Special Supplemental Nutrition Program for Women, Infants and Children (WIC): Vendor Cost Containment, 71708-71731 [05-23365]
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Federal Register / Vol. 70, No. 228 / Tuesday, November 29, 2005 / Rules and Regulations
DEPARTMENT OF AGRICULTURE
Food and Nutrition Service
7 CFR Part 246
RIN 0584–AD71
Special Supplemental Nutrition
Program for Women, Infants and
Children (WIC): Vendor Cost
Containment
Food and Nutrition Service,
USDA.
ACTION: Interim rule.
AGENCY:
SUMMARY: This interim rule amends the
regulations governing the Special
Supplemental Nutrition Program for
Women, Infants and Children (WIC) to
strengthen vendor cost containment.
The rule incorporates into program
regulations new legislative requirements
that affect the selection, authorization,
and reimbursement of retail vendors.
These requirements are contained in the
Child Nutrition and WIC
Reauthorization Act of 2004, enacted on
June 30, 2004. The rule reflects the
statutory provisions that require State
agencies to implement a vendor peer
group system, competitive price criteria,
and allowable reimbursement levels in
a manner that ensures that the WIC
Program pays authorized vendors
competitive prices for supplemental
foods. It also requires State agencies to
ensure that vendors that derive more
than 50 percent of their annual food
sales revenue from WIC food
instruments do not result in higher food
costs to the program than do other
vendors. The intent of these provisions
is to maximize the number of eligible
women, infants, and children served
with available Federal funding.
DATES: Effective Date: This rule is
effective December 29, 2005.
Implementation Date: State agencies
must implement the provisions of this
rule no later than December 30, 2005.
Comment Date: To be assured of
consideration, comments on this interim
rule must be received by the Food and
Nutrition Service (FNS) on or before
November 29, 2006.
ADDRESSES: FNS invites interested
persons to submit comments on this
interim rule. Comments may be
submitted by any of the following
methods:
• Mail: Send comments to Patricia
Daniels, Director, Supplemental Food
Programs Division, Food and Nutrition
Service, USDA, 3101 Park Center Drive,
Room 528, Alexandria, Virginia 22302,
(703) 305–2746.
• Web Site: Go to https://
www.fns.usda.gov/wic. Follow the
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online instructions for submitting
comments through the link at the
Supplemental Food Programs Division
Web site.
• E-Mail: Send comments to WICHQSFPD@fns.usda.gov. Include Docket ID
Number 0584–AD71, Vendor Cost
Containment Interim Rule, in the
subject line of the message.
• Federal eRulemaking Portal: Go to
https://www.regulations.gov. Follow the
online instructions for submitting
comments.
All comments submitted in response
to this interim rule will be included in
the record and will be made available to
the public. Please be advised that the
substance of the comments and the
identities of the individuals or entities
submitting the comments will be subject
to public disclosure. All written
submissions will be available for public
inspection at the address above during
regular business hours (8:30 a.m. to 5
p.m.), Monday through Friday.
FNS also plans to make the comments
publicly available by posting a copy of
all comments on the FNS Web site at
https://www.fns.usda.gov/wic.
FOR FURTHER INFORMATION CONTACT:
Debra Whitford, Chief of the Policy and
Program Development Branch,
Supplemental Food Programs Division,
at the address indicated above or at
(703) 305–2746, during regular business
hours (8:30 a.m.–5 p.m.), Monday
through Friday.
SUPPLEMENTARY INFORMATION:
Executive Order 12866
This rule has been determined to be
Significant and was reviewed by the
Office of Management and Budget under
Executive Order 12866.
Regulatory Impact Analysis
As required for all rules that have
been designated as Significant by the
Office of Management and Budget, a
Regulatory Impact Analysis was
developed for the WIC Vendor Cost
Containment Interim Rule. A complete
copy of the Impact Analysis appears in
the appendix to this rule.
Need for Action
This action is needed to implement
the vendor cost containment provisions
of the Child Nutrition and WIC
Reauthorization Act of 2004, Public Law
108–265. The rule requires WIC State
agencies to operate vendor management
systems that effectively contain food
costs by ensuring that prices paid for
supplemental foods are competitive.
