[Federal Register Volume 63, Number 223 (Thursday, November 19, 1998)]
[Proposed Rules]
[Pages 64211-64215]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 98-30917]
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Proposed Rules
Federal Register
________________________________________________________________________
This section of the FEDERAL REGISTER contains notices to the public of
the proposed issuance of rules and regulations. The purpose of these
notices is to give interested persons an opportunity to participate in
the rule making prior to the adoption of the final rules.
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Federal Register / Vol. 63, No. 223 / Thursday, November 19, 1998 /
Proposed Rules
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DEPARTMENT OF AGRICULTURE
Food and Nutrition Service
7 CFR Part 246
RIN 0584-AC30
Special Supplemental Nutrition Program for Women, Infants, and
Children (WIC): Bloodwork Requirements
AGENCY: Food and Nutrition Service, USDA.
ACTION: Proposed rule.
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SUMMARY: This proposed rule would amend regulations governing the
Special Supplemental Nutrition Program for Women, Infants, and Children
(WIC) to provide that hematological tests for anemia no longer be a
mandatory part of each WIC applicant's certification intake process, so
long as at least one nutrition risk factor is present for the
applicant. This proposed rule would allow the State agency the
discretion to obtain such tests at certification or within 90 days of
the date of certification. Such tests would be used for the purposes of
assessing nutritional status, providing nutrition education, further
tailoring food packages to meet nutritional needs, and referring to
appropriate health and social services in the community. The proposed
revisions to current WIC Program regulations will accommodate a
changing health care environment; facilitate improved coordination with
other health programs serving WIC applicants; minimize potentially
repetitive, costly, and invasive blood testing procedures; reduce
inconvenience to applicants, and expedite services to needy individuals
applying for WIC Program benefits.
DATES: To be assured of consideration, comments must be postmarked on
or before January 19, 1999.
ADDRESSES: Comments should be sent to Ronald J. Vogel, Acting Director,
Supplemental Food Programs Division, Food and Nutrition Service, USDA,
3101 Park Center Drive, Room 540, Alexandria, Virginia 22302, (703)
305-2730. All written comments will be available for public inspection
during regular business hours (8:30 a.m. to 5 p.m., Monday through
Friday) at the above-noted address.
FOR FURTHER INFORMATION CONTACT: Barbara Hallman at (703) 305-2730
during regular business hours (8:30 a.m. to 5 p.m.) Monday through
Friday.
SUPPLEMENTARY INFORMATION:
Executive Order 12866
This rule has been determined to be not significant for purposes of
Executive Order 12866 and, therefore, has not been reviewed by the
Office of Management and Budget.
Regulatory Flexibility Act
This rule has been reviewed with regard to the requirements of the
Regulatory Flexibility Act (5 U.S.C. 601-612). Pursuant to that review,
Samuel Chambers, Jr., Acting Administrator of the Food and Nutrition
Service, has certified that this rule will not have a significant
impact on a substantial number of small entities. State and local
agencies and participants would be most affected by this proposed rule.
This proposal would provide State and local agencies with increased
flexibility in meeting certification requirements for the Program.
Participants and applicants would also be affected by changes in the
certification process which should result in expedited receipt of
program services.
Paperwork Reduction Act
This proposed rule imposes no new reporting or recordkeeping
requirements which are subject to review by the Office of Management
and Budget (OMB) in accordance with the Paperwork Reduction Act of
1995.
Executive Order 12372
The Special Supplemental Nutrition Program for Women, Infants and
Children (WIC) is listed in the Catalog of Federal Domestic Assistance
Programs under No. 10.557. For reasons set forth in the final rule in 7
CFR part 3015, subpart V, and related notice (48 FR 29115), this
program is included in the scope of Executive Order 12372 which
requires intergovernmental consultation with State and local officials.
Executive Order 12998
This proposed rule has been reviewed under Executive Order 12998,
Civil Justice Reform. This rule is intended to have preemptive effect
with respect to any State or local laws, regulations or policies which
conflict with its provisions or which would otherwise impede its full
implementation. This rule is not intended to have retroactive effect
unless so specified in the EFFECTIVE DATE paragraph of this preamble.
Prior to any judicial challenge to the application of the provisions of
this rule, all applicable administrative procedures must be exhausted.
Public Law 104-4
Title II of the Unfunded Mandates Reform Act of 1995 (UMRA), Pub.
