Sec. 204. Special supplemental nutrition program for women, infants, and children
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Section 17 of the Child Nutrition Act of 1966 ( 42 U.S.C. 1786 ) is amended— in subsection (a), in the second sentence, by striking breastfeeding promotion and inserting breastfeeding counseling, promotion, ; in subsection (b)(14), by striking the paragraph designation and all that follows through means those foods and inserting the following: The term supplemental food means any food ; in subsection (d)— in paragraph (2)— in subparagraph (B)— in the matter preceding clause (i), by striking may choose to and inserting shall ; in clause (i)(II), by striking and at the end; in clause (ii)— by striking section 405 of title 37 and inserting section 475 of title 37 ; and by striking the period at the end and inserting ; and ; and by adding at the end the following: any basic allowance for subsistence provided under section 402 of title 37, United States Code, to a member of a uniformed service. ; and by adding at the end the following:
For the purpose of determining income eligibility under this section, a State agency shall exclude from income any child support payment for an applicant who is legally obligated to pay child support for any noncustodial child, as determined by the Secretary. ; and in paragraph (3)— in subparagraph (A)— in clause (iii)— by striking A State and inserting the following: A State ; and by adding at the end the following: A State may elect to certify participant children who have had their fifth birthday but have not yet attained their sixth birthday, during a period that ends on the earlier of— the sixth birthday of the children; or when the children attend full day kindergarten.
Each State that elects to certify children under item
(aa)shall— ensure that participant children receive required health and nutrition assessments; and establish a system to determine when a participant child attends full day kindergarten. ; and by adding at the end the following: A State may elect to certify infants for a period of not more than 2 years, subject to the conditions that— the State shall ensure that the participant infants receive all required health and nutrition assessments; and the local agency shall have at least 1 contact with each certified household every 12 months to confirm income eligibility. ; and by adding at the end the following: The Secretary, in consultation with an interagency work group established by the Office of Management and Budget, and taking into consideration State government perspectives, shall designate data exchange standards to govern, under this Act— necessary categories of information that State agencies in a State operating related programs are required under applicable law to electronically exchange with another State agency; and Federal reporting and data exchange required under applicable law. The data exchange standards required by clause
(i)shall, to the maximum extent practicable— incorporate a widely accepted, nonproprietary, searchable, computer-readable format; contain interoperable standards developed and maintained by intergovernmental partnerships, such as the National Information Exchange Model; incorporate interoperable standards developed and maintained by Federal entities with authority regarding contracting and financial assistance; be consistent with, and implement, applicable accounting principles; be implemented in a manner that— is cost-effective; and improves program efficiency and effectiveness; and be capable of being continually upgraded as necessary. Nothing in this subparagraph requires any change to an existing data exchange standard for Federal reporting that is determined to be effective and efficient. Not later than 2 years after the date of enactment of this subparagraph, the Secretary shall issue a proposed rule to implement this subparagraph. The proposed rule under this clause shall— identify all federally required data exchanges; include specification and timing for the exchanges to be standardized; address the factors used in determining whether and when to standardize data exchanges; specify State implementation options; and describe future milestones. ; in subsection (e)— by striking the subsection designation and all that follows through The State agency shall in the first sentence of paragraph
(1)and inserting the following: A State agency shall ; in paragraph
(1)(as amended by subparagraph (A)), by adding at the end the following: The State agency, in conjunction with the Food and Drug Administration, shall ensure that all participants in the program receiving infant formula under this section (including parents or caretakers of infant participants in the program) are provided education regarding proper disposal of unused or excess infant formula purchased with WIC food instruments. The education under this subparagraph shall include information regarding— the safety hazards of purchasing infant formula outside normal commercial channels; and the penalties associated with the gifting, trading, sale, or resale of infant formula or other supplemental foods purchased with WIC food instruments, in accordance with subsection (o). ; and by striking paragraph
