducted through face-to-face meetings in Richmond, Virginia, or via video conference. For informal settlement meetings that are held via video conference, the authorized
storeretailer or applicant would be required to travel to a local agency that has videoconferencing equipment available.H. After the informal settlement meeting is held and all supporting documentation is received by the state agency, the state agency shall send within 15 days a written summary of the meeting's results to a designated
storeretailer representative. If the resolution offered from the informal settlement meeting is unacceptable to theretail storeretailer, then theretail storeretailer or applicant may request a full administrative review in writing. This written request must be submitted to thevendor managerstate agency and postmarked within 15 calendar days from the date of receipt of the informal settlement meeting summary. Thevendor managerstate agency will identify if thestore'sretailer's request qualifies under federal regulations for a full administrative review. If thestore'sretailer's request is not eligible, then thestoreretailer will receive a written response from thevendor managerstate agency of this decision.12VAC5-195-670. Full administrative review.
A. Authorized
retail storesretailers and applicants shall be offered an opportunity to request a full administrative review only foronlythe adverse action cited in subsection O of this section.B. The
retail storeretailer or applicant has 15 calendar days from the date of receipt of the denial notice, either by letter or an electronic format,or the disqualification letter, either by letter or an electronic format, to request a full administrative review.C. The request for the full administrative review
canmay be mailed by US mail, sent by facsimile transmission or sent via email to thevendor managerstate agency. If the request is mailed, it must be postmarked within 15 calendar days from the date of receipt of letter or electronic notification from the state agency, whichever comes first.D. The
retail storeretailer or applicantmustshould indicate whetheror nothewillintends to be represented by an attorney when the full administrative review request is made.The retail storeThis does not preclude the retailer or applicant from seeking legal counsel at any time. At least five days prior to the scheduled full administrative review, the retailer or applicant mustalsoprovide the state agency with copies of any written informationto be usedthat it wishes to use during the review and names of witnesses thatwill be called at least five days prior to the scheduled full administrative reviewit will call. Failure tonotifyprovide the state agencyofwith these items may result ina rescheduled date and time forrescheduling the full administrative review or the exclusion of documents and witnesses from the full administrative review.E.
UponWithin 30 days of receipt of theretail store'sretailer's or applicant's request for a full administrative review, after consulting with the retailer or applicant and the adjudication officer, the state agencywillshall confirm a date, time, and place for the reviewwithin 30 days. For authorizedstoresretailers and applicants, the reviewmustshall be scheduled to take place within 60 calendar days after the written request is received by the state agency, unless otherwise agreed to by the partiesinvolved.F. Failure to attend the scheduled review
on the agreed upon date and time willshall lead to theretail storeretailer forfeiting its rights to any further administrative reviews.G. The
retail storeretailer or applicant will have one opportunity to reschedule the full administrative review's date or time. All requests to reschedule the review date or time must be submitted in writing at least 24 hours before the scheduled review date,unlessan emergency occurs, as determined at the discretion of the state WIC director or designeegood cause can be shown as determined by the adjudication officer. Rescheduled reviews shall take place within four weeks of the originally scheduled date unlessthe parties mutually agree on a later dateotherwise agreed to by the parties.H. If the
retail storeretailer representative is more than 45 minutes latefrom the agreed uponto the review,start time, thenthiswillshall be considered a "no show" unless he canprovide documentation that the WIC director or designee determines justifies his tardiness or failure to appearshow good cause as determined by the adjudication officer.This outcome means that the retail store has forfeited its rights to a full administrative review.I. A full administrative review
isshall be conducted by an adjudication officer who is employed by the Virginia Department of Health. The adjudication officer shall ensure that administrative actions taken by the WIC Program are consistently and fairly applied and that those administrative actions comply with established policies, procedures, and federal and state statutes and regulations. A representative from the state agencywillshall present its case to the adjudication officer andretail storeretailer or applicant representative. Conversely, thestoreownerretailer owner or designated representative, which may include legal counsel,willshall present its case to the adjudication officer.J. All full administrative reviews
areshall be held in Richmond, Virginia.K. After a full administrative review is held, the state WIC director shall provide written notification of the adjudication officer's decision, including the basis for the decision, to the applicant or authorized retailer within 90 calendar days of the date of receipt of the full administrative appeal review request, unless otherwise agreed to by the parties involved. This notification will also be sent to the appropriate USDA Food and Nutrition Services office.