The rule also responds to data which
indicate that WIC food expenditures
increasingly include payments to a type
of vendor whose prices are not governed
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by the market forces that affect most
retail grocers. As a result, the prices
charged by these vendors tend to be
higher than those of other retail grocery
stores participating in the program. To
ensure that the program pays
competitive prices, this rule codifies the
new statutory requirements for State
agencies to use in evaluating vendor
applicants’ prices during the vendor
selection process and when paying
vendors for supplemental foods
following authorization.
While the Child Nutrition and WIC
Reauthorization Act mandates that
States establish peer groups,
competitive price criteria and allowable
reimbursement levels and states that
these requirements must result in the
outcome of paying above-50-percent
vendors no more than regular vendors,
the Act does not specify particular
criteria for peer groups or acceptable
methods of setting competitive price
criteria and allowable reimbursement
levels. FNS considered mandating
specific means of developing peer
groups, competitive price criteria and
allowable reimbursement levels in order
to ensure that the outcome of this
legislation was achieved. However,
given State agencies’ responsibility to
manage WIC as a discretionary grant
program, the varying retail food market
conditions in each State, and the wide
variations in current vendor cost
containment systems operated by State
agencies, FNS believes that State
agencies need flexibility to develop
their own peer groups, competitive
price criteria and allowable
reimbursement levels.
Thus, the rule gives State agencies
flexibility to design cost containment
practices that would be effective in their
own markets and would ensure
adequate participant access. In addition,
there is little information about the
effectiveness of particular cost
containment practices in the variety of
markets represented by the 89 State
agencies. Mandating more specific
means of developing peer groups,
competitive price criteria and allowable
reimbursement levels could have
unintended, negative consequences on
participant access, food costs and
administrative burden.
As State agencies gain experience and
the results of their vendor cost
containment practices become apparent,
FNS may develop further regulations
and guidance to improve WIC vendor
cost containment. In the interim, FNS
believes that the current rule will
substantially accomplish the goal of the
Act of containing food costs and
ensuring that above-50-percent vendors
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do not result in higher costs to the
program than regular vendors.
As noted previously, FNS believes
that State agencies need flexibility to
develop their own peer groups,
competitive price criteria and allowable
reimbursement levels. Given State
agencies’ responsibility to manage WIC
as a discretionary grant program, the
varying retail food market conditions in
each State, the wide variations in
current vendor cost containment
systems operated by State agencies, the
limited amount of information about the
effectiveness of particular cost
containment practices in the variety of
markets represented by the 89 State
agencies, and the need to minimize
administrative burden, this is the most
appropriate approach for the interim
final rule.
In order to better assess the
effectiveness of specific cost
containment strategies, FNS will be
collecting and analyzing data from State
agencies, in anticipation of issuing a
final rule. This will enable the agency
to analyze the effect of particular vendor
peer group systems, competitive price
criteria, and allowable reimbursement
levels on WIC food prices, participant
access, the vendor community and a
range of other measures. FNS will also
be collecting information on
administrative burden associated with
the new requirements. This will enable
FNS to identify and consider a
reasonable number of regulatory
alternatives when considering the final
rule and adopt the most cost-effective or
least burdensome alternative that
achieves the objectives of the rule.
While we expect the final rule to be
promulgated within three years, it is
important that sufficient time be
allowed to assess the impacts of this
interim final rule before moving to alter
any of its provisions.
Benefits
The WIC Program will benefit from
the provisions of this rule by reducing
unnecessary food expenditures, which
increases the potential to serve more
eligible women, infants, and children
for the same cost. The rule should have
the effect ensuring that payments to
vendors, particularly vendors that
derive more than 50 percent of their
annual food sales revenue from WIC
food instruments reflect competitive
prices for WIC foods. Currently, the WIC
Program pays vendors whose food sales
consist primarily of WIC transactions
substantially more for supplemental
foods than it pays other authorized
vendors. Under this rule, State agencies
that choose to authorize these vendors
will demonstrate that payments to them
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do not exceed the competitive prices
paid to other vendors. FNS
conservatively estimates that
implementation of the rule will result in
a cost savings of approximately $75
million annually.