(3)and inserting the following: The Secretary, after submitting proposed nutrition education materials to the Secretary of Health and Human Services for comment, shall issue the materials for use in the program under this section. A State agency may allow the local agencies or clinics operating under the State agency to share nutrition educational materials with institutions participating in the child and adult care food program established under section 17 of the Richard B. Russell National School Lunch Act ( 42 U.S.C. 1766 ) at no cost to that program, if a written materials-sharing agreement exists between the relevant agencies. ; in subsection (f)— by striking (f)(1)(A) Each State agency and all that follows through the end of paragraph (1)(A) and inserting the following: Each State agency shall submit to the Secretary a plan of operation and administration of the program authorized under this section. Each State agency shall submit— an initial plan not later than such date as is specified by the Secretary; and a subsequent plan every 3 years thereafter or whenever the State agency seeks approval of a substantive change to the plan. ; in paragraph (1)— in subparagraph (B), by striking plan submitted for and inserting plan submitted covering ; and in subparagraph (C)— in clause (x), by striking and at the end; by redesignating clause
(xi)as clause (xiii); and by inserting after clause
(x)the following: a plan to allow for the substitution of products approved for redemption with benefits in times of emergency and disaster; a plan detailing the methods to be used by all local agencies to ensure compliance with subsection (d)(2); and ; in paragraph (5)— by striking
(5)State and local and inserting the following: State and local ; and by adding at the end the following: The Secretary shall periodically review State and local agency compliance with the approved plan of operation and administration of the applicable State. ; in paragraph (10)— by striking
(10)The Secretary and inserting the following: The Secretary ; and by adding at the end the following: If a State agency determines there is a need to temporarily halt approving new vendors to address deficiencies or changes in program administration, the State agency shall notify the Secretary not later than 45 days prior to the implementation date. Notification under clause
(i)shall include— a justification for the moratorium; a timeframe under which the moratorium will be issued, including any renewal or lifting of the moratorium; a process to approve vendors needed for participant access (as defined by the State agency) to supplemental foods. ; and in paragraph (11)— in subparagraph (C)(ii), by striking and cultural eating patterns and inserting cultural eating patterns, commercial availability, and participant demand ; and by adding at the end the following: In adjusting cash value vouchers annually for food cost inflation in the food package under this paragraph, the Secretary shall round to the nearest dollar increment. ; in subsection (g)(1)(A), by striking 2015 and inserting 2020 ; in subsection (h)— in paragraph (8)(A)— in clause (vi)— by striking Effective beginning and inserting the following: Effective beginning ; and by adding at the end the following: Effective beginning on the date of enactment of this subclause, a State agency that has fully implemented electronic benefits transfer systems throughout the State shall have in effect a system to ensure that infant formula rebate invoices, under competitive bidding, provide an actual count of the number of units sold to participants in the program under this section. ; and by adding at the end the following: The contracts awarded under clause
(iii)shall specify that— if the income eligibility limit under title XIX of the Social Security Act ( 42 U.S.C. 1396 et seq. ) for pregnant women or infants is increased, which the Secretary determines will increase the demand for infant formula under the contract by a substantial amount, as determined by the Secretary, the contractor may terminate the existing contract effective on the later of— the date that is 1 year after the date on which the State decision to increase the eligibility limit by amending the State plan is made by— adopting State legislation; issuing a State executive order or administrative rule; or any other applicable State process, as determined by the Secretary; and the first day of the month during which the increase takes effect; and if a contractor elects to terminate a contract pursuant to subclause (I), the contractor shall notify the State agency by not later than the date that is 1 year before the proposed date of termination. ; in paragraph (9)— in subparagraph (B)— in clause (i)— in subclause (I), by striking and at the end; and by adding at the end the following: limit the total term of any contract (including any extension or renewal period) to a maximum of 5 years, and require that any additional extensions shall be approved only on mutual consent of the contractor and the State agency; agree to provide, by not later than 180 days before exercising any termination for convenience clause, a written notice to each contractor; agree— to receive an annual audit of infant formula rebate invoices by a contractor; and to provide to each contractor accurate monthly redemption files; and agree, in evaluating bids, not to provide any State preference based on the connection the bidder has to a State; ; in clause (iii), by striking and at the end; in clause (iv)— by striking 30 and inserting 45 ; and by striking the period at the end and inserting a semicolon; by redesignating clauses
