Source: https://townhall.virginia.gov/L/ViewXML.cfm?textid=1828
Timestamp: 2020-07-13 07:36:36
Document Index: 722914043

Matched Legal Cases: ['§1786', 'art 246', 'art 246', 'art 248', '§32', 'art 246', '§9', '§2']

Implementation of state regulations pertaining to the Virginia ...
5/16/08 4:53 PM [latest] 5/5/08 10:25 AM
12VAC5-195
12VAC5-195-10
12VAC5-195-10. 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.
§32.1-12 of the Code of Virginia; 7 CFR Part 246.
Derived from Virginia Register Volume 24, Issue 19, eff. May 26, 2008.
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 stores (7 CFR 246.12(h)). This agreement identifies the obligations, rights and responsibilities of both the authorized retail store 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(h)(2)(3)).
"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 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 nmber.
"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.
12VAC5-195-40
12VAC5-195-40. (Reserved)
12VAC5-195-50
12VAC5-195-50. (Reserved)
12VAC5-195-60
12VAC5-195-60. (Reserved)
A. Adjunctive financial eligibility requirements. Adjunctive, or automatic income eligibility is determined pursuant to 7 CFR 246.7(d)(2)(vi)(A). Documentation is required as proof of participation in programs that qualify an applicant for adjunctive financial eligibility. The state agency also allows the following state-administered programs to be used in determining adjunctive income eligibility:
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(d)(1).
Applicants shall present proof of identification to obtain all WIC services and benefits. This includes but is not limited to certification and subsequent certification visits, food instrument issuance, special formula issuance, nutrition education and VOC transfers. The local agency shall only accept the following as proof of identification:
1. Valid Medicaid card/letter;
9. Clinic/hospital record or ID;
10. TANF/welfare photo ID;
13. Passport/visa;
3. Deed, mortgage, monthly mortgage statement or residential rental/lease agreement;
4. Valid Virginia drivers license;
6. TANF/Welfare Photo ID.
2. Copy of official Department of Defense orders with Virginia installation assignment; or
3. Leave and earning statement (LES) listing Virginia as the service member's home of record.
12VAC5-195-100
12VAC5-195-100. Proxy.
A. A participant, parent or legal guardian may have the privilege, but not the right, to designate a maximum of two proxies. A proxy may accept and redeem food instruments. The proxy must attend nutrition education to obtain food instruments. The participant and proxy are not required to be present together when the participant designates the proxy. The parent is encouraged to be the primary recipient of all WIC instruments.
B. Local agency personnel shall only discuss the option of designating a proxy if the participant, parent or legal guardian indicates one of the following situations:
1. The participant, parent or legal guardian expresses difficulty with attending the local agency for nutrition education WIC instruments;
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 appointments; or
3. The local agency determines difficulty with the participant, parent or legal guardian attending the local agency during established alternative hours.
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, to obtain and redeem food instruments, and to attend nutrition education. The caretaker assumes all of the rights and responsibilities of the parent or legal guardian who designates them. 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. 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. The parent is always encouraged to be the primary recipient of all WIC benefits.
B. Local agency personnel shall only discuss the option of designating a caretaker if the participant, parent or legal guardian indicates one of the following situations:
1. The participant, parent or legal guardian expresses difficulty with attending the local agency for nutrition education WIC benefits;
12VAC5-195-120
12VAC5-195-120. Certification.
A. The certification process begins when an applicant contacts the local agency to make an oral or written request for WIC benefits.
B. A local agency may choose to serve participants who live outside of their local agency geographic area, but within the state, in cases of hardship.
C. Breastfeeding women shall be certified up to the last day of the month in which her infant turns one year old or until the woman ceases breastfeeding, whichever occurs first.
D. Infants shall be certified up to their first birthday.
12VAC5-195-130
12VAC5-195-130. Nutritional risk priority system.
The state agency places pregnant, breastfeeding, or postpartum women, infants and children who are at nutritional risk solely because of homelessness and migrancy in Priority VII, per 7 CFR 246.7. The state agency does not expand or adjust any other priority level listed in 7 CFR 246.7.
A. Food instrument issuance. All food instruments shall be issued through the automated system after eligibility has been documented and only when the participant, parent or legal guardian, caretaker or proxy is physically present at the local agency to pick up their 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:
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 the stolen items. 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.
