TITLE 25.HEALTH SERVICES

Part 1. TEXAS DEPARTMENT OF HEALTH

Chapter 1. TEXAS BOARD OF HEALTH

Subchapter U. ASSIGNMENT AND USE OF AGENCY VEHICLE IN THE STATE VEHICLE FLEET MANAGEMENT PLAN

25 TAC §1.401

The Texas Department of Health (department) adopts new §1.401 concerning the assignment and use of agency vehicles in the State Vehicle Fleet Management Plan with changes to the proposed text as published in the April 20, 2001, issue of the Texas Register (26 TexReg 2928).

The rule adopts by reference Texas Government Code, Chapter 2171, Travel and Vehicle Fleet Services, §2171.1045 concerning the assignment and use of agency vehicles in order to comply with §2171.1045 which requires each agency to adopt rules consistent with the management plan adopted under Texas Government Code, §2171.104 relating to the assignment and use of agency vehicles. The rule requires that each agency vehicle, with the exception of a vehicle assigned to a field employee, be assigned to the agency motor pool and be available for checkout. Furthermore an agency may assign a vehicle to an individual administrative or executive employee on a regular or everyday basis only if the agency makes a written documented finding that the assignment is critical to the needs and mission of the agency.

No comments were received on the proposal during the comment period.

The new section is adopted under Health and Safety Code §12.001, which provides the board with the authority to adopt rules for the performance of every duty imposed by law on the board, the department, and the commissioner of health; and the Texas Government Code, Chapter 2171, which mandates the adoption of this rule.

§1.401.The Assignment and Use of Agency Vehicles in the State Vehicle Fleet Management Plan.

The Texas Department of Health (department) adopts by reference the state statute, Texas Government Code, §2171.1045, concerning the assignment and use of agency vehicles.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on July 16, 2001.

TRD-200104059

Susan Steeg

General Counsel

Texas Department of Health

Effective date: August 5, 2001

Proposal publication date: April 20, 2001

For further information, please call: (512) 458-7236


Chapter 31. NUTRITION SERVICES

The Texas Department of Health (department) adopts the repeal of existing §§31.1-31.3 and new §§31.1, 31.11-31.12, and 31.21-31.37, concerning the Register of Mother-Friendly Businesses; the Farmers' Market Nutrition Program; and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Sections 31.1, 31.21, 31.22, 31.23, 31.24, 31.25, 31.31, 31.32, 31.33, 31.34, 31.35, and 31.37 are adopted with changes to the proposed text as published in the February 2, 2001, issue of the Texas Register (26 TexReg 1068). Sections 31.11, 31.12, 31.26, 31.27, 31.28, 31.29, 31.30, and 31.36 are adopted without changes, and therefore the sections will not be republished. The repeals are adopted without change, and therefore the repeals will not be republished.

The United States Department of Agriculture (USDA) provides federal grant funds to the department to administer the WIC and Farmers' Market Nutrition Programs, provided the department does so in accordance with federal regulations. The WIC Program is 100% federally funded while the Farmers' Market Nutrition Program is 70% federally funded according to federal and state enabling legislation.

The repeal of §§31.1-31.3 deletes rules concerning the Register of Mother-Friendly Businesses, the Farmers' Market Nutrition Program, and the adoption by reference of state plans, WIC federal regulations, and the WIC Policy and Procedure Manual. The new sections reestablish the Register of Mother-Friendly Businesses and the Farmers' Market Nutrition Program with no substantive changes. The new sections also reestablish without substantive change 37 WIC policies, currently adopted by reference as part of the WIC Policy and Procedure Manual, that address client, local agency, and vendor eligibility and rights of participation in the program and the authorization of WIC allowable foods. The remaining 183 WIC policies currently adopted by reference as part of the WIC Policy and Procedure Manual will be deleted. The 183 policies will continue to be enforced unchanged through contracts between the department and local agencies and WIC food vendors. Deletion of policies affecting WIC local agencies and contracted WIC food vendors by repeal of §31.1 will eliminate duplicate references to the policies in both department rules and local agencies' contracts. Since the relationship of WIC local agencies and participating food vendors to the department is contractual, the repeal will clarify that local agencies and participating food vendors are subject to sanctions solely as a result of noncompliance with their contracts. Neither federal law nor regulations require the department to adopt WIC policies or procedures by rule after approval by USDA.

The policies deleted by the repeal of §31.1 that will not be adopted in the new sections include the following: Explanation of the Federal Definition of "Health Services," AAP:01.4; Local Agency Financial Management Systems, AC:01.0; Reimbursement of Allowable WIC Expenses, AC:01.1; Plan to Allocate Direct Cost, AC:02.0; Allowable Costs - Personnel Compensation, AC:03.0; Allowable Costs - Personnel Benefits, AC:03.1; Allowable Costs - In-State Travel, AC:03.2; Allowable Costs - Out-of-State Travel, AC:03.3; Allowable Costs - Agency Car, AC: 03.5; Property Management, AC:03.6; Allowable Costs - Equipment, AC:03.7; Allowable Costs - Depreciation of Equipment, AC:03.7.1; Allowable Costs - Outreach, AC:03.9; Allowable Costs - Communication & Utilities, AC:03.10; Allowable Costs - Data Processing, AC:03.11; Allowable Costs - Reproduction Expense, AC: 03.12; Allowable Costs - Printing Expense, AC:03.12.1; Allowable Costs - Space Rental, AC:03.13; Allowable Costs - Facility Depreciation, AC:03.13.1; Allowable Costs - Use Allowance, AC:03.13.2; Allowable Costs - Supplies, AC:03.14; Allowable Costs - Postage and Shipping, AC:03.15; Allowable Costs - Non-Professional Contract Services, AC:03.16; Allowable Costs - Professional Contract Services, AC:03.16.1; Allowable Costs - Peer Counselors, AC:03.16.2; Allowable Costs - Facility Renovation, AC:03.17; Allowable Costs - Expendable Medical Supplies, AC:03.18; Allowable Costs - Indirect Costs, AC:03.19; Allowable Costs - Food Purchases, AC:03.20; Allowable Costs - Insurance Expense, AC:03.21; Allowable Costs - Outreach Incentive Items, AC:03.22; Allowable Costs - Laboratory Coats, AC:03.23; Allowable Costs - Employee Uniforms, AC:03.24; Unallowable Costs, AC:04.0; Monthly Reimbursement Maximum, AC:05.0; Monthly Reimbursement Maximum - Start Up Costs, AC:05.1; Cash Advance Payments, AC:05.2; Surplus Funds, AC:06.0; Financial Reporting, AC:07.0; WISE Cost Report, WIC-227 A, AC:07.7; Program Income, AC:08.0; Program Income - Participant Fees, AC:08.1; Close Out Reports, AC:09.0; Expenditure Records, AC:10.0, Nutrition Education Expenditures, AC:10.1; Breastfeeding Promotion Expenditures, AC:10.2; Lost and Stolen Equipment, AC:11.0; Sale or Disposition of Property, AC:12.0; Procurement Procedure, AC:13.0; Audit of Local Agencies, AUD:01.0; Automation Change Management, AUT:01.0; Computer Environment and Platform Modifications, AUT:02.0; Backups, AUT:03.0; Telephone With Data Communications Capabilities, AUT:04.0; Repair of Computer Equipment, AUT:05.0; Surge Protector Requirement, AUT:06.0; Requests for New or Additional Computers and/or Peripherals, AUT:07.0; Breastfeeding Promotion Standards, BF:01.0; Local Breastfeeding Coordinator, BF:02.0, Breastfeeding Peer Counselor, BF:03.0; Breastfeeding Training, BF:04.0; Participant's Rights and Obligations, CR:01.0; Providing Oral and Written Program Information to Non-English or Limited English Speaking Persons, CR:02.1; Nondiscrimination Statement, CR:02.2; Civil Rights Compliance Reviews, CR:04.0; Civil Rights Complaints, CR:04.1; Processing Civil Rights Violations, CR:05.0, Local Agency Processing of Participant Civil Rights Complaints, CR:06.0; Provision of Service to the Handicapped, CR:07.0; Provision of Services to Families with Special Health Care Needs, CR:07.1; Civil Rights Training, CR:08.0; Collection of Racial/Ethnic Data, CR:09.0; Proof of Pregnancy as a Certification Requirement, CS:01.1.1; Midpoint Screening, CS:01.2.1; Time Frames for Processing Applicants, CS:01.3; Appointment System, CS:01.3.1; Inactivation for Failure to Pick Up Food Vouchers, CS:01.5; Caseload Management, CS:01.7; Waiting List for WIC, CS:01.8; Waiting List Recall, CS:01.8.1; Preventing and Detecting Dual Participation, CS:02.2; Collection and Use of Social Security Numbers, CS:03.6; Completion of the Family Certification Form/Release List, CS:03.7; Participant Priority of Risk, CS:04.0; Documentation of a Complete Nutritional Assessment, CS:04.1; Criteria for Identifying Nutritional Risk Conditions, CS:04.2; Infant Born to High Risk or WIC Mother, CS:04.3; Procedures for Weighing and Measuring, CS:04.4; Measuring Equipment, CS:04.4.1; Weighing Equipment, CS:04.4.2; Determination of Hematocrit or Hemoglobin, CS:04.5; Equipment for Determination of Hemoglobin and Hematocrit, CS:04.5.2; Calibration of Hematocrit and Hemoglobin Equipment, CS:04.5.3; Assessment of Dietary Pattern, CS:04.6; Assessment of Medical History, CS:04.7; Use of Medical Data Taken Prior to the Time Eligibility Is Determined, CS:04.9; Competent Professional Authority, CS:05.1; Competent Professional Authority, CS:05.1.a; Issuance of WIC Family Identification Cards, CS:06.0; Issuance of Duplicate Family Identification Cards, CS:06.1; Issuance of Verification of Certification, CS:06.2; Enrollment of Transferring Participants, CS:07.0; Certification Data Entry Forms, CS:09.1; Completing the Supplemental Information Form, CS:09.2; Completion and Issuance of Food Vouchers, FD:01.0; Frequency of Issuance of WIC Food Vouchers, FD:01.2; Signing of Food Voucher by a Proxy, FD:02.0; Disposition of Voided and Destroyed Food Vouchers, FD:03.0; Replacement of Voided Food Vouchers, FD:03.1; Documenting Missing/Stolen Food Vouchers, FD:04.0; Action To Be Taken When Issued Vouchers Are Reported Lost/Stolen By a Participant, FD:05.0; Liability of Local Agency for Food Voucher Inventory Shortages, FD:06.0; Mailing Food Vouchers, FD:07.0; WIC Food Voucher Supplies, FD:08.0; Transfer of Texas WIN Inventory, FD:09.0; Food Packages, FD:22.0; Tailoring Food Packages to Meet Individual Needs, FD:23.0; Program Benefits for Homeless Individuals and Those Lacking Refrigeration, FD:23.1; Issuance of Contract Formula, FD:24.0; Use of Contract Formula Samples, FD:24.0.1; Issuance of Iron-Fortified Ready-To-Use Formula, FD:24.1; Issuance of Non-Contract Formulas and Medical Nutritional Products, FD:24.2; Issuance of Formula to Children and Women with Special Dietary Needs, FD:24.4; Intolerance to All Authorized Formulas, FD:24.6; Issuance of Dry Beans/Peanut Butter, FD:25.0; Reporting of Participant Abuse, FD:29.0.1; Exchange of Formula Between Issuance Dates, FD:32.0; Exchange of Out-of-State Food Instruments, FD:33.0; Conflict of Interest - Local Agency Officials, FD:36.0; Public Information - General, GA:03.0; Public Information - Policy and Procedure Manual, GA:03.1; Confidentiality of Participant Information, GA:03.2; Confidentiality, GA:04.0; Claims Against Local Agencies, GA:06.0; Disposal of Program Records, GA:07.0; Contracts and Agreements with Local Agencies, GA:08.0; Local Agencies Agreement for the Provision of Health Services, GA:08.1; Local Agency Outreach, GA:09.0; Coordination of Program Operations, GA:09.2; Provision of Information to WIC Applicants, GA:09.2.1; Provision of Food Stamp, AFDC, Medicaid, EPSDT, and Child Support Enforcement Information to WIC Applicants, GA:09.2.2; Local Agency Coordination with Hospitals, GA:09.2.3; Eligibility of Local WIC Employees for WIC Services, GA:10.0; Availability of Health Services to WIC Participants, GA:11.0; Agreements and/or Letters of Endorsement from County Agencies, GA:12.0; Use of State Appropriated Funds, GA:15.0; Access to Appointments, GA:16.0; Follow-Up of Pregnant Applicants, GA:16.1; Designation of a Local Agency WIC Director, GA:17.0; Employee Immunization Requirements, GA:18.0; Compliance with the Clinical Laboratory Improvement Amendment of 1988 (CLIA), GA:19.0; No Smoking in Local Agencies, GA:20.0; Compliance with the National Voter Registration Act of 1993, GA:21.0; Operational Procedures, IM:02.0; Standing Delegation Orders, IM:02.1; Monitoring Storage of Vaccines, IM:05.0, Quality Assurance, IM:06.5; Vaccine Distribution and Accountability, IM:07.1; Vaccine Adverse Event Reporting System, IM:07.2; Immunization Records, IM:09.0; Local Immunization Plan, IM:10.0; Local Agency Self-Audit, MON:01.0; Review of Vendors by Local Agencies, MON:02.0; State Agency Monitoring of Clinical Operations and Fiscal/Food Delivery Systems, MON:03.0; Local Nutrition Education Coordinator, NE:01.0; Nutrition Education Plan, NE:01.1; Mailing Nutrition Education Materials to Participants, NE:01.7; Definition of Nutrition Education Contact, NE:02.0; Standards for Nutrition Education Contacts, NE:02.1; Standards for Group Classes, NE:02.2, Standards for Individual Counseling, NE:02.3; Nutrition Education Lessons, NE:03.0; Documentation of Nutrition Education Attendance or Nonattendance, NE:04.0; Nutrition Education for Advance Issuance, NE:04.2, Categorical Classes, NE:04.3; Nutrition Education Audiovisuals, NE:05.0; Distributed or Loaned Nutrition Education Materials, NE:05.1; Purchase of Foods for Demonstration in Nutrition Education, NE:06.0; Local Outreach Coordinator, OR:01.0; In-Service Orientation to New Local Agencies, TR:01.0; Orientation and Training of Local Agency Directors, TR:01.1; Local Training Coordinator, TR:02.0; and Required Local Agency Clinic and Staff Training, TR:03.0.