Costs
In order to comply with this rule,
State agencies will need to make onetime changes in their vendor cost
containment systems. Some State
agencies may already be in full or
partial compliance with the rule, while
others may demonstrate that they meet
the conditions for an exemption from
the vendor peer group system
requirement. Many State agencies,
particularly those that choose to
authorize vendors that rely
predominantly on WIC food instruments
for food sales revenue, will incur
additional costs and administrative
burden to achieve compliance with its
provisions. These costs are associated
with establishing or restructuring
vendor peer groups, revising
competitive price criteria and allowable
reimbursement levels for those peer
groups, collecting and monitoring
vendor shelf prices for supplemental
foods, and evaluating payments to
vendors. Variations in State agency
vendor management systems and
staffing resources make it difficult to
derive a cost estimate. State agencies
will not receive additional funds to
administer the program with these new
requirements.
Some WIC vendors, particularly
smaller stores that are not also
authorized by the Food Stamp Program,
may incur costs to compile data on their
total annual food sales. State agencies
will require this data in order to
determine, as required by law, whether
a vendor derives more than 50 percent
of their total annual food sales revenue
from WIC food instruments.
Regulatory Flexibility Act
This rule has been reviewed with
regard to the requirements of the
Regulatory Flexibility Act (5 U.S.C.
601–612). FNS does not believe this rule
will have a significant economic impact
on a substantial number of small
entities. With the high degree of State
flexibility allowable under this rule,
small entities will be impacted
differently in each State depending
upon how that State chooses to meet the
requirements set forth here. It is
therefore not feasible to accurately
estimate the rule’s impact on small
entities. As FNS is concerned about
these impacts, we plan to collect data on
the implementation of this interim final
rule and the options States select in
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order to better assess the impact for the
final rulemaking and the Final
Regulatory Flexibility Analysis and
publish it for comments.
In fulfilling the intent of the Child
Nutrition and WIC Reauthorization Act
of 2004, the rule may have a significant
economic impact on a small number of
vendors that have been authorized to
participate in the WIC Program. These
vendors tend to be smaller grocery
stores that serve WIC participants
exclusively or predominantly, have a
large volume of WIC transactions, and
are not subject to the retail market forces
that keep food prices at competitive
levels. In accordance with the law, the
rule requires that State agencies
implement effective competitive price
criteria in selecting and reimbursing
vendors, including assurance that
payments to vendors that derive more
than 50 percent of their annual food
sales revenue from WIC food
instruments do not result in higher food
costs to the program than other vendors.
Only those vendors that are able to meet
competitive pricing requirements will
be able to continue participating in the
program. Currently FNS estimates that
between three and four percent of the
approximately 45,000 authorized
vendors will need to make changes in
the prices that they offer the WIC
Program in order to be deemed
competitive.
Public Law 104–4
Title II of the Unfunded Mandates
Reform Act of 1995 (UMRA), Public
Law 104–4, establishes requirements for
Federal agencies to assess the effects of
their regulatory actions on State, local
and tribal governments and the private
sector. Under section 202 of the UMRA,
FNS generally must prepare a written
statement, including a cost benefit
analysis, for proposed and final rules
with ‘‘Federal mandates’’ that may
result in expenditures by State, local or
tribal governments, in the aggregate, or
the private sector, of $100 million or
more in any one year. When such a
statement is needed for a rule, section
205 of the UMRA generally requires
FNS to identify and consider a
reasonable number of regulatory
alternatives and adopt the most costeffective or least burdensome alternative
that achieves the objectives of the rule.
This interim rule contains no Federal
mandates (under the provisions of Title
II of the UMRA) for State, local and
tribal governments or the private sector
of $100 million or more in any one year.
Thus, the rule is not subject to the
requirements of sections 202 and 205 of
the UMRA.
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Executive Order 12372
The Special Supplemental Nutrition
Program for Women, Infants and
Children (WIC) is listed in the Catalog
of Federal Domestic Assistance under
10.557. For the reasons set forth in the
final rule in 7 CFR part 3015, subpart V
and related Notice (48 FR 29115), this
program is included in the scope of
Executive Order 12372, which requires
intergovernmental consultation with
State and local officials.