7. Complete systemwide failure of automated system.
12VAC5-195-150
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 5 p.m. to address barriers in accessing WIC services for current and potential applicants and participants. The local agency shall provide documentation to the state agency that the alternative hours accommodate the needs of the current client caseload.
12VAC5-195-160
12VAC5-195-160. Waiting lists.
The state agency shall provide local agencies with approval before waiting lists are implemented.
12VAC5-195-170
12VAC5-195-170. Termination.
Participants who fail to obtain food instruments for 90 days after the last date to spend during a certification period shall be automatically terminated from the WIC Program.
A. The Virginia WIC Program is a federally administered program. The following fair hearing procedures are a federal process with which the state agency must comply. Pursuant to 7 CFR 246.9(a), the state agency shall provide a hearing procedure through which any individual may appeal a state or local agency action that results in a claim against the individual for repayment of the cash value of improperly issued benefits or results in the individual's denial of participation or disqualification from the program.
D. Participants who appeal the termination of benefits within 60 days must continue to receive WIC benefits until the hearing officer reaches a decision, the participant becomes categorically ineligible, or the certification period expires, whichever comes first.
I. The participant or applicant must appear at the fair hearing in person, but may be accompanied by a representative such as a relative, friend, legal counsel or other spokesperson. The applicant or participant must indicate whether or not they will be represented by an attorney when the fair hearing request is made. The applicant or participant must also provide the state agency with copies of any written information to be used during the hearing and names of witnesses that will be called at least five days prior to the scheduled fair hearing. Failure to notify the state agency of these items may result in a rescheduled date and time for the fair hearing or the exclusion of documents and witnesses from the fair hearing.
L. Pursuant to 7 CFR 246.9(j), the state or local agency shall provide the participant, applicant, or representative an opportunity to:
M. The hearing officer shall hear evidence and testimony and reach a decision. The hearing officer shall notify the applicant or participant, the state WIC director, and the district health director of the decision in writing within 45 days of the date of the fair hearing request.
12VAC5-195-190
Per 7 CFR 246.9(f), the state and local agencies shall not deny or dismiss a request for a hearing unless:
Dual participation  redeeming food instruments from two programs/agencies in same month
Physically abusing the WIC or store staff (An incidence of physical abuse of WIC or store staff/property should be reported to the police)
Accepting cash or credit from a store in connection with a WIC transaction
Creating a public nuisance at the local agency or the store (i.e., verbally abusing, harassing, or threatening WIC or store staff, destroying store merchandise, or disrupting normal local agency or store activities)
Attempting to redeem or redeeming WIC food instruments for unauthorized food, formula or food amounts
Allowing unauthorized person(s) to use the WIC ID Folder to pick-up and/or redeem WIC food instruments
Attempting to redeem or redeeming food instruments at unauthorized stores
12VAC5-195-210. Collection of improperly issued instruments/claims against participants.
The state agency may establish a claim against a participant for the full value of benefits improperly obtained or disposed of and any fees or additional expenses incurred. These improper acts include, but are not limited to:
3. Proxy abuses; or
4. Retention of future food instruments after disqualification.
12VAC5-195-220
12VAC5-195-220. Interruption of benefits.
A. The state agency may discontinue benefits to participants due to funding shortages.
B. Local agencies shall only implement an interruption of benefits as specified by written direction from the state agency.
C. The state agency shall exercise its federal authority to limit participation to high priorities in the case of funding shortages.
A. Individuals involved in administering the WIC Program may not:
1. Act as a proxy for a participant; or
2. Have a financial interest in an authorized WIC retail store.
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.
Local agencies shall follow emergency procedures in the event of an emergency situation. Procedures to continue WIC benefits shall be incorporated by the local agency into the district Office Emergency and Business Recovery Plan.
12VAC5-195-250
12VAC5-195-250. (Reserved)
12VAC5-195-260
12VAC5-195-260. (Reserved)
12VAC5-195-270
12VAC5-195-270. (Reserved)
9. Receive from the state agency an authorization acknowledgement letter granting WIC Program authorization, a Vendor Manual for the Virginia WIC Program, a WIC window decal, and an authorization stamp.
