1. 2015 Record Review Training-Formula Approval Kevin Sarb
Risk Rule Revisions
Kevin Sarb
October 2015

2. 2015 Record Review Training-Formula Approval
Risk Revisions
The following criteria were revised as part of the routine cyclical review process by USDA and will be implemented with the May 18, 2016 Release.
201 Low Hematocrit/Low Hemoglobin
211 Elevated Blood Lead Levels
332 Short Interpregnancy Interval (formerly Closely Spaced Pregnancy)
361 Depression
381 Oral Health Conditions (formerly Dental Problems)
I am happy to share with you the following risk criteria were revised as part of the routine cyclical review process by USDA and will be implemented with the May 18, 2016 Release.
201 Low Hematocrit/Low Hemoglobin
211 Elevated Blood Lead Levels
332 Short Interpregnancy Interval (formerly Closely Spaced Pregnancy)
361 Depression
381 Oral Health Conditions (formerly Dental Problems)
October 2015

3. Risk Revisions (continued)
2015 Record Review Training-Formula Approval
Risk Revisions (continued)
411 Inappropriate Nutrition Practices for Infants
425 Inappropriate Nutrition Practices for Children
601 Breastfeeding Mother of Infant at Nutritional Risk
602 Breastfeeding Complications or Potential Complications
411 Inappropriate Nutrition Practices for Infants
425 Inappropriate Nutrition Practices for Children
601 Breastfeeding Mother of Infant at Nutritional Risk
602 Breastfeeding Complications or Potential Complications
October 2015

4. 201 Low Hematocrit/Low Hemoglobin
2015 Record Review Training-Formula Approval
201 Low Hematocrit/Low Hemoglobin
Priority level for NPP women corrected
Table 201-C was added (previously omitted)
Risk Help document has been revised.
The priority level for non-breastfeeding women was corrected to reflect the apropriate priority levels. Table 201-C was created and included, having been previously omitted. No other revisions were made to this risk.
October 2015

5. 211 Elevated Blood Lead Levels
2015 Record Review Training-Formula Approval
211 Elevated Blood Lead Levels
Definition revised to reflect the current reference value published in guidance from the CDC.
Risk generated when blood levels are ≥ 5 µg/dl (previously ≥ 10 µg/dl) for all categories.
Updated Risk Help
The Definition is revised to reflect the current reference value published in guidance from the CDC. Risk generated when blood levels are ≥ 5 µg/dl. for all categories. Previously ≥ 10 µg/dl generated this risk. Although this risk revision is timely, USDA updated this risk independently of current events based on CDC guidance. Risk Help docs will reflect this change.
October 2015

6. 332 Short Interpregnancy Interval (formerly Closely Spaced Pregnancy)
2015 Record Review Training-Formula Approval
332 Short Interpregnancy Interval (formerly Closely Spaced Pregnancy)
Definition cut-off revised
reflects a more recent review of data
increased risks for adverse outcomes
Interpregnancy interval of < 18 months (540 days).
The cut-off was previously 16 months (480 days).
The Definition cut-off is revised to reflect a more recent review of data indicating increased risks for adverse perinatal and maternal outcomes with and interpregnancy interval of less than 18 months (540 days). The cut-off was previously 16 months (480 days).
October 2015

7. 2015 Record Review Training-Formula Approval
361 Depression
This risk has been should no longer be assigned to the “Children” category.
Depression removed from the Medical Conditions pop-up list
Guidance developed
clarify WIC’s role
increase WIC staff awareness and knowledge
Risk Help updated with revisions and new guidance
This risk has been removed and should no longer be assigned to the “Children” category. Guidance for Screening and Referring Women with or At Risk for Depression: Guidance was developed to accompany risk #361 Depression, to clarify WIC’s role and to increase WIC staff awareness and knowledge in assisting participants diagnosed with or at risk for depression. All sections of the risk help have been revised and updated. New guidance has been added.
October 2015

8. 381 Oral Health Conditions (formerly Dental Problems)
2015 Record Review Training-Formula Approval
381 Oral Health Conditions (formerly Dental Problems)
Title revised to more accurately reflect the conditions included in this criterion.
MI-WIC and Risk Help revised and updated.
The title of this risk was revised to more accurately reflect the conditions included in this criterion. MI-WIC and Risk Help revised and updated.
October 2015

9. 411 Inappropriate Nutrition Practices for Infants
2015 Record Review Training-Formula Approval
411 Inappropriate Nutrition Practices for Infants
Only section revised
Length of time human milk can be safely stored in the refrigerator has been deleted as a risk criterion.
lack of consensus (AAP, ABM) regarding how long human milk can be safely stored in the refrigerator
not possible to set a clear cut-off
MI-WIC and Risk Help Docs have been updated
MI-WIC Nutrition History screen has been revised:
Only section (inappropriate sanitation in the preparation, handling and storage of expressed human milk or formula) of the risk write-up is revised and updated. Of note, a threshold for the amount of time human milk can be safely stored in the refrigerator has been deleted as a risk criterion. There is a lack of consensus among professional entities (e.g., American Academy of Pediatrics and Academy of Breastfeeding Medicine) about the length of time human milk can be safely stored in the refrigerator. Thus, it is not possible at this time to set a clear cut-off to determine WIC nutrition risk. Please see the Justification section of this criterion for more information. MI-WIC Nutrition History screen has been revised for breast fed infants. If the mother expresses breast milk, ask her how she stores the milk. Provide guidance if there is any food safety concern.
October 2015

10. 425 Inappropriate Nutrition Practices for Children
2015 Record Review Training-Formula Approval
425 Inappropriate Nutrition Practices for Children
revised
Final Rule allows for assignment of reduced-fat milk for C1 (12-23 months)
Inadequately fortified milk substitutes
Risk Help and MI-WIC Nutrition History screen have been revised:
Only section (routinely feeding inappropriate beverages as the primary milk source) is revised to be consistent with the March 2014 WIC Regulations Final Rule. Revisions in the WIC food packages which allows the option to issue reduced-fat milk to children months for whom overweight or obesity is a concern, the medical provider has recommended reduced-fat milk, or have a family history of obesity, dyslipidemia or cardiovascular disease. Risk Help docs and MI-WIC screens and have been revised. I also wanted to share with you that we have revised the wording for inadequately fortified milk substitutes. There have been instances where CPAs incorrectly check this box for children assigned a soy milk package, which then assigns this risk. WIC authorized soy milks are fortified to the same level as cow’s milk. I
October 2015

11. 601 Breastfeeding Mother of Infant at Nutritional Risk
2015 Record Review Training-Formula Approval
601 Breastfeeding Mother of Infant at Nutritional Risk
Pregnant women added as an allowable category for assignment of this risk.
October 2015

12. 602 Breastfeeding Complications or Potential Complications
2015 Record Review Training-Formula Approval
602 Breastfeeding Complications or Potential Complications
Pregnant women added as an allowable category for assignment of this risk.
October 2015