The department is making the following minor changes to correct spelling, typographical, and grammatical errors and to clarify the intent and improve the accuracy of the sections.

Change: Concerning §31.1, the department has reassigned administrative responsibility for the register of mother-friendly businesses from the Bureau of Nutrition Services to the Bureau of Women's Health.

Change: Concerning §§31.1, 31.21, 31.22, 31.23, and 31.25, the spelling of "breast-fed" has been changed to "breastfed", and the spelling of "breast-feeding" has been changed to "breastfeeding" to be consistent with the spellings used in federal WIC regulations and policy statements.

Change: Concerning new §31.21(26), a definition of "minor" has been added because the term has been included in §31.24(a) and §31.24(c) to clarify provisions concerning access to immunizations by siblings of WIC applicants and participants. Definitions following new §31.21(26) have been renumbered.

Change: Concerning new §31.21(31), the definition has been amended to clarify that "nutritional risk priorities" are determined based on the participant's eligibility category as well as his or her nutritional risk conditions.

Change: Concerning new §31.21(46), the word "similar" has been added to modify the phrase "monthly WIC sales volume" to clarify that vendors are grouped by a similar volume of WIC dollars redeemed by the vendor, and not by identical monthly sales volume.

Change: Concerning §§31.22(a)(3), 31.22(a)(4), 31.22(a)(5), and 31.22(a)(6), the first word in each paragraph has been capitalized in compliance with Texas Register style requirements.

Change: Concerning §31.22(a)(3)(D)(iii), a comma has been placed within the quotations marks around the word "reimbursement" to correct a typographical error.

Change: Concerning §31.22(a)(3)(D)(vi), the words "Judgment" and "Papago" have been spelled correctly.

Change: Concerning §31.31(b), transposition of the word "plan" has been corrected.

Change: Concerning §31.31(b)(3)(A), a typographical error involving the word "provides" has been corrected.

Change: Concerning §31.31(f), the word "state" has been added to modify "agency" to clarify that the section refers to the department's WIC Director, rather than a local agency or USDA WIC Director.

Change: Concerning §31.32(a), the section has been reworded to clarify its intent.

Change: Concerning §31.32(b)(2), the sentences in the paragraph have been reordered and the phrase "at least one type of" has been deleted to clarify that all vendors are not required to stock "sufficient quantities" of all types of authorized foods.

Change: Concerning new §31.32(b)(2)(C)(i), the reference to "180 ounces of adult cereal, including at least 36 ounces each of oat, corn, wheat, rice, and multi-grain cereals" has been changed to conform to current Program practice, which authorizes "108 ounces of adult cereal, including 36 ounces each of at least three of the following types of cereal: oat, corn, wheat, rice, and multi-grain;".

Change: Concerning §31.33(b)(2), the word "many" has been changed to "may" and the word "valuation" has been changed to "evaluation" to correct typographical errors.

Change: Concerning §31.34(a)(3), the word "account" has been replaced with the word "outlet", and the word "average" has been inserted in the phrase "local agency standard food package costs" to clarify and more accurately reflect current Program procedure.

Change: Concerning proposed §31.37(e)(2)(B), the subparagraph has been deleted because it addresses pricing restrictions for cheese purchased by participants, rather than criteria for authorized foods offered for sale by vendors, which is the subject matter of the section. Sections 31.37(e)(2)(A)(i) - 31.37(e)(2)(A)(iii) have been redesignated as §§31.37(e)(2)(B) - 31.37(e)(2)(D).

The following public comments were received concerning the proposed repeal and new rules. Following each comment is the department's response and any resulting changes.

Comment: Concerning new §31.21(46) and new §31.21(47), one commenter suggested that the definitions of "vendor band" and "vendor competitive pricing" be amended to describe grouping of vendors in bands according to vendor account or outlet volume because outlet volume often represents a more equitable comparison group.

Response: The department agrees and has amended the sections accordingly.

Comment: Concerning §31.22(a)(2)(A)(i), one commenter suggested that an applicant for WIC services should not be able to document his or her residency by presenting a driver's license because federal regulations state that acceptable documentation must include a current address. Since a driver's license may remain valid for several years, the address shown may not be current.

Response: The department agrees and has amended the section accordingly.

Comment: Concerning §31.32(b)(2), one commenter recommended that the specific criteria for determining whether a vendor has sufficient quantities of WIC allowable foods on hand at the time the vendor requests authorization should be deleted and replaced with authorization for the department to exercise its discretion.

Response: Denial of an application for authorization as a WIC vendor because the vendor allegedly did not stock sufficient quantities of WIC allowable foods is subject to appeal by the vendor, and without objective criteria, vendor authorization decisions for similar locations may vary. The specific definitions of "sufficient quantities" for WIC allowable foods included in the section provide clear, unambiguous information to prospective vendors concerning the standards to be applied to the application. No change was made as a result of this comment.

Comment: Concerning §§31.32(e), 31.32(f), 31.35(c)(1), and 31.35(c)(2), one commenter recommended that, in compliance with 7 CFR §246.12(g)(5) concerning the sale of a store to circumvent WIC sanctions, if a new owner acquires a store location or business in the process of being disqualified or that has already been disqualified, the new owner should not be permitted to apply for authorization as a WIC vendor at that location until the department has determined that the sale was a bona fide, arms-length transaction. The commenter added that the department must make such a determination within six months from the date of application by the vendor.

Response: The department agrees and has amended the sections accordingly.

Comment: Concerning §31.33(c)(1)(B), one commenter stated that only vendors who have six-month probationary contracts should be subject to denial of a subsequent contract based on one notice of violation of noncompetitive pricing criteria.

Response: The department agrees and has amended the section accordingly.

Comment: Concerning §31.34(a), one commenter suggested the department add a provision that would allow the department to increase a vendor band average pricing amount when unusual wholesale price increases for a food occur, such as the annual increase in infant formula or when large crop failures occur which might seasonally increase the cost of WIC foods significantly.

Response: The department agrees and has added §31.34(a)(6).

Comment: Concerning §31.34(a)(2), one commenter stated that the department should be able to group vendors into bands based on outlets, which often is more equitable.

Response: The department agrees. The department has deleted the second sentence in the paragraph to permit additional flexibility in assigning vendors to bands.

Comment: Concerning §31.34(a)(5), one commenter recommended using a local agency's average standard food package costs during a prior month, rather than the current month, to assess vendors' competitive pricing. The commenter added that disclosure by the department of average costs for standard food packages in each band in each local agency during a particular month used as the standard would enable vendors to price WIC foods with greater assurance that they will remain in compliance with the competitive pricing criteria.

Response: The department agrees and has amended the section accordingly.

Comment: Concerning §31.34(a), one commenter suggested that the section be amended to allow the department to alter comparison groups in certain limited circumstances. The commenter provided the following examples: (1) Because vendors are grouped on the basis of WIC dollar volume redeemed, certain discount chain store vendors can be grouped with small and medium-size independent vendors if they have the same WIC dollar volume redeemed. The small and medium-size vendors are then evaluated for competitive pricing based on the lower prices of the discount chain stores which are obtained through their large volume purchasing capability. The commenter stated that this practice is unfair. (2) In some rural areas, a vendor may be the only vendor in a town, but the vendor's costs may be higher precisely because of the store's isolated location. If these isolated vendors are removed from the program for noncompetitive pricing, WIC clients may be forced to travel farther to shop and their access to allowable foods may be reduced. The commenter stated that assigning such vendors to an alternate pricing band may benefit both vendors and WIC clients. (3) If only one store in a local agency occupies a pricing band by itself, that store may charge the maximum WIC-allowable price for foods and would always comply with competitive pricing requirements.

Response: The department agrees and has added §31.34(a)(7).

Comment: Concerning §31.37(e)(4)(A)(ii), one commenter recommended including mango-blend juices as an authorized food.

Response: The department has deleted the specific categories of juices currently listed, and has amended the section to permit the WIC program to consider any juice as an authorized food based on cost-effectiveness; and compliance with federal nutritional requirements; packaging requirements; minimum availability requirements; and consumer and cultural acceptability requirements, including suitability for children.

The commenters were the USDA Food and Nutrition Service, Southwest Regional Office, Senator Eddie Lucio, Jr., the Gulf Coast Retailers Association, and one individual. The commenters were not against the rules in their entirety, but made recommendations for change as discussed in the summary of comments.

25 TAC §§31.1 - 31.3

The repeals are adopted under Health and Safety Code, §12.001, which provides the Texas Board of Health (board) with the authority to adopt rules for the performance of every duty imposed by law on the board, the department, and the commissioner of health; Health and Safety Code, §165.003; the Texas Omnibus Hunger Act of 1985, 69th Legislature, Chapter 150, Title II, Human Resources Code, Chapter 33; the Child Nutrition Act of 1966, 42 USC, §1786; 7 CFR Part 246; and 7 CFR Part 248.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on July 16, 2001.

TRD-200104072

Susan Steeg

General Counsel

Texas Department of Health

Effective date: August 5, 2001

Proposal publication date: February 2, 2001

For further information, please call: (512) 458-7236


Chapter 31. NUTRITION SERVICES

Subchapter A. REGISTER OF MOTHER-FRIENDLY BUSINESSES

25 TAC §31.1

The new rule is adopted under Health and Safety Code, §12.001, which provides the Texas Board of Health (board) with the authority to adopt rules for the performance of every duty imposed by law on the board, the department, and the commissioner of health; Health and Safety Code, §165.003; the Texas Omnibus Hunger Act of 1985, 69th Legislature, Chapter 150, Title II, Human Resources Code, Chapter 33; the Child Nutrition Act of 1966, 42 USC, §1786; 7 CFR Part 246; and 7 CFR Part 248.

§31.1.Register of Mother-Friendly Businesses.

(a) Definitions. The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise.

(1) Mother-friendly business - A business that actively promotes and supports breastfeeding by its employees.

