(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.