L. Authorized
retail storesretailers being disqualified may continue to deposit WIC food instruments until a decision has been renderedfrom the full administrative reviewby the adjudication officer. The adverse action effective date shall be postponed by the state agency pending the outcome of the review.M. In accordance with 7 CFR 246.18, if an authorized
storeretailer does not request a full administrative review, then disqualification becomes effective 15 calendar days after the retailer receives the state agency's written disqualification letter.N. An authorized retailer being retained in lieu of disqualification for a state agency violation may elect to voluntarily withdraw from the WIC Program rather than pay a mandated civil monetary penalty
fine. If the retailer voluntarily withdraws and does not payathe civil monetary penaltyfine that previously had been imposed by the program, then a disqualification statuswillshall be documented in the state agency's records. The disqualification period may range from one to six years, depending on the type of sanctions and violations documented by the state agency.O. The state agency shall provide a full administrative review to
retail storesretailers or applicants, upon request, for the following adverse actions pursuant to 7 CFR 246.18:1. Denial of authorization based on the
vendorapplication of the retailer selection criteriafor competitive price orfor minimum variety and quantity of authorized supplemental foods or on a determination that thevendorretailer is attempting to circumvent a sanction (7 CFR 246.12);2. Denial of authorization based upon the
vendorretailer selection criteria for business integrity or for a currentFood StampSupplemental Nutrition Assistance Program disqualification or civil money penalty for hardship (7 CFR 246.12);3. Denial of authorization based on a state agency established
vendorretailer selection criteria if the basis of the denial is avendorWIC retailer sanction or aFood StampSupplemental Nutrition Assistance Program withdrawal of authorization or disqualification;4. Denial of authorization based on the state agency's retailer limiting criteria (7 CFR 246.12);
5. Denial of authorization because a
vendorretailer submitted its application outside the timeframes during which applications are accepted or processed as established by the state agency under(7 CFR 246.12)7 CFR 246.12;6. Termination of a retailer agreement because of a change in ownership,
orlocation, or cessation of operations (7 CFR 246.12);7. Termination of a retailer agreement for cause;
8. Disqualification based on documented WIC Program violations;9.8. Disqualification based on a trafficking conviction (7 CFR 246.12);10.9. Disqualification based on the imposition of aFood StampSupplemental Nutrition Assistance Program civil monetary penalty for hardship (7 CFR 246.12);11.10. Disqualification or civil monetary penalty imposed in lieu of disqualification based on a mandatory sanction imposed by another WIC state agency (7 CFR 246.12);or12.11. Imposition of a fine or a civil monetary penalty in lieu of disqualification;12. Denial of authorization based on the application of the retailer selection criteria for competitive price;
13. The application of the state agency's retailer peer group criteria and the criteria used to identify retailers that are above 50% retailers or comparable to above 50% retailers;
14. Denial of an application based on a determination of whether an applicant retailer is currently authorized by the Supplemental Nutrition Assistance Program;
15. A civil monetary penalty imposed in lieu of disqualification based on a Supplemental Nutrition Assistance Program disqualification under 7 CFR 246.12; and
16. Disqualification unless listed in subsection P of this section.
P. The state agency shall not provide a full administrative review to
retail storesretailers that appeal the following actions, pursuant to 7 CFR 246.18:1. The validity or appropriateness of the state agency's
vendorretailer limiting or selection criteria or retailer selection criteria for minimum variety and quantity of supplemental foods, business integrity, and current Supplemental Nutrition Assistance Program disqualification or civil monetary penalty for hardship (7 CFR 246.12);2. The validity or appropriateness of the state agency's
vendor peer group criteria and thecriteria for competitive price, including peer group criteria and the criteria used to identifyvendorsretailers that are above 50%vendorsretailers or comparable to above 50%vendorsretailers;3. The validity or appropriateness of the state agency's participant access criteria and the state agency's participant access determinations;
4. The state agency's determination whether a
vendorretailer had an effective policy and program in effect to prevent trafficking and that the ownership of thevendorretailer was not aware of, did not approve of, and was not involved in the conduct of the violation (7 CFR 246.12);5. Denial of authorization if the state agency's
vendorretailer authorization is subject to the procurement procedures applicable to the state agency;6. The expiration of the retailer's agreement;
7. Disputes regarding food instrument payments and
vendorretailer claims other than the opportunity to justify or correct avendorretailer overcharge or other error as permitted by (7 CFR 246.12);8. Disqualification of a
vendorretailer as a result of disqualification from theFood StampSupplemental Nutrition Assistance Program (7 CFR 246.12);9. The state agency's determination to include or exclude an infant formula
source from the state agency's list of state-licensed wholesalers, distributors, and retailers and infant formula manufacturers registered with the Food and Drug Administrationmanufacturer, wholesaler, distributor, or retailer from the list required pursuant to 7 CFR 246.12;and10. The state agency's determination whether to notify a
vendorretailer in writing when an investigation reveals an initial violation for which a pattern of violations must be established in order to impose a sanction.; and11. The validity or appropriateness of the state agency's prohibition of incentive items and the state agency's denial of an above 50% retailer's request to provide an incentive item to customers pursuant to 7 CFR 246.12.