(2) Department - Texas Department of Health

(b) Minimum standards. To be considered mother-friendly, a business must:

(1) adhere to the definition of a mother-friendly business;

(2) provide work schedule flexibility to allow employees time for either expressing breast milk or breastfeeding;

(3) provide employees access to a private area for either expressing breast milk or breastfeeding;

(4) provide access to a sink; and

(5) provide access to a hygienic place to store expressed breast milk.

(c) Application for designation as a mother-friendly business. To apply for designation as a mother-friendly business, a business must:

(1) complete a mother-friendly application. Applications are available from the Bureau of Women's Health, Texas Department of Health, 1100 West 49th Street, Austin, Texas 78756 and should be completed by the contact person for mother-friendly activities. Completed applications should be returned to the department's Bureau of Women's Health; and

(2) submit completed applications for review. Completed applications will be reviewed by the staff of the Bureau of Women's Health for compliance with the minimum standards set forth in subsection (b) of this section. Businesses that meet the standards will receive a letter signed by the Commissioner of Health and a certificate suitable for framing and display. Businesses that do not meet the standards will be notified by letter and will be offered technical assistance to achieve compliance.

(d) Maintaining designated status. A business designated as mother-friendly must:

(1) be listed as such by the department. The list of mother-friendly businesses will be maintained by the staff of the department's Bureau of Women's Health. The department will make the list available for public inspection;

(2) keep the staff of the Bureau of Women's Health informed of any changes in the company's mother-friendly policies. If its mother-friendly policies change, a business must submit an amended application; and

(3) comply with minimum standards at all times. If a business does not comply with the program's minimum standards at all times, the department may suspend or revoke the mother-friendly designation. A business may amend its nonconforming policies and may reapply for the mother-friendly designation. Employees and clients should direct complaints about the activities of a business that employs the mother-friendly designation to the department's Bureau of Women's Health.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on July 16, 2001.

TRD-200104073

Susan Steeg

General Counsel

Texas Department of Health

Effective date: August 5, 2001

Proposal publication date: February 2, 2001

For further information, please call: (512) 458-7236


Subchapter B. FARMERS' MARKET NUTRITION PROGRAM

25 TAC §31.11, §31.12

The new rules are adopted under Health and Safety Code, §12.001, which provides the Texas Board of Health (board) with the authority to adopt rules for the performance of every duty imposed by law on the board, the department, and the commissioner of health; Health and Safety Code, §165.003; the Texas Omnibus Hunger Act of 1985, 69th Legislature, Chapter 150, Title II, Human Resources Code, Chapter 33; the Child Nutrition Act of 1966, 42 USC, §1786; 7 CFR Part 246; and 7 CFR Part 248.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on July 16, 2001.

TRD-200104074

Susan Steeg

General Counsel

Texas Department of Health

Effective date: August 5, 2001

Proposal publication date: February 2, 2001

For further information, please call: (512) 458-7236


Subchapter C. SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS, AND CHILDREN (WIC)

25 TAC §§31.21 - 31.37

The new rules are adopted under Health and Safety Code, §12.001, which provides the Texas Board of Health (board) with the authority to adopt rules for the performance of every duty imposed by law on the board, the department, and the commissioner of health; Health and Safety Code, §165.003; the Texas Omnibus Hunger Act of 1985, 69th Legislature, Chapter 150, Title II, Human Resources Code, Chapter 33; the Child Nutrition Act of 1966, 42 USC, §1786; 7 CFR Part 246; and 7 CFR Part 248.

§31.21.Definitions.

The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise.

(1) Adjunctively income eligible -- A determination that an applicant meets the income eligibility requirements by virtue of being able to document his or her eligibility for another program.

(2) Applicant -- A pregnant, breastfeeding or postpartum woman; infant; or child who is applying to receive WIC Program benefits and includes individuals who are subsequently applying after the expiration of a certification period.

(3) Arms-length transaction -- A good faith business transaction between parties, each acting voluntarily in his own self-interest, without necessary advantage to the other in a manner consistent with prevailing business practice.

(4) Breastfeeding -- The practice of feeding a mother's breastmilk to an infant on the average of at least once a day.

(5) Breastfeeding woman -- A woman up to one year postpartum who is breastfeeding.

(6) Caretaker -- An individual age 18 years or older who is related to and has custodial responsibility for a WIC Program participant during the majority of a participant's time awake each day.

(7) Categorical eligibility -- Eligibility for WIC Program benefits based on a person's status as a pregnant woman, breastfeeding woman, postpartum woman, infant, or child.

(8) Certification -- The implementation of criteria and procedures to assess and document each applicant's eligibility for the WIC Program.

(9) Child -- A person who has had his or her first birthday but has not yet had his or her fifth birthday.

(10) Competent professional authority -- An individual on the staff of the local agency authorized to determine nutritional risk and prescribe supplemental foods.

(11) Current income -- The most recent income data and documentation available to the applicant; usually the income received by the family in the month prior to application.

(12) Disqualification -- The act of ending the WIC Program participation of a participant, authorized food vendor, or authorized local agency, whether as a punitive sanction or for administrative reasons.

(13) Dual participation -- Simultaneous participation in the WIC Program through one or more WIC clinics, or participation in the WIC Program and in the Commodity Supplemental Food Program at the same time.

(14) Family -- A group of related or non-related individuals who are living together as one economic unit, except that residents of a homeless facility or institution shall not be considered members of a single family.

(15) Federal fiscal year -- The 12-month period beginning October 1 of any calendar year and ending September 30 of the following calendar year.

(16) Food instrument -- A voucher, check, electronic benefits transfer card (EBT), coupon, or other document which is used by a participant to obtain supplemental foods.

(17) Guardian -- An individual legally appointed and responsible to look after the affairs of a minor.

(18) Homeless facility -- A facility which provides meal service and is a supervised publicly or privately operated shelter (including a welfare hotel, a congregate shelter, or a shelter for victims of domestic violence) designated to provide temporary living accommodation; an institution that provides a temporary residence for individuals intended to be institutionalized; or a public or private place not designated for, or ordinarily used as, a regular sleeping accommodation for human beings.

(19) Homeless individual -- A woman, infant, or child who lacks a fixed and regular nighttime residence; or whose primary nighttime residence is: a supervised publicly or privately operated shelter (including a welfare hotel, a congregate shelter, or a shelter for victims of domestic violence) designated to provide temporary living accommodation; an institution that provides a temporary residence for individuals intended to be institutionalized; a temporary accommodation in the residence of another individual not exceeding 365 days; or a public or private place not designated for, or ordinarily used as, a regular sleeping accommodation for human beings.

(20) Infant -- A person under one year of age.

(21) Income -- Gross income before deductions or net income after business deductions for farm or self-employed individuals.

(22) Individual with disabilities -- A person who has a physical or mental impairment that substantially limits one or more major life activities; a person who has a history or record of such an impairment; or a person who is perceived by others as having such an impairment. Major life activities include functions such as caring for oneself, performing manual tasks, walking, seeing, hearing, speaking, breathing, learning, and working.

(23) Instream migrant farmworker -- A migrant farmworker who follows a route or travels from state to state seeking agricultural work and is not currently at his or her home base.

(24) Local agency -- An entity under contract to the State agency to provide WIC Program nutrition services.

(25) Migrant farmworker -- An individual whose principle employment is in agriculture on a seasonal basis, who has been so employed within the last 24 months, and who establishes, for the purpose of such employment, a temporary abode.

(26) Minor -- A person over 18 years of age who is no and has not been married or who has not had the disabilities of minority removed for general purposes.

(27) Newborn infant -- An infant less than one month of age.

(28) Nonprofit agency -- A private agency which is exempt from income tax under the Internal Revenue Code of 1954, as amended.

(29) Nutrition education -- A benefit offered to WIC Program participants which consists of individual or group education sessions and the provision of information and educational materials designed to improve health status, achieve positive change in dietary habits, and emphasize the relationships between nutrition and health, all in keeping with the individual's personal, cultural, and socioeconomic preferences.

(30) Nutritional risk conditions -- Detrimental or abnormal nutritional conditions detectable by biochemical or anthropometric measurements; other documented nutritionally-related medical conditions; dietary deficiencies that impair or endanger health; conditions that directly affect the nutritional health of a person; or conditions that predispose persons to inadequate nutritional patterns or nutritionally-related medical conditions, including, but not limited to, homelessness and migrancy.

(31) Nutritional risk priorities -- A system of priorities based on the participant's eligibility category (pregnant, postpartum, breastfeeding, infant, or child) and specific nutritional risk conditions with indices for identifying these conditions.

(32) Nutritional risk priority system -- A priority system which ranks participants according to the degree of need for supplemental foods represented by the nutritional risk conditions which the participant has. This system shall be used to prioritize new applicants and participants for eligibility for services when a local agency has reached its maximum participation level.

(33) Parent -- An individual's mother or father.

(34) Participant -- A pregnant woman, breastfeeding woman, postpartum woman, infant, or child who is receiving supplemental foods or food instruments under the WIC Program, and the breastfed infant of a participating breastfeeding woman.

(35) Postpartum woman -- A woman up to six months after termination of pregnancy.

(36) Poverty income guidelines -- The poverty income guidelines prescribed and adjusted annually by the United States Department of Health and Human Services, effective July 1 of each year.

(37) Pregnant woman -- A woman determined to have one or more embryos or fetuses in utero.

(38) Regulations -- United States Department of Agriculture regulations, 7 CFR Part 246.

(39) Separate economic unit -- A group of individuals who indicate that they have a source of income adequate to sustain the unit and usually purchase and prepare food separately from other individuals dwelling in the same household, or a group of individuals who intend to purchase and prepare food separately from other individuals dwelling in the same household after being certified as eligible to receive benefits from the WIC Program.

(40) Shelf price -- The price normally charged all customers by a vendor for an item sold by the vendor.

(41) State agency -- The Texas Department of Health in its role as administrator of the WIC Program.

(42) Supplemental foods -- Those foods containing nutrients determined to be beneficial for pregnant, breastfeeding, or postpartum women, infants, and children as prescribed by the United States Secretary of Agriculture.

(43) United States Department of Agriculture (USDA) -- The federal agency which funds the WIC Program.

(44) Vendor account -- A vendor approved by the state agency with one or more outlets.

(45) Vendor agreement -- The formal and legally binding agreement between the Texas Department of Health and a vendor authorized to accept and redeem WIC Program food instruments.

(46) Vendor band -- A comparison group of WIC Program vendors based on similar monthly WIC sales volume for each account or outlet.

(47) Vendor competitive pricing -- The process of comparing the cost of a standard WIC Program food package for a woman, infant, or child at an outlet to the cost of an average standard food package for the local agency service area where the vendor is located. Vendor accounts or outlets of a similar WIC dollar volume are compared within the same local agency service area.

(48) Vendor outlet -- An individual store location or mobile unit.

(49) Vendor profile -- A form which includes demographic, financial, and other descriptive information for each vendor outlet.

(50) WIC program -- The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) authorized by the Child Nutrition Act of 1966, §17, as amended.

§31.22.Recipient Eligibility Requirements.

(a) An individual shall be eligible to receive services when the individual receives local agency approval after meeting all of the following requirements.

(1) Be determined categorically eligible.

(A) If a woman, be pregnant or not more than six months postpartum if not breastfeeding or within one year postpartum if breastfeeding; or

(B) If a child, be under age five.

(2) Physically reside within the State.

(A) The applicant shall provide documentation of residency within the local agency's approved service area.

(i) The following documents shall be accepted as documentation of residency: utility bill; credit card bill; rent receipt; rental agreement; business letter from an office other than the local agency; other bills; letter from the person the applicant lives with accompanied by documentation of that person's address; voter registration card; property tax receipt; documentation by a third party such as the staff of a church, social service agency, legal-aid society, school, or a public health official, nurse, doctor, or elected public official; homeless facility documentation; or documentation of adjunctive income eligibility.

(ii) If none of the documents referenced in this section exists, an applicant may provide a map indicating where the applicant lives.

(iii) A homeless individual may complete a WIC Program affidavit stating he or she is homeless or is the parent, caretaker, or guardian of a homeless applicant.

(B) If residency has been documented for another family member within the 60-day period prior to application, that documentation shall be sufficient for meeting the residency requirement.

