(b) Definitions.
For most definitions
applicable to the provisions of this section, refer to sec. 199.2. The
following definitions apply only to this section:
(1) Applicant.
Pregnant women,
breastfeeding women, postpartum women, infants, and children who
are applying to receive WIC Overseas benefits, and the breastfed
infants of applicant breastfeeding women. This term also includes
individuals who are currently participating in the Program but are
re-applying because their certification is about to expire.
(2) Breastfeeding
women.
Women
up to 1-year postpartum who are breastfeeding their infants. Their eligibility
will end on the last day of the month of their infant’s first birthday.
(3) Certification.
The implementation
of criteria and procedures to assess and document each applicant’s
eligibility for the Program.
(4) Children.
Persons who have had their first birthday
but have not yet attained their fifth birthday. Their eligibility
will end on the last day of the month of their fifth birthday.
(5) Competent Professional
Authority (CPA).
An individual on the staff of the WIC Overseas
office authorized to determine nutritional risk, prescribe supplemental
foods, and design nutrition education programs. The following are
authorized to serve as a competent professional authority: physicians, nutritionists,
registered nurses, and dieticians may serve as a competent professional
authority. Additionally, a CPA may be other persons designated by
the regional program manager who meet the definition of CPA prescribed
by the USDA as being professionally competent to evaluate nutritional
risk. The definition also applies to an individual who is not on
the staff of the WIC Overseas office but who is qualified to provide
data upon which nutritional risk determinations are made by a competent professional
authority on the staff of the local WIC Overseas office.
(6) Contract brand.
The brand of
a particular food item that has been competitively selected by the DoD
to be the exclusive supplier of that type of food item to the program.
(7) Date-to-use.
The date by
which the drafts must be used to purchase food items.
(8) Department.
The Department
of Defense (DoD), unless otherwise noted.
(9) Dependent.
(i) A
spouse, or
(ii) An unmarried child
who is:
(A) Under 21 years of age; or
(B) Incapable
of self-support because of mental or physical incapacity and is
in fact dependent on the member for more than 1/2 of the child’s
support; or
(C) Is under 23 years
of age, is enrolled in a full-time course of study in an institution
of higher education and is in fact dependent on the member for more
than one-half of the child’s support.
(10) Drafts.
Paper food instruments,
similar to vouchers, issued in the WIC Overseas offices to program
participants. Participants may redeem their drafts at participating
commissaries and NEXMARTs for the types and quantities of foods
specified on the face of the draft.
(11) Economic unit.
All individuals
contributing to or subsidizing the income of a household, whether they
physically reside in that household or not.
(12) Eligible civilian.
An eligible
civilian is a person who is not a member of the armed forces and
who is:
(i) A dependent of
a member of the armed forces residing with the member outside the
United States, whether or not that dependent is command sponsored,
or
(ii) An employee of a military department who is
a national of the United States and is residing outside the United
States in connection with such individual’s employment or a dependent
of such individual residing with the employee outside the United
States; or
(iii) An employee of
a Department of Defense contractor who is a national of the United
States and is residing outside the United States in connection with
such individual’s employment or a dependent of such individual residing
with the employee outside the United States.
(13) Family.
A group of related
or non-related individuals who are one economic unit.
(14) Hematological
test.
A
test of an applicant’s or participant’s blood as described in 7
CFR part 246.7(e).
(15) Income guidelines.
Income poverty
guidelines published by the U.S. DHHS. These guidelines are adjusted
annually by the Department of Health and Human Services (DHHS),
with each annual adjustment effective July 1 of each year. For purposes
of WIC Overseas Program income eligibility determinations, income
guidelines shall mean the income guidelines published by the DHHS pertaining
to the State of Alaska.
(16) Infants.
Persons under
1 year of age.
(17) National of
the U.S.
A
person who:
(i) Is a citizen of
the U.S.; or
(ii) Is not a citizen
of the United States, but who owes permanent allegiance to the United
States, as determined in accordance with the Immigration and Nationality
Act.
(18) NEXMART.
Navy Exchange
Market.
(19) Nutrition education.
Individual or
group sessions and the provision of materials designed to improve
health status, achieve positive change in dietary habits, and emphasize
relationships between nutrition and health, all in keeping with
the individual’s personal, cultural, and socioeconomic preferences.
(20) Nutritional
risk.
(i) The presence of detrimental or abnormal nutritional
conditions detectable by biochemical, physical, developmental or
anthropometric data, or
(ii) Other documented
nutritionally related medical conditions, or
(iii) Documented
evidence of dietary deficiencies that impair or endanger health,
or
(iv) Conditions that directly affect the nutritional
health of a person, such as alcoholism or drug abuse, or
(v) Conditions
that predispose persons to inadequate nutritional patterns, habits
of poor nutritional choices or nutritionally related medical conditions.
(21) Participants.
Pregnant women,
breastfeeding women, postpartum women, infants, and children who
are receiving supplemental foods or food instruments under the WIC
Overseas Program, and the breastfed infants of participant breastfeeding
women.
