P.L. 89-642 sistance programs. Expenditures of funds from State and local sources for the maintenance of food programs for children shall not be diminished as a result of funds received under this Act. SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS, AND CHILDREN SEC. 17 [42 U.S.C. 1786] (a) Congress finds that substantial numbers of pregnant, postpartum, and breastfeeding women, infants, and young children from families with inadequate income are at special risk with respect to their physical and mental health by reason of inadequate nutrition or health care, or both. It is, therefore, the purpose of the program authorized by this section to provide, up to the authorization levels set forth in subsection (g) of this section, supplemental foods and nutrition education through any eligible local agency that applies for participation in the program. The program shall serve as an adjunct to good health care, during critical times of growth and development, to prevent the occurrence of health problems, including drug abuse, and improve the health status of these persons. (b) As used in this section (1) "Breastfeeding women" means women up to one year postpartum who are breastfeeding their infants. (2) “Children” means persons who have had their first birthday but have not yet attained their fifth birthday. (3) "Competent professional authority" means physicians, nutritionists, registered nurses, dietitians, or State or local medically trained health officials, or persons designated by physicians or State or local medically trained health officials, in accordance with standards prescribed by the Secretary, as being competent professionally to evaluate nutritional risk. (4) "Costs for nutrition services and administration" means costs that shall include, but not be limited to, costs for certification of eligibility of persons for participation in the program (including centrifuges, measuring boards, spectrophotometers, and scales used for the certification), food delivery, monitoring, nutrition education, outreach, startup costs, and general administration applicable to implementation of the program under this section, such as the cost of staff, transportation, insurance, developing and printing food instruments, and administration of State and local agency offices. (5) "Infants" means persons under one year of age. (6) "Local agency" means a public health or welfare agency or a private nonprofit health or welfare agency, which, directly or through an agency or physician with which it has contracted, provides health services. The term shall include an Indian tribe, band, or group recognized by the Department of the Interior, the Indian Health Service of the Department of Health and Human Services, or an intertribal council or group that is an authorized representative of Indian tribes, bands, or groups recognized by the Department of the Interior. (7) "Nutrition education" means individual or group sessions and the provision of materials designed to improve health status that achieve positive change in dietary habits, and emphasize relationships between nutrition and health, all in keeping with the individual's personal, cultural, and socioeconomic pref erences. (8) "Nutritional risk" means (A) detrimental or abnormal nutritional conditions detectable by biochemical or anthropometric measurements, (B) other documented nutritionally related medical conditions, (C) dietary deficiencies that impair or endanger health, (D) conditions that directly affect the nutritional health of a person such as alcoholism or drug abuse, or (E) conditions that predispose persons to inadequate nutritional patterns or nutritionally related medical conditions, including, but not limited to, homelessness and migrancy. (9) "Plan of operation and administration" means a document that describes the manner in which the State agency intends to implement and operate the program. (10) "Postpartum women" means women up to six months after termination of pregnancy. P.L. 89-642 (11) "Pregnant women" means women determined to have one or more fetuses in utero. (12) “Secretary" means the Secretary of Agriculture. (13) "State agency" means the health department or comparable agency of each State; an Indian tribe, band, or group recognized by the Department of the Interior; an intertribal council or group that is the authorized representative of Indian tribes, bands, or groups recognized by the Department of the Interior; or the Indian Health Service of the Department of Health and Human Services. (14) "Supplemental foods" means those foods containing nutrients determined by nutritional research to be lacking in the diets of pregnant, breastfeeding, and postpartum women, infants, and children, as prescribed by the Secretary. State agencies may, with the approval of the Secretary, substitute different foods providing the nutritional equivalent of foods prescribed by the Secretary, to allow for different cultural eating patterns. (15) "Homeless individual" means (A) an individual who lacks a fixed and regular nighttime residence; or (i) a supervised publicly or privately operated shelter (including a (ii) an institution that provides a temporary residence for individuals intended to be institutionalized; (iii) a temporary accommodation in the residence of another individual; or (iv) a public or private place not designed for, or ordinarily used as, a regular sleeping accommodation for human beings. (16) "Drug abuse education" means (A) the provision of information concerning the dangers of drug abuse; (C) the provision of materials developed by the Secretary under sub- (17) “Competitive bidding” means a procurement process under which the Secretary or a State agency selects a single source (a single infant formula manufacturer) offering the lowest price, as determined by the submission of sealed bids, for a product for which bids are sought for use in the program authorized by this section. (18) "Rebate" means the amount of money refunded under cost containment procedures to any State agency from the manufacturer or other supplier of the particular food product as the result of the purchase of the supplemental food with a voucher or other purchase instrument by a participant in each such agency's program established under this section. (19) "Discount" means, with respect to a State agency that provides program foods to participants without the use of retail grocery stores (such as a State that provides for the home delivery or direct distribution of supplemental food), the amount of the price reduction or other price concession provided to any State agency by the manufacturer or other supplier of the particular food product as the result of the purchase of program food by each such State agency, or its representative, from the supplier. (20) "Net price" means the difference between the manufacturer's wholesale price for infant formula and the rebate level or the discount offered or provided by the manufacturer under a cost containment contract entered into with the pertinent State agency. (21) Remote indian or native village.