D. Newly authorized stores shall begin accepting WIC food instruments within 15 calendar days after receiving their program authorization stamp and final acknowledgment letter. Authorized stores are required to contact the state agency in writing if the store will be unable to meet this program requirement. Failure to begin accepting WIC food instruments within the established time frame may lead to the state agency's withdrawing its authorization decision.
12VAC5-195-290
D. Written correspondence retained in the state agency's centralized files located in Richmond, Virginia, pertaining to, but not limited to, a store's authorization status, application documentation or WIC and food stamps compliance history is confidential and is protected under federal regulations (7 CFR 246.26(e)). The state agency shall maintain stores' compliance history and background information for at least a three-year period or the contract period, whichever is longer. For civil judgments and food stamp administrative documentation issued against a specific authorized retailer, the state agency will retain this documentation for six years.
9. Meet the mandatory minimum stocking requirement at all times and keep such stock in the customer shopping area or immediately available onsite;
10. Be located at the store 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;
11. Be open for business at least 50 hours per week;
12. Meet all business integrity criteria as defined in Policy 14.1, effective August 1, 2003, of the Vendor Manual for the Virginia WIC Program;
13. 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 that not more than 50% of the store's total food sales were derived from WIC sales;
14. Comply with all financial and corrective actions identified from prior WIC authorization, if applicable;
15. Purchase contract and special formula from a distributor, supplier, wholesaler or retail store whose name is listed by the Virginia WIC Program as approved to sell formula; and
16. Participate in the WIC Program's direct deposit (ACH) process used for reimbursement purposes.
A. The state agency shall not authorize any applicant or retail store that is likely to derive 50% or more of its annual food sales from the sale of supplemental foods to WIC participants. Stores 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.
B. Newly authorized stores with six months of redemption history shall have their status reviewed to determine if they qualify as an above 50% vendor (7 CFR 246.12(g)(4)(i)(B)). If the state agency's assessment determines the store qualifies as an above 50% vendor, the store's WIC Program authorization status shall be terminated.
A. The retailer agreement does not constitute a license or a property right. If an authorized store wishes to continue to be authorized beyond the current agreement period, the store must reapply for authorization. All stores must be selected under the current selection and authorization criteria being used by the state agency (7 CFR 246.12(h)(xxi)).
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 notice from the state agency should federal, state laws or regulations require amendments.
12VAC5-195-330
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(g)(2)). The state agency has the sole authority to define adequate participant access criteria.
B. The state agency collects pricing information for specific food items at least twice a year (7 CFR 246.12(g)(4)(ii)(B)). Prices may be collected more frequently from authorized stores including, but not limited to, the following reasons:
4. An administrative review is being conducted as part of a compliance investigation, participant access analysis, inventory audit or post payment analysis; or
5. Other operational considerations that may occur including, but not limited to, a change in contract formula company, food industry price fluctuations, manufacturer's price increases for "rebateable" products, such as contract formula and infant cereal.
C. Applicants whose prices are determined to be noncompetitive when compared with other authorized stores assigned to 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.
D. 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(g)(4)(ii)(A)). Each authorized store or applicant is assigned to a single peer group.
(0  100 participants)
(101  250 participants)
E. For newly authorized stores the peer group designation assigned during the first three months is determined by the first criterion only; specifically the store's BEA default location. 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.
A. Authorized stores 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 remain valid for at least a 30-day period and are subject to random onsite verification by the state agency. Posted prices that are significantly above what was submitted to the state agency may affect the store's or applicant's authorization selection status.
B. A store or applicant's submitted price shall be compared by the state agency to other authorized stores assigned to the same peer group in order to determine if the prices submitted are competitive. Prices shall be submitted and validated as competitive for specific food items and formulas eligible for payment to the authorized store location.
C. Authorized stores and applicants shall have a pricing point value that is 40 or higher in order to remain eligible for program authorization.
Peer Group Pricing Average, plus 5.1  9.9%
Peer Group Pricing Average, plus 10.0 or higher
D. Authorized stores whose prices are identified as noncompetitive when compared with other authorized stores assigned to the same peer group within a BEA may have their WIC Program authorization terminated, unless inadequate participant access would exist.
E. Authorized stores 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 a vendor claim and be subject to repayment of the full amount paid for all of the items prescribed on the food instrument.