(3) Meet the income requirements as follows:

(A) Income guidelines shall not exceed 185% of the federal poverty income guidelines.

(B) Applicants shall provide documentation of the amount of income received by each member of the family at each certification and subsequent certification except as provided in this subsection.

(C) Income includes the following:

(i) wages, salary, commissions, or fees;

(ii) net income from farm and non-farm self-employment;

(iii) Social Security benefits;

(iv) dividends or interest on savings or bonds, to include interest on certificates of deposit (CD) and Individual Retirement Accounts (IRA), income from estates or trusts, or net rental income;

(v) public assistance or welfare payments;

(vi) unemployment compensation;

(vii) government civilian employee or military retirement or pensions, or veterans' payments;

(viii) private pensions or annuities;

(ix) alimony or child support payments;

(x) regular contributions from persons not living in the household;

(xi) net royalties;

(xii) lump sum payments which are considered as "new money" received in the last 12 months would include but are not limited to gifts, inheritances, lottery winnings, worker's compensation for lost income, and severance pay;

(xiii) student financial assistance, such as grants and scholarships, except those grants and scholarships excluded as income as listed in this section;

(xiv) capital gains and interest earned on the sale amount. If there was a loss on the sale, the amount of interest earned on the sale amount is counted as income. This applies only to capital gains and losses within the past 12 months. Gains from any sale prior to last 12 months shall be computed according to clause (iv) of this subparagraph; and

(xv) other cash income, which includes, but is not limited to, cash amounts received or withdrawn from any source including savings, investments, trust accounts and other resources which are readily available to the family.

(D) Exclusions from income include, but are not limited to, the following:

(i) any basic allowance for quarters received by military personnel residing off military installations;

(ii) the value of inkind housing and other inkind benefits, including, but not limited to, the employer-paid or union-paid portion of health insurance premiums or other employee fringe benefits, food, or housing received in lieu of wages;

(iii) lump sum payments classified as "reimbursement,"such as monies received from insurance companies for loss or damage to real or personal property, such as a home or auto, and payments received from a third party to pay for a specific expense such as medical bills resulting from accident or injury;

(iv) operating expenses for those individuals who are self-employed. For farm income, operating expenses include, but are not limited to, cost of feed, fertilizer, seed, and other farming supplies; cash wages paid to farmhands; depreciation; cash rent; interest on farm mortgages; farm building repairs; and property taxes (but not state and federal income taxes). For nonfarm self-employed persons, operating expenses include, but are not limited to, the cost of goods purchased, rent, heat, utilities, depreciation, wages and salaries paid, and business taxes (but not personal income taxes). Applicants shall complete a WIC Program affidavit or provide written business records;

(v) loans, such as bank loans, which are temporarily available but must be repaid;

(vi) payments or benefits provided under certain federal programs or acts which must be excluded by federal law include, but are not limited to the following: reimbursements from the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970; any payment to volunteers under Title I (VISTA and others) and Title II (RSVP, foster grandparents, and others) of the Domestic Volunteer Service Act of 1973, to the extent excluded by that Act; payment to volunteers under the Small Business Act (SCORE and ACE), §8(b)(1)(B); income derived from certain submarginal land of the United States which is held in trust for certain Indian tribes; payments received under the Job Training Partnership Act; income derived from the disposition of funds to the Grand River Band of Ottawa Indians; payments received under the Alaska Native Claims Settlement Act; the value of assistance to children or their families under the National School Lunch Act, as amended; the Child Nutrition Act of 1966; and the Food Stamp Act of 1977; payments by the Indian Claims Commission to the Confederated Tribes and Bands of the Yakima Indian Nation or the Apache Tribe of the Mescalero Reservation; payments to the Passamaquoddy Tribe and Penobscot Nation or any of their members received pursuant to the Maine Indian Claims Settlement Act of 1980; payments under the Low-Income Home Energy Assistance Act, as amended; student financial assistance received from any program funded in whole or part under Title IV of the Higher Education Act of 1965, including the Pell Grant, Supplemental Educational Opportunity Grant, State Student Incentive Grants, National Direct Student Loan, PLUS, College Work Study, and Byrd Honor Scholarship programs, including any assistance received from these programs used for tuition and fees, the costs for rental or purchase of any equipment, materials, or supplies required of all students in the same course of study, and an allowance for books, supplies, transportation, and miscellaneous personal expenses for a student attending a higher education institution on at least a half-time basis, as determined by the institution, but not including room and board and dependent care expenses; payments under the Disaster Relief Act of 1974, as amended by the Disaster Relief and Emergency Assistance Amendments of 1989; payments received under the Carl D. Perkins Vocational Education Act, as amended by the Carl D. Perkins Vocational and Applied Technology Educational Act Amendments of 1990; payments pursuant to the Agent Orange Compensation Exclusion Act; payments received for Wartime Relocation of Civilians under the Civil Liberties Act of 1988; value of any child care payments made under the Social Security Act, §402(g)(1)(E), as amended by the Family Support Act; value of any "at-risk" block grant child care payments made under Public Law 101-508, §5081; value of any child care provided or paid for under the Child Care and Development Block Grant Act, as amended; mandatory salary reduction amount for military service personnel which is used to fund the Veteran's Educational Assistance Act of 1984 (GI Bill), as amended; payments received under the Old Age Assistance Claims Settlement Act, except for per capita shares in excess of $2000; payments received under the Cranston-Gonzales National Affordable Housing Act, unless the income of the family equals or exceeds 80% of the median income of the area; payments received under the Housing and Community Development Act of 1987; unless the income of the family increases at any time to not less than 50% of the median income of the area; payments received under the Sac and Fox Indian claims agreement; payments received under the Judgment Award Authorization Act, as amended; payments for the relocation assistance of members of Navajo and Hopi Tribes; payments to the Turtle Mountain Band of Chippewas (Arizona); payments to the Blackfeet, Grosventre, and Assiniboine tribes (Montana) and the Papago (Arizona); payments to the Assiniboine Tribe of the Fort Belknap Indian community and the Assiniboine Tribe of the Fort Peck Indian Reservation (Montana); payments to the Red Lake Band of Chippewas; payments received under the Saginaw Chippewas Indian Tribe of Michigan Distribution of Judgment Funds Act; and payments to the Chippewas of Mississippi.

(E) Acceptable documentation of income are: check stubs stating current earnings; United States Internal Revenue Service form W-2 if less than 90 days old at the time of application and if reflective of current income; a signed statement from the employer; completion of WIC Program affidavit allowed in specific circumstances such as for homeless or those with no income; completion of WIC Program affidavit for self-employed individuals with no business accounting records or who are paid in cash and whose employer will not provide documentation of income; bankbook, if reflective of current income; current federal tax records; income receipt book or other accounting records if self-employed; foster child placement letter; other documentation which the local agency requests to use and which has been approved by the state agency; and the placement letter from the welfare agency legally responsible for a foster child.

(i) Only one document is required, such as one check stub for each source of income as long as the document is no older than 60 days unless the applicant only receives such documentation annually, such as a Social Security Award letter.

(ii) Instream migrant farmworkers and their families are required to provide documentation of meeting the income requirements only once every 12 months.

(F) Certain applicants shall be deemed adjunctively income eligible as follows.

(i) Applicants who are fully eligible to receive Food Stamps benefits or who are fully eligible or presumptively eligible to receive Temporary Assistance to Needy Families benefits or Medicaid benefits.

(ii) Applicants who are members of families in which one other member is fully eligible or presumptively eligible to receive Temporary Assistance to Needy Families benefits.

(iii) Applicants who are members of families in which a pregnant woman or infant is fully eligible or presumptively eligible to receive Medicaid benefits.

(iv) Applicants shall provide proof of their status as an applicant who is adjunctively income eligible as follows.

(I) The applicant shall provide written documentation from the other benefit program which shows current eligibility in the benefit program at the time of application to the WIC Program.

(II) The applicant may grant permission for the local agency to conduct a phone or computer on-line verification from the benefit program on behalf of the client when the local agency has the capability to do so.

(v) Applicants eligible to receive Food Stamp benefits shall provide documentation that the applicant himself or herself is fully eligible to receive such benefits.

(vi) Applicants applying as adjunctively income eligible based on receipt of Food Stamps by a family member as head of household shall provide documentation that the person named as head of household for Food Stamps purposes is a member of the applicant's family and is fully eligible to receive such benefits.

(vii) Applicants eligible to receive Temporary Assistance to Needy Families or Medicaid shall provide documentation that the applicant himself or herself is fully or presumptively eligible to receive such benefits.

(viii) Applicants applying as adjunctively income eligible based on a family member's eligibility to receive Temporary Assistance to Needy Families or Medicaid shall provide documentation of the family member's receipt of such benefits and that the recipient is a member of the applicant's family.

(ix) Applicants eligible for adjunctive income eligibility shall verbally declare their total gross family income or net income if self-employed.

(G) Income eligibility shall be based on the total income of the family.

(H) When determining an applicant's income eligibility for WIC Program services, the local agency shall determine the size of the applicant's family as follows:

(i) All family members shall be counted except for individuals who qualify as a member of a separate economic unit.

(I) A pregnant woman shall be counted as more than one person according to the number of children she expects to give birth to. If she is expecting one child, she shall be counted as two individuals; if she is expecting twins, she shall be counted as three individuals and so on.

(II) A foster child shall be considered a separate family of one.

(ii) Persons temporarily absent from the family may be counted if the following circumstances exist:

(I) other members still consider the family to be the principal residence of the absent member;

(II) the absence does not exceed six months;

(III) the absence is for a purpose such as school, training, employment, hospitalization, or institutionalization; and

(IV) the absent member continues to exercise customary family responsibilities such as income, planning, or physical care.

(I) Some individuals may qualify as a separate economic unit as an exception if the unit has an adequate source of income and usually purchases and prepares food separately from other persons who live in the same dwelling or the unit intends after certification to purchase and prepare food separately from other persons who live in the same dwelling. The following shall not be certified as a separate economic unit:

(i) minor children who live with their parent or parents;

(ii) a child under age 18 who lives with family members who serve as managing conservators and provide more than half of the child's support, and the family members state that the child is under parental control;

(iii) spouses; or

(iv) two people who live together and represent themselves to the community as husband and wife.

(J) Individuals who have been determined eligible for WIC Program services are not required to report changes in income during certification periods.

(i) The local agency has no responsibility to monitor the continued income eligibility of the participant during the certification period.

(ii) If the local agency becomes aware of changes in income during a certification period, the participant shall be reassessed for income eligibility under the rules for determining income eligibility.

(4) Have one or more nutritional risk conditions as defined by the United States Department of Agriculture's national nutritional risk codes and conditions, nutritional risk priorities, and nutritional risk priority system.

(A) At subsequent certification, if there is a possibility of regression in nutritional status without WIC nutrition education and supplemental foods, an applicant may be determined at nutrition risk for regression by the competent professional authority.

(B) Regression shall be used only at a subsequent certification and only when no other risk condition can be determined.

(C) Applicants may be certified for regression for one certification period only.

(5) Be physically present at the initial WIC Program certification and the subsequent certification:

(A) Exceptions may be granted in limited circumstances if approved by the competent professional authority as follows.

(i) Newborn infants may be certified without being physically present if all required documentation is available, the local agency has elected to implement this practice, and the infant is physically presented to the local agency by the time the infant is six weeks of age.

(ii) An applicant or parent, caretaker, or guardian of an applicant who is an individual with a disability may be certified without being physically present because he or she is unable to be physically present because of his or her disability.

(I) Disability conditions which meet this standard are a medical condition that necessitates the use of medical equipment that is not easily transportable; a medical condition that requires confinement to bed rest; or a serious illness that may be exacerbated by coming into the local agency.

(II) A verbal declaration by the applicant or parent, caretaker, or guardian of the applicant that the applicant has a disability and cannot be physically present is sufficient to request the exception.

(iii) An infant, other than a newborn infant, or child may be certified without being physically present if being physically present would present an unreasonable barrier and the infant or child has documented ongoing health care from a health care provider other than the WIC local agency.

(iv) An infant, other than a newborn infant, or child may be certified without being physically present if the infant or child was physically present at a WIC Program certification or subsequent certification within the one-year period which ended on the date the infant or child was last certified or subsequently certified and the infant or child is under the care of one or more working parents, caretakers, or guardians who verbally declare that their working status presents a barrier to bringing the infant or child to the WIC local agency.