-The term "remote Indian or Native village" means an Indian or Native village that (A) is located in a rural area; (B) has a population of less than 5,000 inhabitants; and (C) is not accessible year-around by means of a public road (as defined in section 101 of title 23). (c)(1) The Secretary may carry out a special supplemental nutrition program to assist State agencies through grants-in-aid and other means to provide, through local agencies, at no cost, supplemental foods and nutrition education to low-income P.L. 89-642 pregnant, postpartum, and breastfeeding women, infants, and children who satisfy the eligibility requirements specified in subsection (d) of this section. The program shall be supplementary to (A) the food stamp program; (B) any program under which foods are distributed to needy families in lieu of food stamps; and (C) receipt of food or meals from soup kitchens, or shelters, or other forms of emergency food assistance. (2) Subject to amounts appropriated to carry out this section under subsection (A) the Secretary shall make cash grants to State agencies for the purpose of administering the program, and (B) any State agency approved eligible local agency that applies to participate in or expand the program under this section shall immediately be provided with the necessary funds to carry out the program. (3) Nothing in this subsection shall be construed to permit the Secretary to reduce ratably the amount of foods that an eligible local agency shall distribute under the program to participants. The Secretary shall take affirmative action to ensure that the program is instituted in areas most in need of supplemental foods. The existence of a commodity supplemental food program under section 4 of the Agriculture and Consumer Protection Act of 1973 shall not preclude the approval of an application from an eligible local agency to participate in the program under this section nor the operation of such program within the same geographic area as that of the commodity supplemental food program, but the Secretary shall issue such regulations as are necessary to prevent dual receipt of benefits under the commodity supplemental food program and the program under this section. (4) A State shall be ineligible to participate in programs authorized under this section if the Secretary determines that State or local sales taxes are collected within the State on purchases of food made to carry out this section. (d)(1) Participation in the program under this section shall be limited to pregnant, postpartum, and breastfeeding women, infants, and children from low-income families who are determined by a competent professional authority to be at nutritional risk. (2)(A) The Secretary shall establish income eligibility standards to be used in conjunction with the nutritional risk criteria in determining eligibility of individuals for participation in the program. Any individual at nutritional risk shall be eligible for the program under this section only if such individual (i) is a member of a family with an income that is less than the maximum income limit prescribed under section 9(b) of the National School Lunch Act for free and reduced price meals; (ii)(I) receives food stamps under the Food Stamp Act of 1977; or (II) is a member of a family that receives assistance under the State program funded under part A of title IV of the Social Security Act that the Secretary determines complies with standards established by the Secretary that ensure that the standards under the State program are comparable to or more restrictive than those in effect on June 1, 1995; or or (iii)(I) receives medical assistance under title XIX of the Social Security Act; (II) is a member of a family in which a pregnant woman or an infant receives such assistance. (B) For the purpose of determining income eligibility under this section, any State agency may choose to exclude from income any basic allowance for housing received by military service personnel residing off military installations; and (C) In the case of a pregnant woman who is otherwise ineligible for participation in the program because the family of the woman is of insufficient size to meet the income eligibility standards of the program, the pregnant woman shall be considered to have satisfied the income eligibility standards if, by increasing the number of individuals in the family of the woman by 1 individual, the income eligibility standards would be met. (3)(A) Persons shall be certified for participation in accordance with general procedures prescribed by the Secretary. P.L. 89-642 (B) A State may consider pregnant women who meet the income eligibility standards to be presumptively eligible to participate in the program and may certify the women for participation immediately, without delaying certification until an evaluation is made concerning nutritional risk. A nutritional risk evaluation of such a woman shall be completed not later than 60 days after the woman is certified for participation. If it is subsequently determined that the woman does not meet nutritional risk criteria, the certification of the woman shall terminate on the date of the determination. (C) Physical presence. (i) In general.-Except as provided in clause (ii) and subject to the requirements of the Americans with Disabilities Act of 1990 (42 U.S.C. 12101 et seq.) and section 794 of title 29, each individual seeking certification or recertification for participation in the program shall be physically present at each certification or recertification determination in order to determine eligibility under the program. (ii) Waivers.-If the agency determines that the requirement of clause (i) would present an unreasonable barrier to participation, a local agency may waive the requirement of clause (i) with respect to (I) an infant or child who (aa) was present at the initial certification visit; and (bb) is receiving ongoing health care from a provider other than the local agency; or (II) an infant or child who (aa) was present at the initial certification visit; (bb) was present at a certification or recertificationdetermination within the 1-year period ending on the date ofthe certification or recertification determination describedin clause (i); and (cc) has one or more parents who work. (D) Income documentation.