L. 104-4, establishes requirements for Federal agencies to assess the
effects of their regulatory actions on State, local and tribal
governments and the private sector. Under section 202 of the UMRA, the
Food and Nutrition Service generally must prepare a written statement,
including a cost-benefit analysis, for proposed and final rules with
``Federal mandates'' that may result in expenditures to State, local or
tribal governments, in the aggregate, or the private sector, of $100
million or more in any one year. When such a statement is required
under section 202 of the UMRA, section 205 generally requires the Food
and Nutrition Service to identify and consider a reasonable number of
regulatory alternatives and adopt the least costly, most cost-effective
or least burdensome alternative that achieves the objective of the
rule.
This rule contains no Federal mandates (under the regulatory
provisions of Title II of the UMRA) for State, local and tribal
governments or the private sector of $100 million or more in any one
year. Thus, this rule is not subject to the requirements of sections
202 and 205 of the UMRA.
Background
The Department reassesses WIC Program regulations and operations on
an ongoing basis to ensure the continuing efficiency and effectiveness
of the program. The subject of blood testing requirements has
repeatedly been identified as warranting consideration for change based
on frequent expressions of concern from the WIC community, including
health
[[Page 64212]]
and medical officials at both the State and local levels. Numerous
concerns have been brought to the Department's attention on the WIC
Program's current blood test requirements, which may have the
consequences of delaying enrollment of WIC applicants, duplicating
effort, and creating unnecessary administrative expense, and hardship
to applicants.
Three specific concerns regarding changes in the delivery and
operation of health care also compel the Department's reassessment of
the blood testing requirements. First, WIC blood tests coincide with
WIC certification periods, thus, the schedule of blood tests required
at WIC certification does not generally correspond with State, local,
and generally accepted periodicity schedules and guidelines. The
Department has been informed that many health programs, as cost
containment measures, are commonly limiting blood test screening to a
specified minimum seen as medically necessary, consistent with State,
local, and generally accepted guidelines and other auxiliary health
programs such as lead poisoning prevention programs or Early and
Periodic, Screening, Diagnosis and Treatment programs. Health care
providers have expressed concerns to the Department that the WIC
Program's certification schedule, of which blood testing is a mandatory
part, is creating a barrier to public health care coordination by
artificially dictating periodicity for hematological testing, rather
than conforming to standard clinical practice used by the State and
local health care system.
Second, the move towards managed care programs as the primary
source of health care has affected the ability of WIC local agencies to
obtain blood test referral data in a timeframe that coincides with WIC
certification periods. The source of health care for WIC participants
and others has been shifting in many States from local health
department clinics, many of which collected bloodwork to meet WIC's
needs on site at the WIC clinic, to managed care settings in which
blood tests are performed off site from the WIC clinic and thus
provided to WIC on a referral basis.
Third, bloodwork data obtained from referral sources is becoming
more frequently the norm in WIC because of Federal, State and local
policies limiting blood handling only to persons or laboratories with
specified medical credentials, thereby precluding some WIC local
agencies from collecting or analyzing blood samples.
The Proposal
In response to these major concerns, the Department is proposing
changes in the timing of anemia tests, extending the age of the data
that may be used, clarifying allowable costs for anemia tests, and
making corresponding changes to State Plan requirements.
These topics are discussed in greater detail below.
1. Hematological Tests for Anemia (Sec. 246.7 (e), (e)(1), and (e)(1)
(i)-(ii))
Given the logistical difficulties of current bloodwork requirements
described above, the Department is proposing that hematological tests
for anemia no longer be a mandatory part of each WIC applicant's
certification intake process as long as at least one nutrition risk
factor is present for the applicant. However, given the importance of
anemia testing in the target population and WIC's long and successful
track record in reducing national rates of anemia, this rule proposes
to require such a test but would permit its completion within 90 days
of the date of certification, except as noted for infants as discussed
later in this preamble. The test data would be used for the critical
purposes of appropriately assessing an applicant's nutritional status,
providing nutrition education, tailoring food packages and referring to
health care or social services. Although the Department considers the
collection of blood test data at certification as optimal to assist
with performing the most timely and complete nutrition assessment and
providing appropriate nutrition education and referrals, this proposal
addresses the practical realities faced by State agencies by providing
flexibility to obtain this data up to 90 days after the certification
intake process. State agencies would, however, be required to provide
for blood tests at certification for income eligible applicants with no
other documented risk conditions (with the exception of presumptively
eligible pregnant women as discussed below) in order to determine if
they are at nutritional risk due to anemia.