12VAC5-195-360
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 BEA to 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(g)(4)).
2. When equal rankings still 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.
3. 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.
4. If rankings continue to be equal, square footage, excluding storage space, will be used to determine which stores will be offered available slots.
After selecting all of the best qualified stores and applicants, if slots are still available, then low volume retailers whose total pricing score is 100  Best Pricing will be offered any available slots.
C. If a retail store or applicant is not competitively selected for program authorization, then the store may apply again no sooner than six months after being denied authorization.
D. The state agency shall send all authorized stores and applicants a written notice pertaining to their selection status. All stores and applicants being denied WIC Program authorization shall also receive information that explains their right to appeal the state agency's administrative decision.
E. The state agency does not maintain an applicant waiting list.
7. Provide supporting documentation that the store's draw area is broader than the store's immediate trade area. The store's draw area includes cities and counties that cross geographical boundaries.
12VAC5-195-380
12VAC5-195-380. Low volume performance standard.
A. A copy of the current Virginia WIC Program's Approved Food List (effective January 1, 2007) must be stored at each cash register where WIC transactions are handled. A copy of the Approved Food List must also be stored in the Vendor Manual that shall be kept onsite at the authorized store location.
B. The Approved Food List is used in conjunction with the WIC food instrument to identify foods that are eligible for purchase by WIC participants. The food instrument may state specific manufacturers or brands that must be purchased by program participants that are not covered by the general description used in the Approved Food List.
12VAC5-195-400. Authorization stamp  assignment and usage.
A. The state agency assigns a unique stamp number to stores that are authorized and eligible to receive reimbursement for deposited food instruments. The store's authorization number is imprinted on a rubber stamp, which shall be used on every food instrument deposited by the authorized store location. Failure by the retail store to use the issued authorization stamp may result in denied payment for redeemed WIC food instruments.
A. Authorized retail stores shall provide the state agency with advance written notice of at least 15 calendar days prior to any change of ownership as outlined in 7 CFR 246.12(h)(3)(xvii).
12VAC5-195-420
A. Authorized WIC retail stores shall provide the state agency written notice of a store'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 the store's program authorization.
C. The state agency shall ensure that the new location still meets the selection criteria as outlined in the Retailer Selection and Authorization Policy (Policy 14.0 of the Virginia WIC Program Retailer Manual, effective April 1, 2008) including being price competitive. Failure to meet all selection criteria may lead to the store's authorization being terminated, unless inadequate participant access exists. Authorized stores 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 new store location.
12VAC5-195-430
12VAC5-195-430. Change due to closure.
A. Authorized retail stores shall give the state agency written notice of a store's permanent or temporary closure within 15 calendar days before the actual closing date. A temporary closure is defined as a store location being closed to the public for more than 15 consecutive calendar days. Stores 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's WIC authorization status.
12VAC5-195-440
12VAC5-195-440. Voluntary withdrawal.
Authorized retail stores shall give the state agency at least 15 calendar days written notice if the store owner or manager decides to discontinue participation in the Virginia WIC Program.
A. The state agency shall maintain a system of receiving, documenting and investigating all complaints submitted by retail stores, participants, proxies, caretakers, parents, and the general public. From submitted complaints, the state agency may sanction or issue a written warning to participants and retail stores that abuse or misuse program benefits as outlined in the State Plan and Vendor Manual (Attachment to Policy 15.0, Sanction Classification System - Violation Schedule, effective May 26, 2008).
12VAC5-195-460
Authorized retail store management shall ensure that no conflict of interest exists between any store personnel employed by the retailer and any local, state, or federal WIC agency. This includes, but may not be limited to, store employees or spouses of store owners who are also employees of a local, state, or federal WIC agency.
12VAC5-195-470
12VAC5-195-470. Incentives.
Authorized stores may not provide incentives to local agency staff or participants to entice or promote shopping at a specific store location, unless approved in writing by the state agency.
12VAC5-195-480
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(a)).
12VAC5-195-490
A. Background and pricing information collected by the state agency related to evaluating the authorization status of a store or collected from food instruments redeemed by an authorized store is confidential (7 CFR 246.26(e)) and can be released only to:
B. Upon receiving a written request from a store or their parent corporation, the state agency shall only release background and pricing information that has been provided by or pertains to the requestor. Under no circumstances will the state agency release confidential information about the authorization status or redemption revenue paid to stores owned by other corporations.