(B) Exemptions may be granted for one certification period, or for an extended period of time if the competent professional authority approves the extended period of time.

(6) Provide documentation of identification:

(A) The following documents shall be accepted as documentation of identification: birth certificate; hospital records, including a "crib" card, hospital wrist band, or discharge papers; baptismal certificate; marriage license; drivers license; WIC Family Identification Card; immunization card; school identification card; employment identification card; military identification card; official identification card with picture; passport or immigration records; letter from Medicaid, Food Stamps, Temporary Assistance to Needy Families, or the Supplemental Security Income Programs; indigent health care identification card; paycheck stub with imprinted name; voter registration card; identification card from another WIC local agency; Social Security card; housing or rental lease; loan papers from a bank or finance company; or property tax receipt.

(B) Each local agency may designate additional documents which shall be accepted as documentation of identification with the approval of the state agency.

(b) Citizenship is not a requirement for eligibility.

(1) As long as the local agency has caseload openings, individuals who qualify for WIC Program services shall be served without regard to citizenship status.

(2) No individual's participation in the WIC Program may be terminated because the individual is suspected as or known to be an undocumented alien.

(3) WIC Program confidentiality requirements apply to all applicants and participants regardless of their citizenship status.

§31.23.Recipients of Supplemental Food Benefits.

(a) Regardless of their age, pregnant, breastfeeding, and postpartum participants may be designated as recipients of supplemental food benefits for themselves and/or their infants and/or children.

(b) Regardless of their age, parents, guardians, caretakers, or foster parents of infant and/or child participants may be designated as recipients of supplemental food benefits for their infants and/or children.

(c) Caretakers of a participant may be designated as recipients of supplemental food benefits for the participant if the caretakers are at least 18 years of age or older.

(d) A proxy who is 16 years of age or older may be designated in writing by a WIC Program participant, or parent, caretaker, guardian of a participant, or a foster parent to act as the supplemental food benefit recipient. Each time a proxy is designated to act as the recipient, such designation shall be provided in writing to the local agency, and the proxy shall provide identification for himself or herself and present the participant's WIC Program family identification card.

(e) Not more than one month's supplemental food benefits may be issued to a proxy.

(f) Proxies of participants residing in a homeless facility or institution shall not pick up supplemental food benefits for all WIC Program participants in their respective homeless facilities or institutions or transact the food instruments in bulk. The proxy may act on the behalf of only one certified family.

(g) Recipients of supplemental food benefits shall sign the WIC Program Supplemental Information Form prior to receiving such benefits.

(h) Recipients of supplemental food benefits shall provide identification at each issuance of food benefits.

§31.24.Provision of Immunizations to WIC Applicants and Participants.

(a) Immunizations shall be offered to WIC Program applicants and participants and the minor siblings of WIC applicants and participants by local agencies in conjunction with scheduled WIC Program services and in accordance with the local agency immunization plan.

(b) Applicants may receive immunizations at the time of the eligibility determination for WIC Program services regardless of the outcome of the eligibility determination.

(c) Applicants, participants, and the minor siblings of applicants and participants shall be provided immunizations free of charge.

(d) Immunizations shall be provided to infants and children only upon completion of informed consent procedures.

§31.25.Participant Certification Periods.

(a) After eligibility has been determined, applicants shall be enrolled and certified to receive WIC Program benefits for a specified length of time. The certification period shall begin on the date the applicant is determined eligible.

(b) A pregnant woman shall be certified to receive one set of food instruments each month for the duration of her pregnancy and is eligible to receive one set of food instruments between delivery of the baby and six weeks postpartum. The certification expiration date shall be set at six weeks after her expected delivery date.

(c) A postpartum woman who is not breastfeeding shall be certified to receive one set of food instruments each month until she is six months postpartum. The certification expiration date shall be set for the day the woman is six months postpartum.

(d) A breastfeeding woman shall be certified to receive one set of food instruments each month for a six-month period. The certification expiration date shall be set for the last day of the sixth month. Any subsequent certification shall expire on the day of the infant's first birthday.

(e) A child one to five years of age shall be certified to receive one set of food instruments each month for a six-month period. The certification expiration date shall be set for the last day of the sixth month. For a child turning age five, the certification expiration date shall be set for the last day of the month the child turns age five.

(f) An infant six months of age or older at the time of initial enrollment shall be certified to receive one set of food instruments each month for a six-month period. The certification expiration date shall be set for the last day of the sixth month.

(g) An infant younger than six months of age at the time of initial enrollment shall be certified to receive one set of food instruments each month until the infant's first birthday. The certification expiration date shall be set for the day of the infant's first birthday.

§31.31.Selection of a Local Agency as a WIC Provider.

(a) Selection of a local agency to provide WIC Program services will be based on the local agency priority system as follows:

(1) A public or private nonprofit health agency which can provide ongoing routine pediatric and obstetric care or administrative services shall receive first priority consideration.

(2) A public or private nonprofit health or human service agency which will enter into a written agreement with another agency for either ongoing pediatric and obstetric care or administrative services shall receive second priority consideration.

(3) A public or private nonprofit health agency which will enter into a written agreement with private physicians licensed by the state to provide ongoing pediatric and obstetric care to a specific category of participants (women, infants, or children) shall receive third priority consideration.

(4) A public or private nonprofit human service agency which will enter into a written agreement with private physicians licensed by the state to provide ongoing routine pediatric and obstetric care shall receive fourth priority consideration.

(5) A public or private nonprofit human service agency which will provide ongoing routine pediatric and obstetric care through referral to a health provider shall receive fifth priority consideration.

(6) No WIC Program funds shall be expended to reimburse private physicians for the health services performed.

(b) The state agency shall establish an affirmative action plan each year to rank order each county's relative need for WIC Program services based on the total number of potentially eligible persons in each county.

(1) The following criteria shall be used to rank each county.

(A) Estimates of the proportion of infants below 185% of the federal income guidelines by ethnic group; and

(B) Total live births for each county and ethnic group for the previous five years.

(2) The affirmative action plan shall be used to identify the top one-third of Texas counties (1 through 85) as high priority due to their status as having the most unserved potentially eligible persons.

(3) The most needy one-third of Texas counties shall be designated as targets for the most extensive outreach efforts by the state agency when soliciting for local agencies.

(A) If no local agency has applied to provide services, the state agency shall publish a notice in the media of that area to solicit applications from other potential agencies.

(i) The state agency shall include in the notice a brief explanation of the program, a description of the priority system, and a request that interested local agencies notify the state agency of their interest within 30 days.

(ii) The state agency shall also contact all potential agencies in the area to ensure they are aware of the opportunity to apply for selection as a local agency.

(B) If no local agency which meets the criteria for first priority expresses an interest, the state agency may consider applications from agencies in the lower priorities.

(C) The state agency shall fund new local agencies in conformance with the sequential ranking of the affirmative action plan and the local agency priority system.

(c) All WIC Program initiation and expansion shall be executed utilizing a request for proposal (RFP) in accordance with USDA Food and Nutrition Services Instruction 802-1, the state agency's approved affirmative action plan, and 10 Texas Administrative Code, Chapter 199, Electronic Business Daily, under one of the following conditions:

(1) the state agency determines it is in the best interests of the state to initiate an open competitive statewide RFP;

(2) an existing WIC Program local agency is either disqualified as a provider of WIC Program services or does not wish to continue as a local agency;

(3) a state agency Public Health Region wishes to transfer direct WIC Program services to a local agency; or

(4) a prospective agency satisfactorily documents to the state agency that a specific geographical area is underserved and the current WIC local agency providing services in that area is unable to provide services to that geographical area and declines to develop a collaborative effort to deliver services to meet the documented unmet need.

(d) The state agency shall evaluate proposals to serve as a WIC Program local agency submitted in response to an RFP according to the following criteria:

(1) the ranking of the applying agency in the established priority system;

(2) the need for additional WIC Program services in the geographic area based upon review of the number of current participants by priority and the total number who receive services in comparison to the total number of potential eligible participants in an area, and the local agency applicant's estimate of the number to be served;

(3) the clinic locations proposed in an application relative to the existing WIC Program local agency clinics operated by other WIC Program authorized local agencies;

(4) overall estimated costs of operating the new local agency in comparison to the estimated revenue available to cover local agency costs;

(5) the staffing pattern of the local agency to support WIC Program services proposed by the applying local agency;

(6) planned hours of operation to include extended clinic hours which are defined as weekends and outside of traditional hours of 8:00 a.m. to 5:00 p.m., Monday through Friday;

(7) the availability of other medical services through the applicant agency or by referral; and

(8) specific application criteria in the request for proposal.

(e) The state agency shall advise respondent agencies of the status of their applications to provide WIC Program services in accordance with the schedule of events in the public notice and the RFP. At a minimum, the schedule of events shall provide for written notification of approval or disapproval to the applicant agencies within 30 days of the closing date for acceptance of responses to the RFP.

(f) In the event of an emergency or unexpected interruption of WIC Program services, the state agency WIC Director may waive any or all parts of the application process if necessary to ensure uninterrupted delivery of WIC services in a geographic area or areas.

(g) When a local agency submits an incomplete application for participation either unsolicited or at the request of the state agency as a result of an emergency situation, the state agency shall notify the applicant within 15 days of the receipt of the incomplete application of the additional information needed. The state agency shall notify the applicant agency in writing within 30 days of receipt of a complete application of the approval or disapproval of the application.

§31.32.Selection of Vendors for WIC Initial Authorization for Participation.

(a) A representative from the state agency or the nearest local agency shall perform an on-site evaluation of a vendor applying for authorization to redeem WIC food instruments.

(1) The state or local agency representative shall complete a vendor evaluation form during the visit to the vendor indicating the type of WIC-authorized foods in stock and their shelf prices.

(2) The state or local agency representative shall recommend approval or disapproval of the vendor's application based on the observations during the store visit.

(3) The owner or manager or a store representative shall have the opportunity to review the information on the vendor evaluation form and shall sign the form to acknowledge accuracy of shelf prices listed at the time of the evaluation. The evaluator shall provide a copy of the form, including the date, local agency number, and the name of the evaluator, to the vendor at the time of the in-store evaluation.

(b) The state agency shall base its decision to authorize a vendor on the following criteria:

(1) The vendor's shelf prices are competitive for the local agency area.

(2) The vendor has sufficient quantities of authorized milk, evaporated milk, cheese, cereal, contract infant formula, contract infant cereal, eggs, peanut butter, and dried beans.

(A) pharmacy may elect to provide only the designated contract milk and soy formulas and special formulas.

(B) A vendor may elect not to provide infant formula.

(C) For vendors who elect to provide all authorized foods, the following amounts of each food type shall constitute sufficient quantities:

(i) a total of at least 108 ounces of adult cereal, including 36 ounces each of at least three of the following types of cereal: oat, corn, wheat, rice, and multi-grain;

(ii) at least six dozen Grade A or AA large, medium, or small size eggs;

(iii) a total of at least 18 containers of juice, including at least two varieties of juice in 46-ounce fluid cans and/or 12-ounce frozen cans;

(iv) a total of at least six pounds of cheese;

(v) a total of at least nine gallons of milk, some of which must be available in one-half gallon containers;

(vi) at least three one-pound bags of dry beans;

(vii) at least three 18-ounce jars of peanut butter;

(viii) at least eight 12-ounce cans of evaporated milk;

(ix) at least 31 cans of milk or soy concentrate infant formula (contract brand) and either eight cans of milk-based powder formula or nine cans of soy powder formula (contract brand); and

(x) at least two 8-ounce boxes or one 16-ounce box of infant cereal.

(3) The vendor provides milk in gallon and half-gallon containers and juice in 46-ounce or 12-ounce containers.

(4) The vendor's shelf prices do not exceed the maximum prices on WIC food instruments.

(5) The recommendation by the state or local agency representative who conducted the on-site evaluation.

(6) The vendor has a retail food operations permit or food manufacturer's permit from the applicable city, county, district, or state health authority.

(7) The vendor's store is clean, with fresh merchandise (no expired food items).

(8) The vendor has no apparent conflict of interest with the local agency in the vendor's service area.