(22) Postpartum Women.
Women up to
6 months after the end of their pregnancy. Their eligibility will end
on the last day of the sixth month after their delivery.
(23) Pregnant Women.
Women determined
to have one or more embryos or fetuses in utero. Pregnant women
are eligible to receive WIC benefits through 6 weeks postpartum,
at which time they reapply for the program as postpartum or breastfeeding
women.
(24) Rebate.
The amount of
money refunded under cost containment procedures to the Department from
the manufacturer of a contract brand food item.
(25) Regional Lead
Agent.
The
designated major military medical center that acts as the regional
lead agent, having tri-service responsibility for the development
and execution of a single, integrated health care network.
(26) Supplemental
foods.
Foods
containing nutrients determined by nutritional research to be lacking in
the diets of certain pregnant, breastfeeding, and postpartum women,
infants, and children. WIC Overseas may substitute different foods
providing the nutritional equivalent of foods prescribed by Domestic
WIC programs, as required by 10 U.S.C. 1060a(c)(1)(B).
(27) Verification.
Verification
of drafts is a review before payment out of Defense Health Program funds
to determine whether the commissary or NEXMART complied with applicable
date-to-use, food specification, and other redemption criteria.
(c) Certification of
eligibility.
(1) To the extent practicable, participants shall
be certified as eligible to receive Program benefits according to
income and nutritional risk certification guidelines contained in
regulations published by the USDA pertaining to the Women, Infants,
and Children program required under 7 CFR 246.7(d)(2)(iv)(B). Applicants
must meet the following eligibility criteria:
(i) Meet one of the
participant type requirements: be a member of the armed forces on
duty overseas; a family member/dependent of a member of the armed
forces on duty overseas; a U.S. national employee of a military
department serving overseas; a family member of a U.S. national employee
of a DoD contractor serving overseas; a family member of a U.S.
national employee of a DoD contractor serving overseas;
(ii) Reside
in the geographic area served by the WIC Overseas office;
(iii) Meet
the income criteria specified in this section; and
(iv) Meet
the nutrition risk criteria specified in this section.
(2) In
terms of income eligibility, the following apply:
(i) The
Department of Defense shall use the Alaska income poverty guidelines
published by the DHHS for making determinations regarding income
eligibility for the Program.
(ii) Program income
eligibility guidelines shall be adjusted annually to conform to
annual adjustments made by the DHHS.
(iii) For income eligibility,
the Program may consider the income of the family during the past
12 months and the family’s current rate of income to determine which
indicator accurately reflects the family’s status.
(iv) A
pregnant woman who is ineligible for participation in the Program
because she does not meet income criteria shall be deemed eligible
if the criteria would be met by increasing the number of individuals
in her family (economic unit) by the number of children in utero.
(v) The
Program shall define income according to USDA regulations with regard
to the USDA-administered WIC Program. In particular--
(A) A
basic allowance for housing is excluded from income as required
by section 674 of the National Defense Authorization Act for Fiscal
Year 2000.
(B) The value of in-kind
housing benefits is excluded from income as required under USDA regulations.
(C) Cost
of living allowances for duty outside the continental U.S. (OCONUS)
is excluded from income as required under 7 CFR 246.7(d)(2)(iv)(A)(2).
(D) Public
assistance and welfare payments are included in income.
(3) Participants
must be found to be at nutritional risk to be eligible for program
benefits.
(i) A Competent Professional Authority (CPA) shall
determine if an applicant is at nutritional risk.
(ii) At
the request of the program, applicants shall provide, according
to schedules set by the USDA in 7 CFR 246.7(e) (unless deemed impracticable),
nutritional risk data as a condition of certification in the Program.
Such data includes:
(A) Anthropometric
measurements,
(B) The results of
hematological tests,
(C) Physical examination,
(D) Dietary
information, or
(E) Developmental testing
(iii) A
pregnant woman who meets all other eligibility criteria and for
whom a nutritional risk assessment cannot immediately be completed
will be considered presumptively eligible to participate in the
Program for a period up to 60 days.
(iv) Infants under
6 months of age may be deemed to be at nutritional risk if the infant’s
mother was a Program participant during pregnancy or if medical
records document that the mother was at nutritional risk during
pregnancy.
(v) Unless otherwise
specified herein or in 7 CFR 246.7(e), required nutritional risk
data shall be provided to, or obtained by, the WIC Overseas Program
office within 90 days of enrollment.
(4) In
the event that it is impracticable for the WIC Overseas Program
to adhere to the income and nutritional risk eligibility guidelines
contained in USDA regulations, the Director, TRICARE Management Activity
(TMA) may waive the Department’s use of USDA WIC Program eligibility
criteria by determining that it is impracticable to use these standards
to certify participants in the WIC Overseas Program.
(i) Such
determination shall consider relevant practical, administrative,
national security, financial factors and existing Department policies
and their application to the population served by the WIC Overseas
Program.