(iii)and
(iv)as clauses
(iv)and (v), respectively; by inserting after clause
(ii)the following: for any State agency that has fully implemented electronic benefits transfer systems throughout the State, have a system to ensure that rebate invoices under competitive bidding provide an actual count of the number of units sold to participants in the program under this section; ; and by adding at the end the following: provide an opportunity to negotiate the amount of funds to be returned to the contractor by the State agency, and the method of return, on determining and verifying that rebates were paid on any food, including infant formula, sold under fraudulent means; open bids and enter into a contract under paragraph (8)(A)(iii) only after making a reasonable effort to confirm in writing, via email or other means, that the manufacturers on the list the State agency maintains under paragraph (8)(A)(ix) received the initial request for proposals or other bid solicitation document by not later than the date that is 45 days before the date on which the bids are due; agree to provide to contractors supporting documentation for monthly invoices, subject to the participant and vendor confidentiality protections under program rules; and not later than the date that is 90 days after the date for opening bids, submit to the Secretary a copy of the bid solicitation and any other contract documents. ; and by adding at the end the following: Before any State agency enters into a contract for infant fruits, vegetables, or meat under a competitive bidding system, the State agency shall— consider— the impact of the contract on— participation or redemption rates; costs to the State agency for infant fruits, vegetables, or meat, including product, administrative, and procurement costs; and the ability of the State agency— to achieve the purpose described in subsection (a); to provide infants with a variety of developmentally appropriate infant fruits, vegetables, or meat; and to serve the nutritional needs of program participants; whether the contract is compatible with— the management information and food instrument system of the State agency; and the capacity of the manufacturer to meet technical specifications; and provide to the Secretary a written explanation of how the considerations described in clause
(i)affected the decision of the State agency to enter into the contract. ; in paragraph (10)(A), by striking 2015 and inserting 2020 ; by striking paragraph
(11)and inserting the following: The State agency shall— establish a vendor peer group system; in accordance with clauses
(ii)and (iii), establish competitive price criteria and allowable reimbursement levels for each vendor peer group; and if the State agency elects to authorize any types of vendors described in clause (iv)(II)(aa)— distinguish between vendors described in clause (iv)(II)(aa) and other vendors by establishing separate peer groups for vendors described in clause (iv)(II)(aa) or by establishing distinct competitive price criteria and allowable reimbursement levels for vendors described in clause (iv)(II)(aa) within a peer group that contains both vendors described in clause (iv)(II)(aa) and other vendors; and establish competitive price criteria and allowable reimbursement levels that comply with clauses
(ii)and (iii), respectively, and that do not result in higher food costs if program participants redeem supplemental food vouchers at vendors described in clause (iv)(II)(aa) rather than at vendors other than vendors described in clause (iv)(II)(aa). The Secretary may exempt from the requirements of subclause (I)— a State agency that elects not to authorize any types of vendors described in clause (iv)(II)(aa) and that demonstrates to the Secretary that— compliance with subclause
(I)would be inconsistent with efficient and effective operation of the program administered by the State under this section; or an alternative cost-containment system would be as effective as a vendor peer group system; or a State agency— in which the sale of supplemental foods that are obtained with food instruments from vendors described in clause (iv)(II)(aa) constituted less than 5 percent of total sales of supplemental foods that were obtained with food instruments in the State in the year preceding a year in which the exemption is effective; and that demonstrates to the Secretary that an alternative cost-containment system would be as effective as the vendor peer group system and would not result in higher food costs if program participants redeem supplemental food vouchers at vendors described in clause (iv)(II)(aa) rather than at vendors other than vendors described in clause (iv)(II)(aa). The State agency shall establish competitive price criteria for each peer group for the selection of vendors for participation in the program that— ensure that the retail prices charged by vendor applicants for the program are competitive with the prices charged by other vendors; and consider— the shelf prices of the vendor for all buyers; or the prices that the vendor bid for supplemental