C. Authorized stores' peer group designation is confidential and is restricted from disclosure to persons and entities not directly associated with the authorized store location.
D. The state agency's inadequate participant access results completed for administrative purposes are considered confidential and not subject to review by the retail store or its agent, since this profile contains information protected by WIC Program regulations. Upon request, a copy of this work document can be released with any confidential information removed. This document in its entirety will 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
Authorized retail stores shall ensure that no sales tax is charged to the WIC Program. Store 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.
12VAC5-195-510
E. All authorized stores are required to have at least one store representative participate in annual training provided by either the state agency or a certified corporate trainer (7 CFR 246.12(h)(xi)).
12VAC5-195-530
A. Authorized stores shall post a "WIC Accepted Here" window decal in the store's front entrance or in a conspicuously visible location that identifies to the general public that the store location participates in the WIC Program. Authorized stores may use alternative signage if approved by the state agency prior to being used.
B. Retail stores, food manufacturers, distributors and suppliers shall receive written approval from the state agency prior to producing or distributing window decals, channel strips or shelf talkers that use either the WIC acronym or logo.
C. Retail stores 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 the store is registered or in the name under which it does business, if different.
D. Retail stores, food manufacturers, distributors and suppliers shall not use the WIC acronym or logo in the packaging of their products. Retail stores, 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.
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.
A. The state agency classifies each authorized store as either high risk, probationary, or nonhigh risk. In accordance with federal regulations (7 CFR 246.12(j)(3)), high risk stores have demonstrated from prior authorization history a pattern of noncompliance with documented vendor management policies or violations documented from covert, undercover buys. The state agency may also change a store's designation to high risk based upon noncompliance documented from onsite monitoring visits.
The state agency may select stores for compliance monitoring based on statistical trends documented from a retail store's redemption pattern. A store's designation being changed to high risk will only occur as result of documented violations identified from compliance investigations or other types of objective monitoring practices used by the state agency.
B. Authorized stores designated as high risk will be selected for more frequent onsite and covert monitoring investigations.
12VAC5-195-560. Nonhigh risk stores.
Authorized stores 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 risk stores.
12VAC5-195-570. Probationary stores.
Newly authorized stores with less than one year of continuous program authorization shall be designated a probationary retailer. During a probationary store'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.
2. Number of paid and rejected food instruments;
3. Prices charged for WIC-approved foods and formula;
4. Level of compliance in following program requirements; and
5. Use of approved wholesalers and suppliers in purchasing WIC-approved foods and formulas.
F. State agency personnel may conduct an unannounced monitoring visit to ensure that authorized stores or applicants meet all program requirements. Authorized stores and applicants shall have available onsite the minimum stocking requirement at all times as established by the state agency. The specific foods, contract formulas and administrative procedures associated with meeting this requirement are outlined in Policy 10, Minimum Stocking Requirement, effective May 1, 2007, of the Vendor Manual.
G. Authorized stores with more than one year of continuous participation in the program may request in writing to the state agency that an exception be granted for one or more items that are part of the minimum stocking requirement. The state agency shall provide a written decision to the store's exception request within 30 calendar days after receipt. The exception to the minimum stocking requirement for a required item shall expire upon the presentation to the store, on behalf of a participant, of a WIC food instrument for the purchase of that required food item. The authorized store shall provide the food item within 48 hours after presentation of the WIC food instrument.
L. Each federal fiscal year, a sample of authorized stores shall be selected for one or more announced onsite formula monitoring visits. The state agency shall ensure that authorized stores purchase and sell WIC-approved formulas from a legitimate source. This outcome is accomplished by state agency personnel reviewing formula purchasing records and invoices, comparing formula redemption data from WIC sales and completing a pre- and postphysical inventory of formula available at the store location during a specific analysis period. Stores 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 visit are documented and a written assessment is sent to the store once the state agency has completed its analysis.
E. Food instruments or IRDs rejected for payment or undeposited FIs that require WIC Program review and exception payment consideration must be submitted by the authorized store to the state agency within 30 calendar days of the last date printed on the food instrument.