(ii) Absent a written
finding of impracticability described in section 199.23(c)(4), the
eligibility criteria for the WIC program, contained in USDA regulations
shall apply.
An
applicant for the WIC Overseas Program who presents a valid WIC
Program Verification of Certification card, which is issued to participants
in the domestic WIC Program when they intend to move, shall be considered
eligible for participation in the WIC Overseas Program for the duration
of the individual’s current domestic WIC certification period, as
long as he/she is an eligible service/family member or eligible
civilian/family member.
(d) Program benefits.
(1) Drafts.
WIC participants
shall be issued drafts that may be redeemed for supplemental food
prescribed under the program.
(i) Drafts shall at
a minimum list the food items to be redeemed and the date-to-use.
(ii) Food
items listed on the draft must be approved for use under the Program.
(iii) Drafts
generally shall allow for a three-month supply of food items for
each participant, unless the participant’s nutritional status necessitates
more frequent contacts with the WIC Overseas office.
(iv) Participating
commissaries and NEXMARTS shall accept the drafts in exchange for
approved food items.
(v) Commissary and
NEXMART personnel shall be trained on verification and processing
of drafts.
(vi) Program guidelines
shall provide for training of new participants in how to redeem
drafts.
(2) Supplemental
Food.
Participants
shall redeem drafts for appropriate food packages at intervals determined
in accordance with the USDA regulations.
(i) The
Director, TMA shall identify to the Defense Commissary Agency (DeCA)
and NEXCOM a list of food items approved for the WIC Overseas Program.
This list shall be developed in consultation with the USDA and shall
include information regarding the appropriate package and/or container
sizes and quantities available for participants, as well as the
frequency with which food items can be acquired. Additions and/or
deletions of food items from this list shall be communicated to
the commissaries and NEXMARTS on an ongoing basis.
(ii) A
CPA shall prescribe appropriate foods from among the approved list
to be included in food packages.
(iii) A CPA shall coordinate
documentation of medical need when such documentation is a prerequisite
for prescribing certain food items.
(iv) The Director,
TMA may authorize changes regarding the supplemental foods to be
made available in the WIC Overseas Program when local conditions
preclude strict compliance or when such compliance is impracticable.
(3) Nutrition Education.
Nutrition education
shall be provided to all participants at intervals prescribed in
USDA regulations at 7 CFR Part 246.11.
(i) The
WIC Overseas nutrition education program shall be locally overseen
by a CPA based on guidance and materials provided by TMA.
(ii) Nutrition
education and its means of delivery be tailored to the greatest
extent practicable to the specific nutritional, cultural, practical,
and other needs of the participant. Participant profiles created during
certification may be used in designing appropriate nutrition education.
A CPA may develop individual care plans, as necessary, consistent
with USDA regulations.
(iii) Nutrition education
shall consist of sessions wherein individual participants or groups
of participants meet with a CPA in an interactive setting such that
participants can ask, and the CPA can answer, questions related
to nutrition practices. In addition, nutrition education shall utilize
prepared educational materials and/or Internet sites. Both the sessions
and the information materials shall be designed to improve health
status, achieve positive change in dietary habits, and emphasize relationships
between nutrition and health. Individual and group sessions can
be accomplished through, among other things, face-to-face meetings,
remote tele-videoconferencing, real-time computer-based distance
learning, or other means.
(iv) Nutrition education
services shall generally be provided to participants twice during
each 6-month certification period, unless a different schedule is
specified in USDA regulations.
(v) The nutrition education
program shall promote breastfeeding as the optimal method of infant nutrition,
encourage pregnant participants to breastfeed unless contraindicated
for health reasons, and educate all participating women about the
harmful effects of substance abuse.
(vi) Individual participants
shall not be denied supplemental food due to the failure to attend scheduled
nutrition education sessions.
(g) Administrative
appeals and civil rights.
(1) Applicants who
are denied certification or participants that are denied recertification
shall be provided with a notice of ineligibility. The notice shall
include information on the applicant’s right to appeal the determination
and instructions on doing so.
(2) Benefits shall
not be provided while an appeal is pending when an applicant is
denied benefits, a participant’s certification has expired or a
participant becomes categorically ineligible.
(3) A
request for appeal shall be submitted in writing within five working
days. If the decision is an adverse one it shall include notice
to the applicant of his further appeal rights as reflected in (iii)
below, and that he/she has five working days to effect any such
appeal.
(4) Appeal reviews shall be conducted in the first
instance by the CPA or team leader in charge of the local WIC Overseas
office.
(i) Written notice of a decision shall be provided
to the applicant within five working days.
(ii) If
the appeal is upheld, retroactive benefits shall not be provided.
(iii) At
an applicant’s request a denied appeal may be forwarded to the regional
program manager for review, who will provide a decision on the appeal
within 5 working days.
(iv) If the regional
program manager denies the appeal, there shall be no further right
of appeal.
(5) Complaints about
discriminatory treatment shall be handled in accordance with procedures established
at each local WIC Overseas site.