Federalism Summary Impact Statement
Executive Order 13132 requires
Federal agencies to consider the impact
of their regulatory actions on State and
local governments. Where such actions
have federalism implications, agencies
are directed to provide a statement for
inclusion in the preamble to the
regulations describing the agency’s
considerations in terms of the following
three categories called for under section
(6)(b)(2)(B) of Executive Order 13132.
Prior Consultation With State Officials
State agencies have expressed
concerns and shared information
regarding implementation of the new
vendor cost containment legislative
requirements. Because the WIC Program
is a State-administered, federally funded
program, our regional offices have
formal and informal discussions with
State agencies on an ongoing basis
regarding program implementation and
policy issues. This arrangement allows
State agencies to raise questions and
provide comments that form the basis
for many of the implementation detail
decisions in this and other WIC Program
rules. Following the enactment of Public
Law 108–265, several regional offices
convened meetings with State WIC staff
that included discussion of the vendor
cost containment provisions of this law.
As a result of these meetings, FNS
continues to receive State agency
requests for policy guidance on the
vendor cost containment requirements.
These questions have helped us make
the rule responsive to State agency
concerns.
In addition, in October 2004, the
Supplemental Food Programs Division
(SFPD) convened a meeting of WIC State
agency representatives, USDA
headquarters and regional office staff,
and an outside expert on competitive
pricing systems, to obtain more
information on State agencies’ current
vendor cost containment systems.
During the meeting, participants
identified salient issues that State
agencies are likely to confront in
implementing the new competitive
pricing requirements. Following the
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meeting, FNS received input from
additional State agencies on their
current competitive pricing policies, as
well as from representatives of retail
grocers.
Nature of Concerns and the Need To
Issue This Rule
State agencies have inquired about the
intent of the vendor cost containment
provisions, particularly as amended by
Public Law 108–265. They have asked
whether these provisions require State
agencies to improve the effectiveness of
their competitive pricing systems, or
whether they primarily address the
competitiveness of prices charged by a
comparatively small number of stores
that derive their revenue from WIC food
instruments predominantly and that
generally charge higher prices than
other authorized vendors. State agencies
also have requested clarification of the
term ‘‘comparable vendors;’’ guidance
on how to determine a vendor’s revenue
from food sales; criteria for developing
effective vendor peer groups and for
obtaining an exemption from the vendor
peer group requirement; and criteria for
identifying, grouping, and setting
allowable reimbursement levels for
stores that are likely to derive more than
50 percent of their annual revenue from
food sales from WIC transactions. Some
State agencies have expressed concern
over the potential cost of implementing
changes to their automated systems for
editing and payment of WIC food
instruments. Many have indicated that
the regulations should allow them
maximum flexibility to define the
competitive pricing approaches that best
suit their individual circumstances.
Extent to Which We Will Meet Those
Concerns
FNS has considered the impact of this
interim rule on WIC State and local
agencies. This rule makes changes
required by law that became effective
October 1, 2004. Through the
rulemaking process, FNS has attempted
to balance the need for State agencies to
meet the new competitive pricing
requirements against the administrative
challenges that State agencies are likely
to encounter in meeting them. These
challenges include the commitment of
adequate resources to configuring
vendor peer groups and allowable
reimbursement methodologies, ongoing
monitoring of vendors’ prices, and
maintaining competitive pricing over
time.
There is limited information available
on proven competitive pricing
approaches. Variations in State agency
vendor populations, geography, and
other characteristics also preclude the
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use of a standardized approach.
Therefore, this rule sets forth principles
to guide State agency efforts, while
allowing State agencies the flexibility to
meet the legislative requirements
through a variety of acceptable
approaches. The inclusion of
competitive pricing principles in this
interim rule responds to State agency
requests for criteria for developing
effective peer groups and allowable
reimbursement levels, so that foods can
be purchased at the lowest prices
consistent with maintaining adequate
participant access to vendors.