2. Timing of Hematological Tests (Sec. 246.7 (e), (e)(1), and (e)(1)
(i)-(ii))
Age of Bloodwork Data
The Department has received comments from State agencies that the
allowable age for bloodwork data limits local agency flexibility to
coordinate with other health care programs. To address the concerns
with the age of bloodwork data, this proposed rulemaking would expand
the current regulatory standard from 60 days to 90 days as the maximum
age of bloodwork data used to assess nutritional risk. The proposed 90-
day limit should allow additional flexibility to coordinate referral
data with other health care programs, yet at the same time assure that
the data accurately represent the applicant's health status. This
rulemaking would assist in assuring this by continuing to require that
such data are reflective of the categorical nutritional status/risk of
women applicants. Thus, for a pregnant woman the test must be conducted
during pregnancy, and for a breastfeeding or a postpartum woman the
test must be conducted after the termination of their pregnancy.
The categorical restrictions do not apply to infants and children.
As such, State agencies may use bloodwork data obtained from an infant
to certify a child applicant, provided such data is not more than 90
days old. For example, bloodwork data obtained when the infant was 10
months old may be used to certify a 13-month old child.
Timing of Bloodwork
This proposed rule is intended to allow sufficient flexibility to
States to accommodate generally accepted recommendations of maternal
and child health and medical experts. In April 1998, the Centers for
Disease Control and Prevention (CDC) issued a document titled,
``Recommendations to Prevent and Control Iron Deficiency in the United
States.'' These recommendations are intended to guide primary health
care providers in preventing and controlling iron deficiency in
infants, preschool children, and women of childbearing age,
particularly pregnant women--populations served by the WIC Program
which are at high risk for iron-deficiency anemia. As such, the CDC
recommendations stipulate that blood test results should be obtained at
the earliest opportunity during pregnancy, from 4 to 6 weeks after
delivery for postpartum and breastfeeding women, between 9 and 12
months of age for infants, and 6 months later (15-18 months) and
annually from ages 2 to 5 years for children. This rule would provide
States with the flexibility to conform to these recommendations to
better assure that WIC staff have blood test data reflecting current
status at appropriate times during the certification period yet provide
that WIC participants receive timely nutrition care and referral during
their certification periods.
For pregnant, breastfeeding, and postpartum women, a hematological
test for anemia must be performed at
[[Page 64213]]
certification or within 90 days of the date of certification. The test
may be from a referral source or may be conducted by WIC. The referral
data may be up to 90 days old, so long as it is reflective of women
applicants' categories, meaning the test must have been taken for
pregnant women during pregnancy and for postpartum or breastfeeding
women following termination of pregnancy.
Regarding pregnant women, current regulations at
Sec. 246.7(e)(1)(iii), which reflect WIC legislation, provide State
agencies an additional flexibility by allowing them to presume that
income-eligible pregnant women are nutritionally at risk and thus
eligible to participate in the program. Presumptively eligible women
can be certified immediately and can receive program benefits up until
60 days from the date they were certified, by which time a nutrition
assessment must be conducted to establish nutritional risk. If the
subsequent assessment determines that the woman does not meet
nutritional risk criteria, the certification terminates on the date of
the determination, or 60 days after the participant was certified,
whichever is sooner. This proposed rule would eliminate the bloodwork
requirement at certification or within the 60-day presumptive
certification period for these women, further easing burden. However,
under this proposal, if the nutrition assessment performed during the
60-day period does not include anemia testing and does not identify any
other qualifying risk factor, a blood test must be performed or
obtained from referral sources before that 60-day period elapses to
permit continuity of service for women found to be anemic. This
requirement enables such pregnant women to have the temporary
presumptive certification extended to a full certification period
without disruption to continued receipt of WIC benefits, should they be
found anemic.
Consistent with the new CDC recommendations, all infants 9 months
of age or older must have a hematological test for anemia between 9 and
12 months of age. Such test may be performed by the WIC agency or
obtained from referral data. A blood test taken between 6 and 9 months
of age may be used to meet the test requirement, however State agencies
are encouraged to obtain blood test data between 9 and 12 months of age
as recommended by CDC. In addition, recognizing that the CDC guidelines
state that blood tests for anemia for infants under 6 months of age may
be appropriate for preterm infants and low birthweight infants who were
not fed iron-fortified formula, this proposal would permit, but not
require, blood tests for such infants.