(9) The vendor has posted prices for food items.

(10) If applicable, the vendor's history of WIC Program noncompliance.

(c) If the state agency disapproves the application by a vendor for authorization, the reasons for the disapproval shall be provided to the vendor in writing.

(d) Vendors who apply for authorization who have been evaluated twice within a six-month period and denied approval both times shall not be evaluated again until at least six months from the last evaluation.

(e) In the event a vendor purchases or acquires a store location or business which was in the process of being disqualified or which is disqualified from the WIC Program at the time of acquisition, the vendor's application for that store location or business shall not be considered until the state agency makes a determination that the sale was a bona fide arms-length transaction. The state agency will make this determination no later than six months from the date of application. If the state agency determines that the transfer was not an arms-length transaction, the application shall not be considered until the disqualification period has been served.

(f) If the state agency has allowed the vendor agreement for a previous owner of a store location or business to expire for noncompliance or notified the previous owner that the vendor agreement for the store location or business will be allowed to expire for noncompliance, a new owner's application for that store location or business shall not be considered until at least six months from the expiration date of the previous owner's last vendor agreement unless the state agency makes an earlier determination that the sale was a bona fide arms-length transaction.

(g) The state agency may waive the requirement for an on-site evaluation when a grocery chain comprising 20 or more outlets authorized to participate in the WIC Program purchases or merges with another chain with 20 or more authorized outlets if the merger or purchase does not materially change the stores' staff or pricing structure.

(h) Upon request, the state agency may provide an applicant vendor with tentative authorization to redeem WIC food instruments starting the day the store opens.

(1) To obtain tentative authorization, the vendor shall comply with all of the following criteria:

(A) The owner of the applicant store owns one or more stores that have been participating in the WIC Program under the current ownership for at least the six-month period prior to application for authorization.

(B) For the six-month period prior to application for authorization, none of the participating stores has exceeded 108% of the competitive pricing criteria for both the woman/child and infant food packages for their respective local agency vendor bands.

(C) None of the participating stores has been disqualified from program participation for two or more months within the 12-month period prior to application for authorization.

(D) The applicant store notifies the state agency at least two months prior to the official opening date.

(E) The applicant store's manager or assistant manager acknowledges receipt and understanding of the WIC Program vendor manuals provided with the agreement, the allowable foods list, and vendor rules and policies.

(F) The applicant store's manager or assistant manager has scored at least 70% on a written test provided by the state agency and returned to the state agency no later than five days prior to the applicant store's opening date.

(2) If, after evaluation, a store which has received tentative authorization from the state agency does not meet all authorization criteria, the store shall be notified of its tentative agreement expiration date and instructed to discontinue redeeming the WIC Program food instruments. The state agency shall honor properly redeemed food instruments from the opening date until the tentative agreement expiration.

(i) On a temporary basis, the state agency may consider and approve applications from new vendors for the following reasons:

(1) the vendor has been authorized to accept Food Stamps;

(2) the disqualification of an existing authorized vendor in a local agency service area would create inadequate access for WIC Program participants;

(3) a currently-authorized vendor outlet(s) changes ownership; or

(4) authorization of a new vendor would result in a significant cost advantage to the WIC Program.

(j) The state agency may deny an application to participate as a vendor if an owner, partner, principal stockholder, officer, director, manager, or operator of the applicant was an owner, partner, principal stockholder, officer, director, manager, or operator of another vendor which has been disqualified or which has violated WIC Program procedures, policies, rules or regulations.

(k) The state agency may hold an authorized vendor individually responsible for previous violations by an owner, partner, manager, or principal stockholder of the vendor when considering renewal of the vendor's agreement or future applications for vendor agreements.

§31.33.Selection of Vendors for Reauthorization for Participation.

(a) Vendors with a current vendor agreement shall be evaluated for issuance of a subsequent vendor agreement under WIC Program procedures, policies, rules, and regulations and shall be reauthorized unless notified in writing by the state agency at least 15 days before expiration of the vendor agreement.

(b) Prior to reauthorization, the state agency shall assess and review the qualifications of all vendors to assure that each continues to meet the WIC Program's goals. Criteria utilized in assessment and determination of qualifications for reauthorization include, but are not limited to.

(1) Competitive prices for the local agency area. A vendor's prices shall be considered competitive if the combined prices for the items included in the standard woman/child and/or infant food package do not exceed 108% of the local agency food package averages for the vendor's band.

(2) Volume of WIC sales. The vendor's volume of WIC sales exceeds $300 a month. If monthly sales fall below $300 a month for three consecutive months prior to the time of the vendor agreement reauthorization evaluation, the vendor agreement may not be renewed.

(3) Previous compliance with WIC Program procedures, policies, rules, and regulations. The vendor has satisfactorily complied with food instrument redemption and submission procedures, policies, rules, and regulations.

(4) Continuing to meet selection criteria. The vendor continues to meet the selection criteria as stated in this section.

(c) Previous noncompliance with WIC Program procedures, policies, rules, and regulations shall be considered by the state agency in determining if the vendor is eligible for a subsequent contract.

(1) Examples of noncompliance violations include, but are not limited to:

(A) Two or more state agency written notifications of problems with competitive pricing criteria within the term of a 12-month vendor agreement;

(B) one or more state agency written notifications of problems with competitive pricing criteria within the term of a six-month probationary vendor agreement;

(C) previous voluntary withdrawal as an authorized vendor after having received a warning or disqualification letter from the state agency. Such a warning or disqualification shall be entered into the vendor's record.

(2) The state agency shall also consider a history of noncompliance when evaluating a vendor's application for authorization at new or additional sites.

(d) The state agency shall allow a vendor's agreement to expire and not be renewed if the vendor has a history of noncompliance with provisions in the vendor agreement or the WIC Program procedures, policies, rules, and/or regulations, including compliance with the competitive pricing criteria unless, at the request of an otherwise compliant vendor, the state agency negotiates a civil money penalty in lieu of nonrenewal.

(1) Expiration of the vendor agreement is not subject to appeal.

(2) In the event the vendor's agreement has been allowed to expire due to previous noncompliance, a vendor's request for reauthorization shall not be considered until at least six months from the expiration date of the vendor's last agreement.

(e) Any vendor for which the state agency has identified violations that have resulted in, or would have resulted in, a one-month disqualification from the WIC Program but has not had any state agency written notification of problems with competitive pricing within the current agreement term, shall have a probationary vendor agreement that expires March 31 or September 30 of the current federal fiscal year, whichever results in the shorter contract period.

(f) If the state agency agrees to negotiate a civil money penalty in lieu of nonrenewal of the vendor agreement for noncompetitive pricing for an otherwise compliant vendor, the following shall apply:

(1) The state agency shall not negotiate a civil money penalty in lieu of nonrenewal for competitive pricing for the second of two consecutive agreement periods.

(2) The civil money penalty for noncompetitive pricing shall be calculated as follows:

(A) The vendor's average monthly redemptions for the most recent six-month period prior to the date of the nonrenewal notice shall be determined.

(B) The resulting average monthly redemptions shall be multiplied by 50% (.50).

(C) The final calculated civil money penalty shall not exceed $10,000.

(g) All vendors must have a retail food operation permit or food manufacturers' permit from the applicable city, county, district, or state health authority.

§31.34.Calculation and Use of Vendor Competitive Pricing Data.

(a) The state agency shall use the following calculation to determine whether an applicant vendor's prices are competitive with those of similar vendors in the local agency service area.

(1) The state agency data system calculates by vendor outlet the average unit costs to the state agency for each food type based on the food instruments redeemed by that vendor outlet.

(2) Authorized vendor outlets within a local agency service area are grouped into volume vendor bands.

(3) Utilizing food-type averages for each vendor outlet within a vendor band, the state agency determines the local agency average standard food package costs for an infant and/or a woman/child participant for each vendor band.

(4) A vendor outlet's average standard food package costs are determined based on the store evaluation for an applicant vendor or actual WIC redemption data for authorized vendors.

(5) The state agency compares the vendor outlet's standard food package costs to the local agency's average standard food package costs for that vendor band. Local agency averages for a prior period will be used. An outlet's standard food package costs are considered competitive if they are less than or equal to 108% of the local agency's average standard food package costs for that vendor band.

(6) The state agency may make adjustments to the local agency averages due to anomalies, such as those caused by sharp wholesale price increases or crop failures since the prior period in which the averages were calculated.

(7) The state agency may reassign a vendor to an alternative comparison group when the vendor, such as a high-volume, national discount superstore, is not characteristic of other vendors in the band; when the vendor is the only store in a rural area within the local agency; or when the vendor is the sole occupant of a band.

(b) The state agency shall provide a vendor with written notification of noncompliance with competitive pricing. Any vendor that receives one written notification of noncompliance with competitive pricing during the last six months of the federal fiscal year shall receive a probationary six-month agreement at the beginning of the next fiscal year if all noncompliance issues have been corrected.

§31.35.Vendor Agreement with the State Agency.

(a) Once a vendor has been approved to participate in the WIC Program, a written agreement shall be executed and signed by authorized officials of the state agency and the vendor.

(1) The agreement shall be prepared by the state agency and mailed to the vendor for endorsement.

(2) Upon receipt by the vendor, the vendor shall enter the store's business name, telephone number, federal income tax number, and State of Texas Comptroller number; sign the agreement; and return it to the state agency.

(3) Each vendor agreement shall include at least one vendor profile detailing, at a minimum, the name, location, type of facility, gross sales, gross food sales, and gross non-food sales for each outlet covered by the agreement.

(4) The state agency shall assign a WIC account number to the vendor and enter it on the agreement. Outlet identifiers shall also be assigned where applicable.

(5) A state agency official shall sign the agreement. The state agency shall forward one copy to the vendor and shall retain the original document.

(6) Upon receipt of the copy signed by the state agency official and bearing a WIC account number, the vendor may commence accepting WIC Program food instruments.

(b) Any vendor that has not previously been authorized by the WIC Program shall receive a probationary vendor agreement that expires March 31 or September 30 of the current federal fiscal year, whichever results in the shorter contract period.

(c) A change of ownership of an authorized outlet or account terminates the agreement between the state agency and the vendor. A change of ownership occurs when all, or substantially all, of the property or assets of a vendor are acquired by a purchaser in a bona fide arms-length transaction.

(1) In the event a store location/business under previous ownership was disqualified or is in the process of being disqualified at the time of acquisition, the new owner's application for that store location/business shall not be considered until the state agency makes a determination that the sale was a bona fide arms-length transaction. The state agency will make this determination no later than six months from the date of application. If the state agency determines that the transfer was not a bona fide arms-length transaction, the application shall not be considered until the disqualification has been served.

(2) If the state agency has notified the previous owner that the vendor's agreement for a store location/business shall be allowed to expire, the new vendor's application for that store location/outlet shall not be considered until at least six months from the expiration date of the previous vendor's last agreement unless the state agency makes an earlier determination that the sale was a bona fide arms-length transaction.

(3) If a store/location under previous ownership is not disqualified or is not in the process of being disqualified at the time of acquisition, and/or the previous owner has not been notified that the vendor agreement for that store location/business will be allowed to expire, and the acquiring party is in compliance with the rules, regulations, and vendor qualification criteria of the WIC Program, the acquiring party may, upon request, be authorized as a WIC Program vendor.

(A) The applicant vendor must submit a written affidavit stating that a change of ownership has been effected and duly executed by the seller and purchaser or their duly authorized officers or other agents.

(B) The affidavit shall include, at a minimum, the following information and any other information the state agency deems necessary: name and business address of the seller; name and business address of the purchaser; WIC vendor account number and outlet number, if applicable; name(s) and street address(es) of the outlet location(s); effective date of ownership change; and State of Texas Comptroller tax number of new owner.

(d) WIC food instruments redeemed at an applicant store shall not be paid until the store has been duly authorized, including completion of an on-site evaluation, approval by the local agency, execution of the vendor agreement and vendor profile, and assignment of an account/outlet number by the state agency.

(e) A vendor's unilateral termination of a vendor agreement after receipt of notification by the state agency of a violation shall not deprive the state agency of jurisdiction to impose sanctions for WIC Program violations.

(f) The vendor agreement does not constitute a license, since a vendor does not require the state agency's approval to engage in the retail grocery business in Texas and the vendor would not effectively be deprived of this right in the absence of WIC Program authorization.