foods, which shall not exceed the shelf prices of the vendor for all buyers. In establishing competitive price criteria, the State agency shall consider participant access by geographical area. The State agency shall establish procedures to ensure that a retail store selected for participation in the program does not, subsequent to selection, increase prices to levels that would make the store ineligible for selection to participate in the program. The State agency shall establish allowable reimbursement levels for supplemental foods for each vendor peer group that ensure that— payments to vendors in the vendor peer group reflect competitive retail prices; and the State agency does not reimburse a vendor for supplemental foods at a level that would make the vendor ineligible for authorization under the criteria established under clause (ii). The allowable reimbursement levels may include a factor to reflect fluctuations in wholesale prices. In establishing allowable reimbursement levels, the State agency shall consider participant access in a geographical area. The State agency may exempt from competitive price criteria and allowable reimbursement levels established under this subparagraph— pharmacy vendors that supply only exempt infant formula or medical foods that are eligible under the program; and vendors— for which more than 50 percent of the annual revenue of the vendor from the sale of food items consists of revenue from the sale of supplemental foods that are obtained with food instruments; or who are new applicants likely to meet the criteria of subitem
(AA)under criteria approved by the Secretary; and that are nonprofit. If a State agency elects to authorize any types of vendors described in clause (iv)(II)(aa), the State agency shall demonstrate to the Secretary, and the Secretary shall certify, that the competitive price criteria and allowable reimbursement levels established under this paragraph for vendors described in clause (iv)(II)(aa) do not result in average payments per voucher to vendors described in clause (iv)(II)(aa) that are higher than average payments per voucher to comparable vendors other than vendors described in clause (iv)(II)(aa). Effective on the date that is 120 days after the date of enactment of this subclause, in calculating the allowable reimbursement levels established under this paragraph for vendors described in clause (iv)(II)(aa), a State agency that does not use electronic benefit transfer shall exclude food instruments not fully redeemed, based on a calculation of the minimum full redemption value for each food instrument type or food item, by individual vendor. Nothing in this paragraph creates a private right of action. Nothing in this subparagraph compels a State agency to achieve lower food costs if program participants redeem supplemental food vouchers at vendors described in clause (iv)(II)(aa) rather than at vendors other than vendors described in clause (iv)(II)(aa). A State agency shall comply with this subparagraph not later than 18 months after the date of enactment of this clause. Not later than 180 days after the date of enactment of the Improving Child Nutrition Integrity and Access Act of 2016 , the Secretary shall review the current processes used by State agencies to approve vendors for the program authorized under this section. In conducting the review described in subclause (I), the Secretary shall examine ways to reduce duplication in site visit requirements and application paperwork while preserving the unique aspects of vendor participation in the program authorized under this section. Not later than 180 days after completing the review described in subclause (I), the Secretary shall update regulations as necessary to revise the current application process— to coordinate vendor authorization, where applicable, for the program authorized under this section and the supplemental nutrition assistance program authorized under the Food and Nutrition Act of 2008 ( 7 U.S.C. 2011 et seq. ); and to consolidate, to the maximum extent practicable— applications to reduce duplicative reporting of information; and on-site review requirements. Subject to subclause (II), each State agency shall establish a requirement that, prior to authorization or reauthorization for purposes of the program authorized under this section, a vendor shall be an authorized retailer under the supplemental nutrition assistance program under the Food and Nutrition Act of 2008 ( 7 U.S.C. 2011 et seq. ). A State agency shall have discretion regarding whether subclause