Q. A full administrative review request shall not be denied or dismissed unless:
1. The request to the state agency is not postmarked or received within 15 calendar days of the applicant or authorized
store'sretailer's receipt of the notice of disqualification or adverse action;2. The request to the state agency
wasis submitted by an individual who does not have the legal or delegated authority to represent theownerapplicant or authorized retailer;3. The retailer or authorized representative withdraws the request in writing;
4. The retailer or authorized representative fails
without good causeto appear at the scheduled review date and time without good cause as determined by the adjudication officer; or5. The request for a full administrative review is not eligible for this consideration based on the specific exclusion criteria outlined in subsection P of this section.
12VAC5-195-680. Food application process.
A. Food items that are approved for purchase by eligible WIC participants must have a food application submitted and approved by the state agency. The food application process does not apply to WIC approved formulas.
B. The state agency shall conduct a review of the approved foods every two years. Food applications shall be accepted and processed during a two-month period.
C. The state agency shall notify prospective manufacturers, suppliers, and distributors when food applications will be accepted by sending them an announcement letter. The state agency shall also post the food application announcement letter on the state agency website.
D. The state agency shall maintain a database with the contact names and companies who previously submitted food applications or expressed an interest in having their products considered for WIC approval. Individuals may request to be added to the database on behalf of manufacturers by completing a food application contact form, which is an online form located on the state agency's website at http://www.vahealth.org/DCN/Publications/pubswic.htm.
E. Incomplete food applications shall not be eligible for selection and inclusion on the WIC approved food list.
F. The state agency is responsible for evaluating all completed food applications to ensure each product meets both federal and state nutritional and administrative guidelines.
G. After the food application evaluation and selection process has been completed, a new food list will be printed and distributed to local agencies, WIC participants, and retailers by the state agency. The state agency shall pay all costs associated with producing, printing, and distributing the WIC approved food list. Funds from manufacturers, suppliers, distributors, or other sources shall not be used to reprint the approved food list.
H. If a manufacturer, supplier, or distributor changes the name of an approved product whose trade name appears on the approved food list, the new product shall not be automatically eligible for purchase under the current food list. The manufacturer, supplier, or distributor must submit a written request to the state agency, a sample nutritional label for the new product, and documentation outlining the product availability at authorized retailers to have the new product considered for approval. Once this information is received, the state agency shall decide on a case-by-case basis if the new product can be transitioned under the current food list or must wait for the next food list submission cycle. A new product shall not be approved prior to it being available at retailer locations. If the new product is not eligible for inclusion under the current food list, the manufacturer, supplier, or distributor may submit a new food application using the new product name when food applications are being accepted.
I. If a manufacturer, supplier, or distributor changes the nutritional formulation of an approved product, the new product shall not be eligible for purchase under the current food list. The manufacturer, supplier, or distributor must submit a new food application for the new product when food applications are being accepted.
J. Manufacturers, suppliers, or distributors shall not send product samples to the state agency at any time.
K. Changes to the approved food list made during the scheduled two-year period may be made on a case-by-case basis as determined by the state agency based on federal guidance if applicable.
NOTICE: The following form used in administering the regulation was filed by the agency. The form is an online form and is not being published. The form may be found at the web address listed after the form. A copy of the form is available from the agency contact or may be viewed at the Office of the Registrar of Regulations, General Assembly Building, 2nd Floor, Richmond, Virginia 23219.
FORMS (12VAC5-195)
Food application contact form, an online form available at http://www.vahealth.org/DCN/Publications/pubswic.htm.
DOCUMENTS INCORPORATED BY REFERENCE (12VAC5-195)
Vendor Manual for the Virginia WIC Program, August 2008, Virginia Department of Health.Virginia WIC Program Approved Food List, effective January 1, 2007, Virginia Department of Health.Retailer Agreement, effective July 1, 2008, Virginia Department of Health.Volume No. 1 – Policies & Procedures, Function No. 20000 – General Accounting, Section No. 20500 – Accounts Receivable, dated June 2004, Office of the Comptroller, Commonwealth of Virginia.Virginia WIC Program Sanction Violation Schedule, March 2009, Virginia Department of Health.USDA Memo – SFP 09-020 Clarification on the use of the WIC acronym and logo, January 2009, United States Department of Agriculture, Food and Nutrition Service.Vendor Manual for the Virginia WIC Program, January 2011, Virginia Department of Health.
WIC Approved Food List, April 2012, Virginia Department of Health.
Virginia WIC Program - Sanction Violation Schedule, December 1, 2011, Virginia Department of Health.
VA.R. Doc. No. R13-2983; Filed January 17, 2013, 12:13 p.m.