(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.