(I)shall apply to a vendor described in subparagraph (A)(iv)(II)(aa)(AA) that sells only WIC-eligible foods (as defined by the State agency). A State agency shall permit a vendor to apply simultaneously for approval to participate in the program authorized under this section and the supplemental nutrition assistance program authorized under the Food and Nutrition Act of 2008 ( 7 U.S.C. 2011 et seq. ). ; in paragraph (12)— in subparagraph (A)(i), by striking food delivery system that provides and inserting method to deliver ; and by adding at the end the following: As State agencies transition to electronic benefit transfer for the program, the Secretary shall update regulations to account for the fact that State agencies— are receiving transaction pricing more frequently than twice a year from vendors; and should adjust vendor reimbursement levels more frequently to reflect program food price changes in the marketplace. There is authorized to be appropriated to carry out this paragraph $25,000,000 for each of fiscal years 2016 through 2020. The Secretary shall allocate the funds made available under this subparagraph to States for purposes of enhancing and accelerating the implementation of electronic benefit transfer systems. For any State agency that fails to comply with subparagraph (B), including a State agency receiving an exemption under subparagraph (C), the Secretary shall— withhold such amounts otherwise required to be allocated to the State agency for nutrition services and administration as the Secretary determines to be appropriate; and direct the amounts withheld for use by the State agency solely for achieving compliance with subparagraph (B). ; and in paragraph (13), by adding at the end the following: The Secretary shall make available on request the national universal product code database information to vendors approved for participation in the special supplemental food program established under this section. ; by striking subsection (k); by redesignating subsections ( l ) through
(q)as subsections
(k)through (p), respectively; in subsection ( l )(9)(A) (as so redesignated), by striking 2015 and inserting 2020 ; in subsection
(o)(as so redesignated)— in paragraphs
(1)and (2)(B), by striking subsection (o)(1)(A) each place it appears and inserting subsection (n)(1)(A) ; in paragraph (5)— in subparagraph (C), by striking and at the end; in subparagraph (D), by striking the period at the end and inserting ; and ; and by adding at the end the following: fifth, to reimburse any WIC infant formula manufacturer for any rebate provided to the State agency on WIC infant formula unlawfully trafficked under a provision of law described in paragraph (2), subject to the condition that the funds are recovered by the State. ; and by adding at the end the following: For any investigation into the trafficking of WIC infant formula pursuant to this subsection, to the maximum extent practicable, the Secretary shall provide notice of resolution of the disposition of an unlawful action resulting from the investigation to all contracted manufacturers of the trafficked infant formula. Not later than 90 days after the date on which notice is provided under subparagraph (A), the State shall submit to the contracted manufacturer an estimate of— the number of units, if any, for which rebates may have been issued as a result of the violation; and the total dollar amount of the rebates. ; and by adding at the end the following: The Secretary shall encourage any advisory council or board operated by a State agency to include adequate representation of all appropriate program stakeholders, including— vendors approved for participation in the special supplemental food program established under this section; program beneficiaries; community representatives; and representatives of organizations intended to reduce hunger and improve the health and well-being of program participants. The Secretary shall encourage the meetings of an advisory council or board described in paragraph
(1)to provide for— participation by means other than in-person; and public availability or dissemination of a description of— the activities of the advisory council or board; the proceedings of the advisory council or board; and the meeting minutes of the advisory council or board. Not later than 180 days after the date of enactment of this subsection, the Secretary shall review current guidance, regulations, and practices regarding fraud and safety for purposes of this section. The review under paragraph
(1)shall include a review of issues relating to— excess and unused infant formula; invoices pertaining to products subject to rebate; the sale of infant formula by unauthorized entities; and the purchase of infant formula from unauthorized entities. Based on the findings of the review under paragraph (1), the Secretary shall update current regulations and guidance and issue additional regulations and guidance, as necessary— to minimize fraud; and to ensure the safety of participants. Notwithstanding any other provision of law, State agencies and law enforcement agencies shall share WIC vendor information relating to investigations or prosecutions under the program under this section, as determined by the Secretary. Subject to paragraph (2), the Secretary may conduct pilot projects to test alternative certification, food delivery procedures, service delivery methods, and mechanisms for providing additional food assistance under this section. In conducting pilot projects under paragraph (1), the Secretary may not waive or modify the application of program eligibility, supplemental foods, or cost containment requirements. The Secretary shall evaluate each pilot project carried out under this subsection after the pilot project has been in operation for 3 years. . In this subsection: The term adjunctively eligible , with respect to an individual, means an individual who is eligible for WIC under section 17(d)(2)(A)(iii) of the Child Nutrition Act of 1966 ( 42 U.S.C. 1786(d)(2)(A)(iii) . The term Comptroller General means the Comptroller General of the