F. A maximum allowable reimbursement amount for each peer group and food item combination is established using pricing data (7 CFR 246.12(h)(3)(viii)). 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 stores 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. A maximum reimbursement amount will be established for cash value food instruments used by participants to purchase fruits and vegetables. The retailer must allow participants to spend up to the maximum payable amount printed on each of these types of food instruments. If the total dollar value being purchased exceeds the cash value, then the participant must be allowed to pay up to $ .99 per food instrument above the printed value.
H. 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 stores prior to being used by the banking contractor.
I. Food instruments or IRDs that are ineligible for payment and are rejected will be returned to the store's depository bank by the state agency's banking contractor. These returned food instruments will be stamped with a descriptive error message.
J. The state agency may make payment exceptions for food instruments that would normally be denied payment by its banking services contractor. The authorized store shall submit all such requests in writing 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.
K. 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(k)(1)-(3)). From the postpayment review process, the state agency may determine that one or more payments already made to a retail store were noncompliant with the vendor management policies and procedures (Policy 9.0, Reimbursement of Paid and Returned WIC Food Instruments, effective May 26, 2008, of the Vendor Manual), including the signed retailer agreement. The state agency reserves the right to bill and recoup payments of these ineligible payments, which will be referred to as a vendor claim (7 CFR 246.12(h)(3)(ix)). The state agency shall not bill an authorized store if the vendor claim amount is less than $10.
L. A retail store 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.
A. Each federal fiscal year, the state agency shall conduct compliance investigations on a minimum of 5.0% of authorized stores (7 CFR 246.12(j)(4)), including completing investigations of all high risk stores, all probationary stores and selective nonhigh risk stores. The state agency will conduct at least two compliance buys at each store selected for an investigation.
$100 fine assessed per documented incident, including repeat incidents of the same violation, plus a written warning sent to the store.
Eight or more technical program violations within a consecutive 12-month period of time; or
One-year disqualification, if a pattern of noncompliance is required and met. Otherwise, a $100 technical fine per incident shall be assessed for all federally mandated violations that do not meet the pattern threshold requirement.
Three documented incidents during a single investigation  Three-year disqualification.
Six-year disqualification  only one documented incident is required.
H. All documented overcharges or payments for ineligible food items identified during a compliance investigation will be considered a vendor claim and be subject to repayment.
I. Copies of any investigative evidence collected by the state agency from an open compliance investigation will be available to the authorized store, upon request, once the investigation has been closed and the store is notified in writing of the final compliance investigation results.
12VAC5-195-610
A. Prior to taking disqualification actions against an authorized store, the state agency shall complete a participant access assessment (7 CFR 246.12(l)(ix)). This type of assessment is completed for denied authorizations if an informal settlement meeting or full administrative review is requested by a store applicant. Participant convenience is not a valid consideration for the state agencies in making any adequate access decisions.
12VAC5-195-620
12VAC5-195-620. Participant impact.
Participant impact may be an additional factor considered by the state agency in deciding if a store shall be assessed a civil monetary penalty in lieu of disqualification. For stores 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
B. The state agency shall notify the authorized store in writing if it will be retained in lieu of disqualification and the civil monetary penalty fine that has been assessed (7 CFR 246.12(l)(x)).
A. A civil monetary penalty (CMP) fine may be assessed for documented state agency and federally mandated violations (7 CFR 246.12(l)(x)).
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(l)(2). The state agency is unable to make any reductions in the maximum CMP amount due since this formula is defined in federal regulations.
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 will process all past due obligations for any of the following including penalty fines, vendor claims, civil monetary penalty fines or overcharges assessed against authorized stores in accordance with the Office of the Comptroller's Policies and Procedures. Section Number 205000 (Accounts Receivable), dated June 2004. The state agency will 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).
12VAC5-195-650
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 use voluntary withdrawal or nonrenewal for state agency sanctions only.
B. The state agency shall disqualify an authorized store 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 from the compliance investigation process;
3. Reciprocal administrative action due to the store being disqualified from the Food Stamp Program (FSP);
4. Failure to pay a CMP or vendor claim within 30 calendar days after being assessed;
5. Provision of false, incomplete, inaccurate or misleading information that affects the store'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 stamp office of any WIC Program disqualifications and termination actions taken against an authorized store location.