The Department also wishes to clarify that in cases where the State
agency has opted to certify infants under 6 months of age up to their
first birthday, as permitted in Sec. 246.7(g)(1)(iv), such infants must
receive a blood test between 9 and 12 months of age. The extension of
the certification period up to the first birthday is only permitted
provided the quality and accessibility of health care services are not
diminished. A blood test for anemia is considered a critical component
of health care services and thus, must be performed or obtained from
referral services. As stated earlier in this preamble, the CDC
recommendations identify the period between 9 and 12 months as the
optimal timeframe for anemia testing for infants. Also considered as a
critical component of health care services during the one-year period,
is securing current length and weight measurements in order to assess
the infant's growth.
State agencies that certify infants at 6 month intervals must
ensure that infants 9 months of age or older receive a blood test. A
blood test taken at 6 months of age may be used to meet the infant
blood test requirement, because such data would fall within the 90-day
age of bloodwork data timeframe.
For children, current provisions at Section 246.7(e)(1) allow State
and local agency discretion to waive the blood test for children who
were determined to be within the normal range at their last
certification period, provided that such test is performed at least
once every 12 months. The new CDC guidelines recommend a blood test
between 9 and 12 months of age, 6 months thereafter (around 15 to 18
months of age), and annually thereafter for each year from ages 2 to 5
years of age. Thus, this rule proposes that State agencies perform a
blood test between 12 and 24 months of age to permit them full
flexibility to accommodate arrangements for bloodwork for these
children within the CDC recommended 6-month timeframe following their
infant bloodwork. While for most children, this would fall between 15
and 18 months of age, this proposal would expand the allowable
timeframe to accommodate practical logistical difficulties and
circumstances where, for example, there was no previous bloodwork
during infancy, it was taken during infancy at a time other than the
recommended 9 to 12 month period, or other logistical complications
which made bloodwork during the optimal 15 to 18 month period
infeasible. Nevertheless, because pediatric health authorities
generally recommend that children have a blood test during the most
vulnerable period of 15 to 18 months, when anemia is more likely to
become manifest, State agencies are expected to make every effort to
coordinate the scheduling of bloodwork for children between 12 and 24
months old within the recommended 15 to 18 month timeframe.
As for women, the referral bloodwork data allowed to be used to
certify children and infants can be up to 90 days old. However,
although bloodwork data obtained when an infant was between 9 and 12
months old may be used to certify a 12-month old child, such data
cannot be used to fulfill the blood test that is required between 12
and 24 months of age nor can it be used to waive a blood test. Children
who had an inadequate iron intake during infancy are at greatest risk
of developing anemia between 12 and 24 months of age. Thus, it is
critical that children receive a blood test for anemia during the
period of 12-24 months of age. As such, the current provision at
Sec. 245.7(e) has been modified to state that for children ages two and
older who were determined to be within the normal range at their last
certification, the blood test may be waived, provided that a blood test
is performed at least once every 12 months.
Other Nutrition Assessment Data
The Department again emphasizes that this proposal provides for
flexibility only in the timing of the collection and age of anemia
blood test data: If not completed at certification (using current data,
or data up to 90 days old), it must be completed within 90 days of
certification except as noted for infants as discussed earlier in this
preamble. All other nutrition assessment data, e.g., height and weight,
and dietary and medical assessment data, must be collected as currently
required; namely: It must be collected at certification for
breastfeeding and postpartum women, infants and children, and, for
pregnant women unless the State agency has opted to implement
presumptive eligibility for pregnant women. State agencies implementing
presumptive eligibility must still collect height, weight and dietary
and medical assessment data for pregnant women within 60 days of
certification to determine eligibility. The Department considers the
effort at certification to measure and record height or length and
weight and collect dietary and other medical data for all applicants to
be minimal but necessary during the intake process, and not subject to
the difficulties related to bloodwork
[[Page 64214]]
assessment. These timely measurements and data are fundamental to the
assessment of nutritional risk of all categories of applicants.
3. Allowable Costs for Anemia Tests (Sec. 246.14(c)(2) (i)-(iv))
Current WIC Program regulations (Sec. 246.14(c)(2) (i)-(iv))
stipulate that fees, equipment, salary and other costs associated with
the collection of hematological data to test for anemia for
certification purposes are allowable Program costs. This proposed rule
would specify that collection of hematological data is not only for
certification purposes, but also for health assessment and monitoring
purposes. This proposal would also allow State agencies to perform one
additional hematological test as medically necessary in follow-up to a
finding of anemia within a certification period. The Department
proposes changes in Sec. 246.14(c)(2) and (c)(2) (i)-(iv) to clarify
that this follow-up test for nutrition assessment purposes is an
allowable WIC cost when deemed necessary for health monitoring as
determined by the WIC competent professional authority (CPA).