(1) The vendor agreement conveys no property interest since federal law does not give rise to a legitimate claim of entitlement for vendors.

(2) The terms of authorization are established in the vendor agreement between the state agency and the vendor, and the contractual relationship ends with the expiration of the vendor agreement.

(3) The state agency as well as officers, agents, and employees of the state agency are not responsible for losses incurred by a vendor as a result of the expiration of the vendor agreement.

§31.37.Selection of WIC Program Allowable Foods.

(a) Criteria for approving products for inclusion in the WIC Program food package are based on federal regulations, packaging, cost, cultural acceptability, and nutritive value.

(b) A product shall meet the federal regulations governing the WIC Program food package in order to be considered for approval through the WIC Program.

(c) The state agency may restrict the number of brands and types of any products in order to contain the cost of the food package and minimize the confusion for WIC participants. The state agency is not obligated to authorize every available food that meets the federal requirements.

(d) The state agency shall review the WIC Program list of allowable foods annually to determine the need for adding or deleting food products.

(1) If the state agency determines that the list of allowable foods should be changed, the state agency shall notify both juice and cereal manufacturers of that intent through a request for information (RFI).

(2) Juice and cereal manufacturers may contact the WIC Program at any time during the year to request that their names and addresses be added to the mailing list for an RFI.

(e) The criteria for each food type are as follows:

(1) Milk.

(A) Any brand of unflavored, fresh, whole, reduced fat (2.0%), low-fat (0.5% or 1.0%) or fat-free (nonfat or skim) cow's milk including cultured buttermilk marketed in Texas containing or fortified with vitamins A and D to meet the federal standards.

(i) Only gallon and half-gallon plastic or paper cartons are allowed.

(ii) "High calcium" fluid milk is not allowed.

(iii) Goat's milk is not allowed.

(iv) Fluid milk with added enzymes, such as lactose-free milk, may qualify in quart, half-gallon, and gallon containers. Brands shall be approved as needed.

(B) Any brand of whole or fat-free (nonfat) evaporated cow's milk marketed in Texas containing or fortified with vitamins A and D to meet the federal standards.

(i) Only 12-ounce cans are allowed.

(ii) Evaporated filled milk is not allowed.

(iii) Sweetened condensed milk is not allowed.

(C) Any brand of nonfat, dry, powdered milk marketed in Texas containing or fortified with vitamins A and D to meet the federal standards. Nonfat, dry, powdered milk may be issued in 9.6-ounce, 25.6-ounce, and 64-ounce boxes.

(2) Cheese.

(A) Any unflavored domestic brand of pasteurized processed American, Monterey Jack, Colby, Colby-Jack, Natural Cheddar, Longhorn, or Mozzarella cheese in block or sliced form.

(B) Package sizes smaller than 10 ounces are not allowed.

(C) Shredded or individually wrapped slices of cheese are not allowed.

(D) Cheese foods or cheese spreads are not allowed.

(3) Cereals.

(A) Cereal brands shall contain a minimum of 28 milligrams of iron per 100 grams of dry cereal, and not more than 21.2 grams of sucrose and other sugars per 100 grams of dry cereal (6 grams per ounce).

(i) Package sizes less than 10 ounces are not acceptable. The state agency may further limit the package size(s) authorized for a brand.

(ii) Culturally acceptable cereals or cereals targeting specific ethnic groups shall be considered.

(iii) If cereals from one manufacturer have similar names and package designs and some do not qualify, the state agency reserves the right to not approve those types that would otherwise qualify to reduce the potential for confusion by vendors and participants.

(iv) The state agency reserves the right to determine the number and brands of cereals, which shall include at least one hot cereal and at least one corn, wheat, oat, rice, and multi-grain cereal.

(B) Except as provided in this subparagraph, authorized brands of cereals shall be the least expensive per ounce within the respective grain groups.

(i) The state agency may authorize a more expensive brand with higher fortification and/or lower sugar content in lieu of a less expensive brand within a particular grain group.

(ii) The state agency may consider consumer acceptability as well as the suitability for children among its selection criteria.

(C) The product shall be available for retail purchase on or before the effective date of the approved food list or it will not be considered by the state agency for authorization.

(D) The product form and marketing approach shall be consistent with the promotion of good nutrition and education.

(4) Juice.

(A) All single-strength fluid fruit or vegetable juices shall contain a minimum of 30 milligrams of vitamin C per 100 milliliters and all frozen concentrated fruit or vegetable juices shall contain a minimum of 30 milligrams of vitamin C per 100 milliliters of reconstituted juice.

(i) Juices shall be 100% juice and shall contain no added sugar, or other natural or artificial sweeteners.

(ii) The state agency may determine the number and types of juices authorized and may consider their suitability for children.

(iii) Fluid juice shall be packaged in 46-ounce containers.

(iv) Frozen juice shall be packaged in 11.5-ounce or 12-ounce containers.

(v) Fluid juice for the special homeless food package shall be packaged in a 6-ounce can.

(vi) Fluid juice shall not be packaged in glass, plastic, or cardboard containers.

(vii) Canned and frozen varieties of juice with the same brand name shall be evaluated separately.

(B) The state agency reserves the right to limit the authorized packaging of specific types of juice due to pricing or other considerations.

(C) If juices from one manufacturer have similar names and package designs and some do not qualify, the state agency reserves the right to not approve those types that would otherwise qualify to reduce the confusion by vendors and participants.

(D) The product shall be available for retail purchase on or before the effective date of the approved food list or it will not be considered by the state agency for authorization.

(E) The product form and marketing approach shall be consistent with the promotion of good nutrition and education.

(5) Eggs.

(A) Only fresh grade A or grade AA large, medium, or small chicken eggs are allowed.

(B) Fertile, brown, or free-range eggs are not allowed.

(C) Eggs shall be packaged only in cartons of a dozen.

(D) Extra large or jumbo eggs are not allowed.

(6) Beans/Peas/Lentils.

(A) All brands of dried beans, peas, or lentils are approved in one-pound packages or bulk.

(B) Mixed or seasoned beans, peas, or lentils are not allowed.

(7) Peanut Butter.

(A) Any brand of peanut butter in an 18-ounce container qualifies if it contains no other ingredients such as jelly, marshmallows, or honey.

(B) Low fat or lite peanut butter is not allowed.

(8) Tuna.

(A) Any domestic brand of chunked light tuna packed in water in a six-ounce can is authorized. Tuna packaged in 3.25-ounce cans shall be authorized only for the homeless food package.

(B) Albacore and solid white tuna is not allowed.

(C) Tuna packaged with other items such as crackers or relish is not allowed.

(D) Tuna packed in oil is not allowed.

(9) Carrots.

(A) All one-pound or two-pound cello bags of fresh, large carrots without tops are allowed.

(B) All 14-ounce to 16-ounce cans of sliced carrots are allowed.

(C) Baby carrots and frozen carrots are not allowed.

(10) Infant formula.

(A) Infant formulas authorized for the WIC Program shall be registered with the United States Food and Drug Administration as complying with the legal definition of infant formula.

(B) Infant formulas shall comply with calorie and iron content prescribed by federal WIC regulations, except as provided by state agency policy.

(C) Infant formulas shall be approved by USDA for use in the WIC Program.

(D) The product form and marketing approach shall be consistent with the promotion of good nutrition and education.

(E) The state agency reserves the right to solicit rebates for infant formulas from manufacturers through a competitive bid process. The formulas selected shall be designated as the primary milk-base and soy-base brands authorized for issuance by the WIC Program.

(11) Infant cereal.

(A) Infant cereals shall contain a minimum of 45 milligrams of iron per 100 grams of dry cereal.

(B) Infant cereal with added fruit, sugar, or other ingredients shall not be authorized.

(C) Infant cereal shall be dehydrated flakes in eight-ounce or 16-ounce boxes.

(D) The state agency reserves the right to solicit rebates for infant cereals from manufacturers through a competitive bid process.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on July 16, 2001.

TRD-200104075

Susan Steeg

General Counsel

Texas Department of Health

Effective date: August 5, 2001

Proposal publication date: February 2, 2001

For further information, please call: (512) 458-7236


Chapter 97. COMMUNICABLE DISEASES

Subchapter A. CONTROL OF COMMUNICABLE DISEASES

25 TAC §§97.1 - 97.4, 97.6

The Texas Department of Health (department) adopts amendments to §§97.1 - 97.4 and 97.6 concerning the diseases in animals that are notifiable by veterinarians, without changes to the proposed text as published in the April 20, 2001, issue of the Texas Register (26 TexReg 2929), and therefore the sections will not be republished.

The sections will enable veterinarians to more clearly identify the conditions and diseases that must be reported, define the minimal reportable information on these conditions and diseases, and describe the procedures for reporting to the department. Specifically, amendment §97.1 adds the term "animal" to the definition of "case" and "contact," and new definitions for "research facility" and "veterinarian." Minor changes in §97.2 define the term patient to mean person or animal. Amendment §97.3 adds to the list of reportable conditions the following clinically diagnosed or laboratory-confirmed animal cases: anthrax, arboviral encephalitis, Mycobacterium tuberculosis infection in animals other than those housed in research facilities, plague, and psittacosis. It also adds a requirement that all non-negative rabies tests performed on animals from Texas at laboratories located outside of Texas be reported; all non-negative rabies tests performed in Texas be reported by the laboratory conducting the testing; and, in addition to individual case reports, any outbreak, exotic disease, or unusual group expression of disease which may be of public health concern should be reported by the most expeditious means. Amendment §97.3 also defines the minimal information that shall be reported for each disease as species and number of animal(s) affected, disease or condition, and the veterinarian's name and phone number. Minor corrections were made in §97.3 and §97.4 by italicizing the genus and species names for bacteria. Amendments §97.4 and §97.6 outline the procedures for reporting a notifiable condition in animals.

The following comments were received concerning the proposed rules. Following each comment is the department's response and any resulting change(s).

Comment: Concerning §97.3(b)(1) one commenter stated the wording "any outbreak, exotic disease, or unusual group expression of disease which may be of public health concern" as being too vague. The suggestion was to change the wording to "any outbreak of an animal disease foreign to Texas which is of public health concern".

Response: The department disagrees. The wording "any outbreak, exotic disease, or unusual group expression of disease which may be of public health concern" is identical to the wording in the requirement for physicians to report notifiable diseases (§97.3(a)(2)(B)). In both cases, the wording is intentionally broad in order to cover the wide range of possible disease occurrences that could adversely affect public health. Examples in which "animal disease foreign to Texas" would be inadequate include: the occurrence of zoonotic diseases which normally occur in one geographic area of the state but which appear in a different area, thereby indicating possible environmental changes; congenital malformations that may signal environmental contamination; a normally occurring zoonotic disease manifesting itself at an usually high incidence rate or during an unusual season or time of the year, thereby alerting public health officials to a possible act of bioterrorism; instances in which unusual symptoms are obvious to the veterinary practitioner, but the actual disease remains undiagnosed (as happened in New York with West Nile virus); and the increased occurrence of normally occurring zoonotic diseases as the result of changes in animal husbandry practices (such as vaccinations).

The program certainly understands the practicing veterinarian's desire for language that is more defined; however, attempts at a more definitive expression have not been inclusive enough to meet the needs of public health surveillance and early detection. Therefore, the program recommends keeping the language as proposed. No change was made as a result of this comment.

Comment: Concerning a general comment of the public health significance of domestic abuse and its relationship to animal abuse one commenter supported a requirement to report cases of animal abuse.

Response: The relationship between animal abuse and violent behavior toward humans is well documented. The program whole-heartedly acknowledges the benefits of reporting animal cruelty if such reporting were to result in the prevention of child abuse. However, it is not clear that the intent of the Health and Safety Code Chapter 81 extends to the reporting of animal abuse. Health care professionals in Texas are required to report suspected cases of child abuse through statutory law (Family Code §261.101); therefore, a similar requirement for veterinarians would logically require a statutory mandate rather than administrative rules. No change was made as a result of this comment.

Comment: One commenter stated that veterinarians should be actively involved in reporting diseases.

Response: The department agrees and no change was made as a result of this comment.