D. Authorized stores that are being disqualified due primarily to documented overcharges that have participated in a full administrative review and the adjudication officer's findings confirm that the disqualification actions being taken by the state agency are appropriate, then a fine will be assessed. A maximum 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 fine will be assessed.
12VAC5-195-660
A. An informal settlement meeting may be requested by an authorized store or applicant. Authorized stores may request an informal settlement meeting for any adverse action or program decision impacting a store. A store applicant may request an informal settlement meeting related to a denied authorization decision. During this meeting, the state agency will be represented by the state WIC director or designee.
B. The retail store or applicant has 15 calendar days from the date of receipt of the denial notice or adverse action 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 manager.
F. If the retail store 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. This outcome means that the retail store has forfeited its rights to the informal settlement meeting.
H. Informal settlement meetings are primarily held in Richmond, Virginia. A store may request that the informal settlement meeting be held using videoconferencing technology. This option will be available to the store if traveling to Richmond will create an undue hardship on the owner or store representative. Undue hardship is defined as travel distance greater than a three-hour drive one way or any other situation determined at the discretion of the state WIC director or designee. The authorized store or applicant would be required to travel to a local agency that has videoconferencing equipment available.
I. After the informal settlement meeting is held, the state agency shall send within 15 days a written summary of the meeting's results to a designated store representative. If the resolution offered from the informal settlement meeting is unacceptable to the retail store, then the retail store or applicant may request a full administrative review in writing. This written request must be submitted to the vendor manager within 15 calendar days from the date of receipt of the informal settlement meeting summary. The vendor manager will identify if the store's request qualifies under federal regulations for a full administrative review. If the store's request is not eligible, then the store will receive a written response from the vendor manager of this decision.
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, within 90 calendar days of the date of receipt of the full administrative appeal review request.
M. In accordance with 7 CFR 246.18(b)(2), if an authorized store 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.
O. The state agency shall provide a full administrative review to retail stores or applicants for the following adverse actions pursuant to 7 CFR 246.18(a)(1)(i) and (ii):
1. Denial of authorization based on the vendor selection criteria for competitive price or for minimum variety and quantity of authorized supplemental foods (7 CFR 246.12(g)(3)(i) and (ii)) or on a determination that the vendor is attempting to circumvent a sanction (7 CFR 246.12(g)(4));
2. Denial of authorization based upon the vendor selection criteria for business integrity or for a current Food Stamp Program disqualification or civil money penalty for hardship (7 CFR 246.12(g)(3)(iii) and (iv);
4. Denial of authorization based on the state agency's retailer limiting criteria (7 CFR 246.12(g)(2));
5. Denial of authorization because a vendor submitted its application outside the timeframes during which applications are accepted or processed as established by the state agency under 7 CFR 246.12(g)(7);
6. Termination of a retailer agreement because of a change in ownership or location or cessation of operations (7 CFR 246.12(h)(3)(xvii));
9. Disqualification based on a trafficking conviction (7 CFR 246.12(l)(1)(i));
10. Disqualification based on the imposition of a Food Stamp Program civil montary penalty for hardship (7 CFR 246.12(l)(2)(ii));
11. 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(l)(2)(iii)); or
P. The state agency shall not provide a full administrative review to retail stores that appeal the following actions pursuant to 7 CFR 246.18(a)(1)(iii):
1. The validity or appropriateness of the state agency's vendor limiting or selection criteria (7 CFR 246.12(g)(2) and (3));
4. The state agency's determination whether a vendor had an effective policy and program in effect to prevent trafficking and that the ownership of the vendor was not aware of, did not approve of, and was not involved in the conduct of the violation (7 CFR 246.12(l)(1)(i)(B));
7. Disputes regarding food instrument payments and vendor claims other than the opportunity to justify or correct a vendor overcharge or other error as permitted by 7 CFR 246.12(k)(3); or
8. Disqualification of a vendor as a result of disqualification from the Food Stamp Program (7 CFR 246.12(l)(1)(vii)).
12VAC5-195-680:2
Virginia WIC Program Retailer Manual (Vendor Manual), Department of Health:
Attachment to Policy 15.0, Sanction Classification System  Violation Schedule, effective May 26, 2008.
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.