While this rule would permit WIC to pay for one follow-up test,
State agencies are encouraged to weigh the cost effectiveness of WIC
expenditures for such purposes against other competing and critical WIC
needs. The Department generally believes that follow up monitoring of
blood values of persons with anemia is largely the responsibility of
health care providers, and should be treated as a medical, rather than
solely a nutritional, concern. As such, the Department encourages State
agencies to explore other locally available sources for ongoing health
care and assessments for WIC participants with anemia.
4. State Plan (Sec. 246.4(a)(11)(i))
State agencies must incorporate their blood test data requirements
and timeframes in detail in the ``Certification Procedures'' section of
their State Plan Procedure Manual.
Appropriate procedures that must be followed when blood test data
are obtained include: (1) Make notations in the participant's file with
respect to nutrition risk factors listed and priority as appropriate;
(2) inform the woman or parent/guardian of the outcome and meaning of
the blood test if the results show anemia; (3) provide follow-up
nutrition education, if appropriate; (4) make adjustments in the food
package, as appropriate; and (5) make referrals to health care or
social services, as appropriate.
List of Subjects in 7 CFR Part 246
Administrative practice and procedure, Civil rights, Food
assistance programs, Food and Nutrition Service, Food donations, Grant
programs-health, Grant programs--social programs, Indians, Infants and
children, Maternal and child health, Nutrition, Nutrition education,
Penalties, Reporting and recordkeeping requirements, Public assistance
programs, WIC, Women.
For the reasons set forth in the preamble, 7 CFR part 246 is
proposed to be amended as follows:
PART 246--SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS
AND CHILDREN
1. The authority citation for part 246 continues to read as
follows:
Authority: 42 U.S.C. 1786.
2. In Sec. 246.4, paragraph (a)(11)(i) is revised to read as
follows:
Sec. 246.4 State Plan.
(a) * * *
(11) * * *
(i) Certification procedures, including a list of the specific
nutritional risk criteria by priority level which cites conditions and
indices to be used to determine a person's nutritional risk,
hematological data requirements including timeframes for the collection
of such data, the State agency's income guidelines for Program
eligibility, and any adjustments to the participant priority system
made pursuant to Sec. 246.7(e)(4) to accommodate high-risk postpartum
women or the addition of Priority VII;
* * * * *
2. In Sec. 246.7:
a. The introductory text of paragraph (e) is revised;
b. The introductory text of paragraph (e)(1) is removed;
c. Paragraphs (e)(1)(i), (e)(1)(ii), (e)(1)(iii), and (e)(1)(iv)
are redesignated as paragraphs (e)(1)(iii), (e)(1)(iv), (e)(1)(v), and
(e)(1)(vi) respectively;
d. New paragraphs (e)(1)(i) and (e)(1)(ii) are added;
e. Newly redesignated paragraphs (e)(1)(iii), (e)(1)(iv) and
(e)(1)(vi) are amended by adding a heading; and
f. Newly redesignated paragraphs (e)(1)(v) is revised.
The revisions and additions read as follows:
Sec. 246.7 Certification of participants.
* * * * *
(e) Nutritional risk. To be certified as eligible for the Program,
applicants who meet the Program's eligibility standards specified in
paragraph (c) of this section must be determined to be at nutritional
risk. A competent professional authority on the staff of the local
agency shall determine if a person is at nutritional risk through a
medical and/or nutritional assessment. This determination may be based
on referral data submitted by a competent professional authority not on
the staff of the local agency. Nutritional risk data shall be
documented in the participant's file and shall be used to assess an
applicant's nutritional status and risk, tailor the food package to
address nutritional needs, design appropriate nutrition education, and
make referrals to health and social services for follow-up, as
necessary and appropriate. Except as stated in paragraph (e)(1)(v) of
this section, at least one nutritional risk must be documented at the
time of certification in order for an income eligible applicant to
receive WIC benefits.
(1) Determination of nutritional risk.--(i) Required nutritional
risk data. At a minimum, height or length and weight shall be measured
and documented in the applicant's file at the time of certification. In
addition, a hematological test for anemia such as a hemoglobin,
hematocrit, or free erythrocyte protoporphyrin test shall be performed
at certification or within 90 days of the date of certification.
However, such hematological tests are not required, but are permitted,
for infants under nine months of age. All infants nine months of age
and older (who have not already had a hematological test performed or
obtained, between the ages of six and nine months, by a competent
professional authority), shall between nine and twelve months of age
have a hematological test performed or obtained from referral sources.