Comment: Concerning §97.3(b)(1) and the language being too vague, one commenter suggests that the language should read, "In addition to individual case reports, any outbreak of an animal disease foreign to Texas which is of public health concern." The commenter says this language would allow the Texas Department of Health to gather the information it needs without unduly burdening veterinarians by requiring them to report every single zoonotic disease that they see in their practice.

Response: The wording "any outbreak, exotic disease, or unusual group expression of disease which may be of public health concern" is identical to the wording in the requirement for physicians to report notifiable diseases (§97.3(a)(2)(B)). In both cases, the wording is intentionally broad in order to cover the wide range of possible disease occurrences that could adversely affect public health. Examples in which "animal disease foreign to Texas" would be inadequate include: the occurrence of zoonotic diseases which normally occur in one geographic area of the state but which appear in a different area, thereby indicating possible environmental changes; congenital malformations that may signal environmental contamination; a normally occurring zoonotic disease manifesting itself at an usually high incidence rate or during an unusual season or time of the year, thereby alerting public health officials to a possible act of bioterrorism; instances in which unusual symptoms are obvious to the veterinary practitioner, but the actual disease remains undiagnosed (as happened in New York with West Nile virus); and the increased occurrence of normally occurring zoonotic diseases as the result of changes in animal husbandry practices (such as vaccinations). No change was made as a result of this comment.

The commenters were individuals who were generally in favor of the rules, but expressed concerns and made recommendations.

The amendments are adopted under the Communicable Disease Prevention and Control Act, Health and Safety Code, §81.004, which provides the Board of Health with the authority to adopt rules concerning communicable diseases; §81.041 which requires the board to identify reportable diseases; §81.044 which requires the board to prescribe the form and method of reporting communicable diseases; and §12.001, which provides the Texas Board of Health with the authority to adopt rules for the performance of every duty imposed by law on the Texas Board of Health, the Texas Department of Health, and the Commissioner of Health.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on July 16, 2001.

TRD-200104060

Susan Steeg

General Counsel

Texas Department of Health

Effective date: August 5, 2001

Proposal publication date: April 20, 2001

For further information, please call: (512) 458-7236


Chapter 229. FOOD AND DRUG

Subchapter T. LICENSURE OF TANNING FACILITIES

25 TAC §§229.342, 229.343, 229.345 - 229.349, 229.351 - 229.354, 229.356, 229.357

The Texas Department of Health (department) adopts amendments to §§229.342 - 229.343, 229.345 - 229.349, 229.351 - 229.354, and 229.356 - 229.357, concerning the licensure of tanning facilities, without changes to the proposed text as published in the February 2, 2001, issue of the Texas Register (26 TexReg 1090), and therefore the sections will not be republished.

The amendments clarify and update minimum standards for tanning devices in order to conform with current federal requirements promulgated by the U.S. Food and Drug Administration (FDA). In addition, the amendments clarify the requirements for protective eyewear availability, acceptable flooring materials used in tanning facilities, and the content of records associated with individual consumers and sanitizer cleaning solutions. The amended sections reflect changes that allow the department to streamline its licensure procedures to allow for more efficient and timely processing of license applications. The rules contain new language that clarifies existing licensure policies with respect to amended licenses, consolidating multiple license anniversary dates, and for reporting to the department any changes affecting the license application. The sections establish new definitions to clarify the date of issuance of a license as well as a change in ownership of a tanning facility. Finally, the rules establish requirements to improve the department's ability to handle suspensions, denials, and revocations of a license and to update references applicable to the enforcement provisions under Health and Safety Code, Chapter 431.

Government Code §2001.039 requires that each state agency review and consider for readoption each rule adopted by the agency pursuant to the Government Code, Chapter 2001 (Administrative Procedures Act). These sections have been reviewed and the department has determined that the reason for readopting the sections continues to exist; however the rules need revisions as described in this preamble. In addition, the department has reviewed §§229.341, 229.344, 229.350, and 229.355 and proposes to readopt these sections without any changes. However, the department will accept comments from the public on these sections.

The department published a Notice of Intention to Review §§229.341 - 229.357 in the Texas Register (25 TexReg 3062) on April 7, 2000. No comments were received by the department on these sections.

The following comments were received regarding the proposed sections. The commenters were generally in favor of the rules, but expressed concerns, asked questions, and made recommendations. The commenters were Indoor Tanning Association, Segler Enterprises, Inc., Stylistic, Inc., Sun Ergoline, Inc., and Super Tans of Texas.

Comment: Concerning §229.343(4), one commenter suggested that changes in ownership of a tanning facility that involve sole proprietors and corporations should only include changes in which more than 5% of the ownership is transferred.

Response: The department disagrees with the commenter and considers the proposed language to accurately reflect a more universal understanding of what constitutes a change of ownership for these business entities. The department also believes the proposed language will result in more accurate information regarding the ownership of a tanning facility. No change was made as a result of the comment.

Comment: Concerning §229.345(d), one commenter suggested that all tanning facility licenses expire on December 31st of each year and that the license fees assessed for the first year of licensure be prorated accordingly.

Response: The department disagrees with the commenter and is not proposing changes to the subsection at this time. The department's prior experience in consolidating all license expirations to occur on December 31st of each year revealed that significant resource difficulties exist in processing large volumes of licensure renewals at a single time during the year. No change was made as a result of the comment.

Comment: Concerning §229.346(c), one commenter suggested that a penalty be assessed to a firm in an amount exceeding the $100 delinquent fee if the firm fails to license with the department as a tanning facility.

Response: The department disagrees with the commenter and believes adequate enforcement options exist in §229.357 to address the violation of operating a tanning facility without a license. No change was made as a result of the comment.

Comment: Concerning §229.349(b), one commenter requested that the department revise the subsection to allow advertising of medically verifiable benefits associated with tanning devices.

Response: The department disagrees with the commenter and is not proposing changes to the subsection at this time. The department recognizes that the FDA has preemptive authority for approving marketing clearances for tanning devices and that currently the FDA does not permit medical claims of benefit for these devices. No change was made as a result of the comment.

Comment: Concerning §229.349(c), two commenters believed the subsection did not properly reference the restrictions placed on a sexually oriented business.

Response: The department disagrees with the commenters and has reviewed the proposed reference and determined that it is the correct reference. No changes were made as a result of the comments.

Comment: Concerning §229.351(c), one commenter suggested removing the requirement for taking a customer's skin type into consideration when determining the recommended exposure to ultraviolet radiation from a tanning device.

Response: The department disagrees with the commenter and is not proposing changes to the subsection at this time. The department believes that consideration of a customer's skin type is necessary in order to interpret and follow correctly the recommended ultraviolet radiation exposure schedule as determined by the tanning device manufacturer with guidance from the FDA. No change was made as a result of the comment.

Comment: Concerning §229.351(f), one commenter questioned the basis for setting a maximum temperature limit of 100 degrees Fahrenheit for consumer contact areas of a tanning device.

Response: The department disagrees with the commenter and is not proposing changes to the subsection at this time. The department believes that setting a maximum temperature limit of 100 degrees Fahrenheit for consumer contact surfaces and the surrounding area is consistent with general health and safety expectations for operating these devices. No change was made as a result of the comment.

Comment: Concerning the deletion of §229.351(l), two commenters suggested the current language be maintained or strengthened with respect to physical barriers in stand-up tanning devices.

Response: The department disagrees with the commenters and believes the proposed language is necessary in order to conform state requirements for tanning devices to existing federal performance standards applicable to sunlamp products. The department recognizes the need to maintain an acceptable level of standardization with federal requirements due to the explicit preemptive nature of federal laws and regulations affecting tanning devices. No changes were made as a result of the comments.

Comment: Concerning §229.352(c), one commenter stated the proposed change affecting the location of protective eyewear available to consumers was needed based on the current language of the subsection.

Response: The department agrees with the commenter that the proposed change to the subsection will serve to clarify the intent to ensure availability of protective eyewear to consumers. No change was made as a result of the comment.

Comment: Concerning §229.352(c), one commenter suggested deleting any reference to the location of protective eyewear provided to consumers.

Response: The department disagrees and is committed to ensuring that consumers have ready access to protective eyewear during times when they are prepared to use a tanning device. No change was made as a result of the comment.

Comment: Concerning §229.354(c), three commenters suggested that the period between exposures to ultraviolet radiation from a tanning device be changed from 24 hours to a single calendar day.

Response: The department disagrees since the use of a calendar day does not represent an effective means of providing each consumer with a minimum amount of time following an exposure in order to identify, control, and limit any acute injury or delayed adverse effects caused by the ultraviolet radiation. No changes were made as a result of the comments.

Comment: Concerning §229.354(c), one commenter suggested that the requirement for a 24-hour period between exposures to ultraviolet radiation from a tanning device be repealed.

Response: The department disagrees with the commenter and believes the requirement is essential to controlling and limiting any injury or delayed adverse effect from exposure to ultraviolet radiation. In addition, the department believes the requirement is consistent with maximum recommended exposure frequencies established by the manufacturers of many tanning devices. No change was made as a result of the comment.

Comment: Concerning §229.354(c), one commenter suggested that any individual who uses a tanning device more than once within a 24-hour period be required to sign a release waiver.

Response: The department disagrees with the commenter and believes a waiver alone would not serve to limit or reduce the risks associated with multiple exposures to ultraviolet radiation. No change was made as a result of the comment.

Comment: Concerning §229.354(c), one commenter suggested that the requirement for a 24-hour period between exposures to ultraviolet radiation from a tanning device be changed to an 18-hour period.

Response: The department disagrees with the commenter and believes the current language more accurately reflects the guidance and recommendations provided by the FDA and tanning device manufacturers with regards to device exposure schedules and maximum frequencies of exposure. No change was made as a result of the comment.

Comment: Concerning §229.354(c), one commenter suggested omitting the proposed language requiring the individual records of a consumer to contain the consumer's date of birth due to the offensive nature of the requirement.

Response: The department disagrees with the commenter and believes the information regarding the consumer's date of birth is necessary in order for the tanning facility to effectively comply with existing restrictions pertaining to the use of tanning devices by persons under the age of 18. No change was made as a result of the comment.

Comment: Concerning §229.356(d), one commenter suggested that the proposed language requiring operators to maintain a log of the tests performed on sanitizers used in the cleaning of tanning devices should be omitted since it was unnecessary and burdensome.

Response: The department disagrees with the commenter and believes the documentation of sanitizer strength tests is necessary in order to establish that routine testing of these cleaning solutions is performed as required. No change was made as a result of the comment.

Comment: Concerning §229.356(g), two commenters requested that the proposed changes to the subsection be removed and the current language be maintained based on the belief that the changes pose an undue hardship on facility operators and that nonabsorbent flooring materials do not convey any public health benefits compared to carpeted floors.

Response: The department disagrees with the commenter and believes the transitional period since February 1994 has been sufficient time for existing tanning facilities to replace any carpeted floors in affected areas with nonabsorbent material, thereby significantly lessening any potential for undue economic hardship related to the proposed change. In addition, the department believes the proposed language is consistent with the intent of the current language to exclude carpeted floors in new or remodeled rooms containing tanning devices in an effort to facilitate the adequate cleaning and sanitation of consumer contact surfaces in these rooms. No changes were made as a result of the comments.

Comment: Concerning §229.356(g), one commenter asked that the effective date of the proposed change to this subsection be extended several months to a year beyond the effective date of other proposed sections in order to provide additional time for tanning facilities to comply with the requirement.

Response: The department disagrees with the commenter and believes that adequate time has elapsed since the requirement was implemented in 1994 to allow tanning facilities to install compliant flooring material in rooms containing tanning devices. No change was made as a result of the comment.

The amendments are adopted under Health and Safety Code, §145.011, which provides the department with the authority to adopt necessary regulations pursuant to the enforcement of Chapter 145; and §12.001, which provides the Texas Board of Health (board) with the authority to adopt rules for the performance of every duty imposed by law on the board, the department, and the commissioner of health.

This agency hereby certifies that the adoption has been reviewed by legal counsel and found to be a valid exercise of the agency's legal authority.

Filed with the Office of the Secretary of State on July 13, 2001.

TRD-200104045

Susan Steeg

General Counsel

Texas Department of Health

Effective date: August 2, 2001

Proposal publication date: February 2, 2001

For further information, please call: (512) 458-7236