Executive Order 12988
This rule has been reviewed under
Executive Order 12988, Civil Justice
Reform, and is intended to have
preemptive effect with respect to any
State or local laws, regulations or
policies which conflict with its
provisions, otherwise impede its full
implementation, or result in any delay
of implementation of provisions beyond
the statutory implementation date
established in the Child Nutrition and
WIC Reauthorization Act of 2004, Public
Law 108–265. Section 203(e)(10) of
Public Law 108–265 amends section
17(h) of the Child Nutrition Act of 1966
by adding the new paragraph 17(h)(11)
which specifies that the State agencies
shall comply with the provisions of the
paragraph not later than 18 months after
the date of enactment. Since the
amendment was enacted on June 30,
2004, State agencies must be in
compliance by December 30, 2005. This
rule is not intended to have retroactive
effect unless so specified in the DATES
paragraph of this preamble. Prior to any
judicial challenge to the provisions of
this rule or the application of its
provisions, all applicable administrative
procedures must be exhausted.
Civil Rights Impact Analysis
FNS has reviewed this interim rule in
accordance with Departmental
Regulation 4300–4, ‘‘Civil Rights Impact
Analysis,’’ to identify and address any
major civil rights impacts the rule might
have on minorities, women, and persons
with disabilities. FNS has determined
that the rule’s intent and provisions will
not adversely affect access to WIC
services by eligible persons. All data
available to FNS indicate that protected
individuals have the same opportunity
to participate in the WIC Program as
non-protected individuals. FNS
specifically prohibits State and local
government agencies that administer the
WIC Program from engaging in actions
that discriminate based on race, color,
national origin, sex, age or disability.
Section 246.8 of the WIC regulations (7
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CFR part 246) indicates that Department
of Agriculture regulations on nondiscrimination (7 CFR parts 15, 15a and
15b) and FNS instructions ensure that
no person shall on the grounds of race,
color, national origin, age, sex, or
disability, be excluded from
participation in, be denied benefits of,
or be otherwise subjected to
discrimination under the Program.
Discrimination in any aspect of
program administration is prohibited by
Department of Agriculture regulations
on non-discrimination (7 CFR parts 15,
15a, and 15b), the Age Discrimination
Act of 1975 (Pub. L. 94–135), the
Rehabilitation Act of 1973 (Pub. L. 93–
112, section 504), and title VI of the
Civil Rights Act of 1964 (42 U.S.C.
2000d). Enforcement action may be
brought under any applicable Federal
law. Title VI complaints shall be
processed in accordance with 7 CFR
part 15. Where State agencies have
options, and they choose to implement
a particular provision, they must
implement it in such a way that it
complies with the § 246.8 of the WIC
regulations.
Paperwork Reduction Act
The Paperwork Reduction Act of 1995
(44 U.S.C. Chap. 35; see 5 CFR 1320)
requires that the Office of Management
and Budget (OMB) approve all
collections of information by a Federal
agency before they can be implemented.
Respondents are not required to respond
to any collection of information unless
it displays a current valid OMB control
number. This interim rule contains new
information collections that are subject
to review and approval by the Office of
Management and Budget. FNS is
submitting for public comment the
information collection burden that
would result from the implementation
of the provisions in this rule.
Comments are invited on: (a) Whether
the proposed collection of information
is necessary for the proper performance
of the functions of the agency, including
whether the information shall have
practical utility; (b) the accuracy of the
agency’s estimate of the burden of the
proposed collection of information,
including the validity of the
methodology and assumptions used; (c)
ways to enhance the quality, utility, and
clarity of the information to be
collected; and (d) ways to minimize the
burden of the collection of information
on those who are to respond, including
use of appropriate automated,
electronic, mechanical, or other
technological collection techniques or
other forms of information technology.
Comments may be sent to Debra R.
Whitford, Chief, Policy and Program
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Development Branch, Supplemental
Food Programs Division, Food and
Nutrition Service, U.S. Department of
Agriculture, 3101 Park Center Drive,
Room 522, Alexandria, Virginia 22302.