— (i) In general.-Except as provided in clause (ii), in order to participate in the program pursuant to clause (i) of paragraph (2)(A), an individual seeking certifi cation or recertification for participation in the program shall provide documentation of family income. (ii) Waivers.-A State agency may waive the documentation requirement of clause (i), in accordance with criteria established by the Secretary, with respect to or (I) an individual for whom the necessary documentation isnot available; (II) an individual, such as a homeless woman or child, forwhom the agency determines the requirement of clause (i) wouldpresent an unreasonable barrier to participation. (E) Adjunct documentation.-In order to participate in the programpursuant to clause (ii) or (iii) of paragraph (2)(A), an individual seeking certification or recertification for participation in theprogram shall provide documentation of receipt of assistance describedin that clause. (F) Proof of residency. An individual residing in a remote Indian or Native village or an individual served by an Indian tribal organization and residing on a reservation or pueblo may, under standards established by the Secretary, establish proof of residency under this section by providing to the State agency the mailing address of the individual and the name of the remote Indian or Native village. (e)(1) The State agency shall ensure that nutrition education and drug abuse education is provided to all pregnant, postpartum, and breastfeeding participants in the program and to parents or caretakers of infant and child participants in the program. The State agency may also provide nutrition education and drug abuse education to pregnant, postpartum, and breastfeeding women and to parents or caretakers of infants and children enrolled at local agencies operating the program under this section who do not participate in the program. (2) The Secretary shall prescribe standards to ensure that adequate nutrition education services and breastfeeding promotion and support are provided. The State agency shall provide training to persons providing nutrition education under this section. Nutrition education and breastfeeding promotion and support shall be evaluated annually by each State agency, and such evaluation shall include the views P.L. 89-642 of participants concerning the effectiveness of the nutrition education and breastfeeding promotion and support they have received. (3) Nutrition education materials. (A) In general.— The Secretary shall, after submitting proposed nutrition education materials to the Secretary of Health and Human Services for comment, issue such materials for use in the program under this section. (B) Sharing of materials. The Secretary may provide, in bulk quantity, nutrition education materials (including materials promoting breastfeeding) developed with funds made available for the program authorized under this section to State agencies administering the commodity supplemental food program authorized under sections 4(a) and 5 of the Agriculture and Consumer Protection Act of 1973 (7 U.S.C. 612c note; Public Law 93-86) at no cost to that program. (4) The State agency shall (A) provide each local agency with materials showing the maximum income limits, according to family size, applicable to pregnant women, infants, and children up to age 5 under the medical assistance program established under title XIX of the Social Security Act (in this section referred to as the "medicaid program"); and (B) provide to individuals applying for the program under this section, or reapplying at the end of their certification period, written information about the medicaid program and referral to such program or to agencies authorized to determine presumptive eligibility for such program, if such individuals are not participating in such program and appear to have family income below the applicable maximum income limits for such program. (C) may provide a local agency with materials describing other programs for which a participant in the program may be eligible. (5) Each local agency shall maintain and make available for distribution a list of local resources for substance abuse counseling and treatment. (f)(1) (A) Each State agency shall submit to the Secretary, by a date specified by the Secretary, an initial plan of operation and administration for a fiscal year. After submitting the initial plan, a State shall be required to submit to the Secretary for approval only a substantive change in the plan. (B) To be eligible to receive funds under this section for a fiscal year, a State agency must receive the approval of the Secretary for the plan submitted for the fiscal year. (C) The plan shall include_ (i) a description of the food delivery system of the State agency and the method of enabling participants to receive supplemental foods under the program, to be administered in accordance with standards developed by the Secretary; (ii) a description of the financial management system of the State agency; (iii) a plan to coordinate operations under the program with other services or programs that may benefit participants in, and applicants for, the program; (iv) a plan to provide program benefits under this section to, and to meet the special nutrition education needs of, eligible migrants, homeless individuals, and Indians; (v) a plan to expend funds to carry out the program during the relevant fiscal year; (vi) a plan to provide program benefits under this section to unserved and underserved areas in the State (including a plan to improve access to the program for participants and prospective applicants who are employed, or who reside in rural areas), if sufficient funds are available to carry out this clause; (vii) a plan for reaching and enrolling eligible women in the early months of pregnancy, including provisions to reach andenroll eligible migrants; (viii) a plan to provide program benefits under this section to unserved infants and children under the care of foster parents, protective services, or child welfare authorities, including infants exposed to drugs perinatally; (ix) a plan to provide nutrition education and promote breastfeeding; (D) The Secretary may permit a State agency to submit only those parts of a plan that differ from plans submitted for previous fiscal years. (E) The Secretary may not approve any plan that permits a person to participate simultaneously in both the program authorized under this section and the com |