United States. The term Medicaid means the Medicaid program under title XIX of the Social Security Act ( 42 U.S.C. 1396 et seq. ). The term poverty line means the most recent annual Federal Poverty Income Guidelines published by the Department of Health and Human Services. The term WIC means the special supplemental nutrition program for women, infants, and children established by section 17 of the Child Nutrition Act of 1966 ( 42 U.S.C. 1786 ). The Comptroller General shall conduct a study to examine the impact of adjunctive eligibility on WIC participation, including the administrative burden, number of participants in WIC, and other impacts on the participants. In conducting the study described in paragraph (2), the Comptroller General shall examine the extent to which individuals certified as adjunctively eligible to receive supplemental foods and services through WIC have incomes above 185 percent of the poverty line. The Comptroller General shall collect data to determine— the total number of pregnant women, postpartum women, breastfeeding women, infants, and children participating in WIC; an estimate of the share of individuals described in subclause
(I)who are certified as adjunctively eligible; and an estimate of the share of individuals described in subclause
(II)for whom income (for purposes of Medicaid eligibility) is above 185 percent of the poverty line, above 250 percent of the poverty line, above 300 percent of the poverty line, and above any other demarcation thresholds as determined by the Comptroller General. The Comptroller General shall collect the information described in clause
(i)from— for subclause
(I)and
(II)of that clause, WIC program data; and for subclause
(III)of that clause, a review of the income of a representative sample of WIC participants (for purposes of Medicaid eligibility) at the time of WIC certification. The estimate developed under clause (i)(III) shall be based on data collected in selected States in which the income eligibility limit for infants under 1 year of age for Medicaid is at or above 185 percent of the poverty line. Following collection of the data described in paragraph (3), the Comptroller General shall assess the feasibility, benefits, and costs of requiring that WIC use an automated process to document that only applicants with income below a specified threshold may be certified as adjunctively eligible based solely on Medicaid receipt. The assessment described in subparagraph
(A)shall include an evaluation of the capacity of the management information systems for both WIC and Medicaid, including the ability of the systems to exchange data. The Comptroller General shall assess— which State agencies and tribal organizations operating WIC use management information systems with the capacity, via an automated process, for local WIC clinics to document— income as a share of the poverty level for purposes of Medicaid eligibility; or Medicaid enrollment and income below a specified level; the steps necessary to prepare all local WIC clinics to obtain and to access that income information as a part of the WIC application process as well as part of the associated costs of modifying WIC automated systems and training staff; and other information determined relevant by the Comptroller General, such as the impact of the identified steps on administrative costs, clinical services, and waiting times for appointments. The Comptroller General shall assess— whether the mechanized claims processing and information retrieval systems of States under section 1903(a)(3)(A)(i) of the Social Security Act ( 42 U.S.C. 1396b(a)(3)(A)(i) ) have the capacity to provide, at the time of WIC certification and via an automated process, data to an agency or tribal organization operating WIC regarding— income as a share of the poverty level for purposes of Medicaid eligibility; or whether a Medicaid recipient has income below a specified level; the steps necessary to ensure that mechanized claims processing and information retrieval systems in States for which the income eligibility limit for infants under 1 year of age under Medicaid is above 185 percent of the poverty line have the capacity to provide the information described in clause
(i)to local WIC clinics for the purpose of documenting adjunctive eligibility under an option that would limit that eligibility to individuals with income below a specific threshold; and other information determined relevant by the Comptroller General and the Secretary of Health and Human Services, including the impact of the identified steps on administrative costs. Not later than 3 years after the date of enactment of this Act, the Comptroller General shall submit to the Committee on Education and the Workforce of the House of Representatives and the Committee on Agriculture, Nutrition, and Forestry of the Senate a report describing— the data collected under paragraph (3); the assessments made under paragraph (4); and the feasibility, costs, benefits, and effects on participants of a new requirement that would only permit adjunctive eligibility for individuals with household income below a specified level.
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Sec. 204
Special supplemental nutrition program for women, infants, and children
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