Comments may also be submitted via
the FNS Web site at https://
www.fns.usda.gov/wic, by following the
online instructions. In all cases, please
label your comments as ‘‘Proposed
Collection of Information: WIC Vendor
Cost Containment Interim Rule.’’ All
written comments will be open for
public inspection at the office of the
Food and Nutrition Service during
regular business hours (8:30 a.m. to 5
p.m. Monday through Friday) at 3101
Park Center Drive, Room 522,
Alexandria, Virginia 22302. All
responses to this notice will be
summarized and included in the request
for OMB approval. All comments will
be a matter of public record.
OMB Number: 0584–0043.
Expiration Date: March 31, 2007.
Type of Request: Revision of a
currently approved collection.
Abstract: The information collection
and reporting burden associated with
this interim rule meets new vendor cost
containment requirements contained in
the Child Nutrition and WIC
Reauthorization Act of 2004, Public Law
108–265. These requirements affect the
selection, authorization, and
reimbursement of WIC vendors. The
rule requires State agencies to report on
a number of factors so that FNS can
meet the goals of effectively containing
food costs by ensuring that the WIC
Program pays competitive prices for
WIC foods and providing guidance to
State agencies on best competitive
pricing practices. These include new
State Plan components, collection of
information to identify vendors that
derive more than 50 percent of their
food sales revenue from WIC food
instruments, and collection of vendor
shelf prices for WIC foods. FNS deems
this information collection and
reporting burden to be necessary in
order to fulfill the legislative
requirements and ensure State agency
compliance with the interim rule.
Section 246.4(a)(14)(xv) is a new
section on vendor cost containment. It
requires a State agency to include in the
State Plan a description of the vendor
peer group system and allowable
reimbursement levels that demonstrates
that the State agency is in compliance
with WIC cost containment provisions.
The vendor peer group description will
include the criteria used to classify
vendors into groups, the number and
types of vendors in each peer group,
identification of peer groups with
vendors that derive more than 50
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percent of their annual food sales
revenue from WIC food instruments and
comparable vendor peer groups, and the
competitive price criteria and maximum
reimbursement levels applicable to each
peer group. The State Plan also must
include the information specified in
§ 246.12(g)(4)(iv) of the interim rule on
non-profit vendors that the State agency
plans to exempt from the competitive
price criteria and allowable
reimbursement levels that are applicable
to other vendors. State agencies seeking
an exemption from the vendor peer
group requirement based on the
conditions stated in § 246.12(g)(4)(v) of
the interim rule must submit a
justification with documentation
supporting their request. The
justification will consist largely of a
detailed description of how the State
agency’s alternative vendor cost
containment system operates, with shelf
price and/or redemption data to
demonstrate that the system is as
effective as a vendor peer group system.
Under § 246.12(g)(4)(vi) of the rule,
State agencies that authorize vendors
that derive more than 50 percent of their
annual food sales revenue from WIC
food instruments must describe their
methodology for ensuring that average
payments per food instrument to such
vendors do not exceed average
payments per food instrument to
comparable vendors in order to obtain
vendor cost containment certification.
To demonstrate that their competitive
price criteria and allowable
reimbursement levels meet regulatory
requirements, State agencies will
provide the following data for selected
food instruments redeemed by vendors
that derive more than 50 percent of their
annual food sales from WIC food
instruments and regular vendors: The
number of food instruments redeemed;
average food instrument redemption
amounts and standard deviations by
peer group; and the average variance in
redemption amounts; the total dollar
amount of WIC redemptions by peer
group; and statewide weighted average
redemption prices to demonstrate
whether vendors that derive more than
50 percent of their annual food sales
from WIC food instruments resulted in
higher costs than would have occurred
if participants had used other vendors.
State agencies using EBT systems must
make similar comparisons between the
prices paid to vendors that derive more
than 50 percent of their annual food
sales revenue from WIC food
instruments and the prices paid to
comparable vendors. FNS will require
annual updating of selected food
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instrument redemption data.—874
hours
Section 246.12(g)(4)(i) requires a State
agency to collect annual food sales data
from authorized vendors and vendor
applicants in order to identify the
vendors that derive, or that may be
expected to derive, more than 50
percent of their food sales revenue from
WIC food instruments. A State agency
that elects to authorize vendors that
meet the above-50-percent criterion
must identify these vendors annually
using a methodology approved by FNS.