This hematological test does not have to occur within 90 days of the
date of certification. Only one test is required for children between
12 and 24 months of age. At the State or local agency's discretion, the
hematological test is not required for children ages two and older who
were determined to be within the normal range at their last
certification. However, the hematological test shall be performed on
such children at least once every 12 months. Hematological test data
submitted by a competent professional authority not on the staff of the
local agency may be used to establish nutritional risk. Height or
length and weight measurements and, with the exceptions specified in
this paragraph, hematological tests, shall be obtained for all
participants, including those who are determined at nutritional
[[Page 64215]]
risk based solely on the established nutritional risk status of another
person, as provided in paragraphs (e)(1)(iv) and (e)(1)(v) of this
section.
(ii) Timing of nutritional risk data.
(A) Weight and height or length. Weight and height or length shall
be measured for program participation at the time of certification.
(B) Hematological test for anemia. For pregnant, breastfeeding, and
postpartum women, and child applicants, the hematological test for
anemia shall be performed or obtained from referral sources at the time
of certification or within 90 days of the date of certification.
However, a State agency cannot use hematological data obtained from
referral sources that is taken more than 90 days prior to the date of
certification for program participation.
Infants nine months of age and older (who have not already had a
hematological test performed, between six and nine months of age, by a
competent professional authority or obtained from referral sources),
shall between nine and twelve months of age have a hematological test
performed or obtained from referral sources. Such a test may be
performed more than 90 days after the date of certification. For
pregnant women, the hematological test for anemia shall be performed
during their pregnancy. For persons certified as postpartum or
breastfeeding women, the hematological test for anemia shall be
performed after the termination of their pregnancy. The participant or
parent/guardian shall be informed of the test results when there is a
finding of anemia, and notations reflecting the outcome of the tests
shall be made in the participant's file. Nutrition education, food
package tailoring, and referral services shall be provided to the
participant or parent/guardian, as necessary and appropriate.
(iii) Breastfeeding dyads.* * *
(iv) Infants born to WIC mothers or women who were eligible to
participate in WIC. * * *
(v) Presumptive eligibility for pregnant women. A pregnant woman
who meets the income eligibility standards may be considered
presumptively eligible to participate in the program, and may be
certified immediately without an evaluation of nutritional risk for a
period up to 60 days. A nutritional risk evaluation of such woman shall
be completed not later than 60 days after the woman is certified for
participation. A hematological test for anemia is not required to be
performed within the 60-day period unless the nutrition risk evaluation
performed does not identify a risk factor. If no risk factor is
identified, a hematological test for anemia must be performed or
obtained from referral sources before the 60-day period elapses. Under
the subsequent determination process, if the woman does not meet any
nutritional risk criteria, including anemia criteria, the woman shall
be determined ineligible and may not participate in the program for the
reference pregnancy after the date of the determination, unless she
subsequently reapplies for program benefits and is found to be both
income eligible and at nutritional risk. Notification of the
ineligibility determination shall be given in accordance with paragraph
(j)(5) of this section. In addition, if the nutritional risk evaluation
is not completed within the 60-day timeframe, the woman's participation
shall end. As set forth in paragraph (j)(8) of this section,
notification must be given prior to expiration of the certification
period.
(vi) Regression. * * *
* * * * *
3. In Sec. 246.14, paragraph (c)(2) is revised to read as follows:
Sec. 246.14 Program costs.
* * * * *
(c) * * *
(2) The cost of Program certification and nutrition assessment
procedures, including the following:
(i) Laboratory fees incurred for up to two hematological tests for
anemia per individual per certification period conducted to assess
nutritional status and determine whether such individual is at
nutritional risk. The first test shall be to determine anemia status.
The second test may be performed only in follow up to a finding of
anemia when deemed necessary for health monitoring as determined by the
WIC State agency;
(ii) Expendable medical supplies necessary to assess nutritional
status and to determine whether persons are at nutritional risk;
(iii) In connection with nutrition assessment and nutritional risk
determinations, medical equipment used for taking anthropometric
measurements, such as scales, measuring boards, and skin fold calipers;
and for blood analysis to detect anemia, such as spectrophotometers,
hematofluorometers and centrifuges; and
(iv) Salary and other costs for time spent on nutrition assessment
and certification.
* * * * *
Dated: October 2, 1998.
Samuel Chambers, Jr.,
Acting Administrator, Food and Nutrition Service.
[FR Doc. 98-30917 Filed 11-18-98; 8:45 am]
BILLING CODE 3410-30-U