A State agency that chooses not to
authorize such vendors must use an
approved methodology to identify
vendor applicants that would be
expected to meet the more than 50
percent criterion if authorized.—45,178
hours.
Section 246.12(g)(4)(ii)(B) requires
State agencies to collect the shelf prices
for WIC-approved foods from authorized
retail vendors twice annually. In
meeting this requirement, a State agency
may limit data collection to prices that
have changed from a vendor’s previous
submission. A State agency also may
collect prices from a random sample of
authorized vendors and/or for selected
supplemental foods.—90,178 hours.
Respondents: WIC State agencies and
vendors.
Estimated Number of Respondents: 89
State agencies and 45,000 vendors.
Estimate of Burden: Estimates of the
information collection and reporting
burden contained in this interim rule
are detailed below.
ESTIMATED ANNUAL REPORTING BURDEN
Estimated
average
burden
hours per
response
Estimated
annual
burden
hours
Estimated
number of
respondents
Section of interim rule
Data collections
or reports
required annually
89
1 .........................
4
356
5
30
1
8
5
80
8
173
65
89
45,000
89
45,000
1 .........................
1—every three
years.
1—every three
years.
1 .........................
1 .........................
1 .........................
2 .........................
2 .........................
4
2
1
1
1
260
178
45,000
178
90,000
....................
....................
....................
....................
............................
............................
............................
............................
....................
....................
....................
....................
136,230
203
2,817,091
2,953,524
246.4(a)(14)(xv)
• Description of vendor peer group system and allowable reimbursement
levels; average redemption amounts for selected food instruments.
• Notification of exemption of non-profit vendors ............................................
• Request for exemption from vendor peer group requirement ......................
• Information required for certification of vendor cost containment system
and to monitor ongoing compliance with certification requirements.
65
246.12(g)(4)(i) ..........................................................................................................
246.12(g)(4)(ii)(B) ....................................................................................................
Burden hours due to program changes ...........................................................
Total adjustments * ..................................................................................................
Currently Approved WIC Reporting and Recordkeeping Burden Hours ................
Total Proposed WIC Reporting and Recordkeeping Burden Hours .......................
* Adjustments are due to an increase in the number of State agencies from 88 to 89.
FNS also plans an information
collection to assess the impact of this
regulation on State agencies at a later
time.
Government Paperwork Elimination
Act
FNS is committed to compliance with
the Government Paperwork Elimination
Act (GPEA), which requires Government
agencies to provide the public the
option of submitting information or
transacting business electronically to
the maximum extent possible. This
interim rule encourages WIC State
agencies to collect data from retail
vendors using electronic methods.
Good Cause Determination
As discussed above, section 203(e)(10)
of the Child Nutrition and WIC
Reauthorization Act of 2004, Public Law
108–265, contained provisions that
significantly impact vendor cost
containment in the WIC Program,
particularly the costs of vendors that
derive more than 50 percent of their
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Jkt 208001
food sales revenue from WIC food
instruments. Section 501 of Public Law
108–265 requires that guidance to
implement section 203(e)(10) of the law
be issued as soon after the date of
enactment as practicable, and authorizes
the issuance of interim final regulations.
Therefore, Under Secretary Eric M. Bost
has determined, in accordance with 5
U.S.C. 553(b), that prior notice and
comment would be unnecessary, and
that good cause exists for making this
rule effective without first publishing a
proposed rule.
Background
Retail vendors make a major
contribution to the success of the WIC
Program by providing supplemental
foods to program participants as an
extension of their normal business
practices. FNS recognizes that State
agencies must balance multiple
objectives when authorizing vendors,
i.e., they must ensure adequate
participant access to supplemental
foods; maintain effective program
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management within available
administrative resources; and pay
reasonable food costs. Therefore, State
agencies have broad authority to
authorize only those vendors needed to
best serve these objectives. Since WIC is
best served if foods are purchased for
the lowest prices, while maintaining
reasonable access for program
participants, this authority includes
eliminating vulnerability to excessive
food payments by applying competitive
price methods during and following
vendor selection, so the State agency
can serve the maximum number of
participants with limited funding.
Major amendments to the WIC
Program regulations governing food
delivery systems were last published on
December 29, 2000, at 65 FR 83248.
These amendments, referred to as the
WIC Food Delivery Systems Rule,
established mandatory vendor selection,
training, and monitoring requirements
to strengthen State agency vendor
management systems and prevent abuse
of the program. The WIC Food Delivery
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Systems Rule implemented provisions
of the William F. Goodling Child
Nutrition Reauthorization Act of 1998,
Public Law 105–336 (which amended
the Child Nutrition Act of 1966, 42
U.S.C. 1786), that required State
agencies to identify high-risk vendors,
conduct compliance buys on high-risk
vendors, and consider food prices in the
selection of vendors. State agencies
were required to implement the
provisions of the WIC Food Delivery
Systems Rule no later than October 1,
2002.
The use of a price criterion in the
vendor selection process has been a
critical first step in ensuring that the
WIC Program pays competitive prices
for supplemental foods. Appropriate
application of this criterion, coupled
with price limitations on the amount
that the State agency will pay vendors
subsequent to authorization, is essential
to successful food cost containment.
The WIC Food Delivery Systems Rule
authorized State agencies to make price
adjustments to the purchase price on
food instruments submitted by the
vendor for redemption to ensure
compliance with the price limitations
applicable to the vendor.
The Child Nutrition and WIC
Reauthorization Act of 2004 (Pub. L.
108–265) amended the Child Nutrition
Act of 1966 (CNA) to reinforce and
strengthen the use of competitive price
criteria and price limitations for vendor
cost containment. It expanded the
competitive pricing requirement of the
WIC Food Delivery Systems Rule to
address the application of competitive
pricing methods to vendors that derive
their revenue from food sales
predominantly, if not exclusively, from
WIC food instruments. The prices that
such stores (often referred to as ‘‘WIConly stores’’) charge for supplemental
foods are generally higher than prices of
other authorized retailers. Recent trends
showing an annual increase in the
number of WIC-only stores and in the
percentage of the total WIC redemptions
that they receive were a primary factor
in the development of the vendor cost
containment provisions of Public Law
108–265. Congress intended that the
authorization of WIC-only stores should
not result in higher food costs than if
program participants used their food
instruments in regular grocery stores.
Section 203(e)(10) of Public Law 108–
265 amended section 17(h)(11) of the
CNA to address the emergence of such
vendors in the WIC Program because of
their potential adverse impact on the
future cost of the program particularly if
these trends continue. The vendor cost
containment provisions of this interim
rule will promote sound stewardship of
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taxpayer dollars; help ensure that the
WIC Program continues to rely on
market forces to contain food costs; and
protect the program’s ability to serve the
greatest number of eligible women,
infants, and children.
Overview of the New Vendor Cost
Containment Requirements
In accordance with section 203(e)(10)
of Public Law 108–265, this interim rule
requires State agencies to implement
competitive pricing systems that foster
financial integrity and the most efficient
use of their food funds. When State
agencies craft these systems properly,
they will not pay higher prices than
necessary for supplemental foods. While
State agencies have the discretion to
determine many of the details of their
competitive pricing approaches, section
203(e)(10) of Public Law 108–265 now
requires them to establish a vendor peer
group system, and competitive price
criteria and allowable reimbursement
levels for each vendor peer group.
Previously, the use of peer groups in
competitive pricing systems was
optional under § 246.12(g)(4)(i) of the
WIC regulations.
This rule also implements new
legislative requirements for State
agencies that choose to authorize forprofit vendors that derive more than 50
percent of their revenue from food sales
from WIC food instruments. It requires
State agencies to ensure that vendors
that meet, and vendor applicants that
are expected to meet, the more than 50
percent criterion are cost neutral to the
program. (Note: This preamble will refer
to vendors that meet or are expected to
meet the more than 50 percent criterion
as ‘‘above-50-percent vendors.’’) The
first cost neutrality requirement in
section 203(e)(10) of Public Law 108–
265 is that payments to above-50percent vendors may not result in
higher food costs than if program
participants purchased their WIC foods
at regular vendors. The second cost
neutrality requirement is that average
payments per food instrument to above50-percent vendors may not be higher
than average payments per food
instrument to comparable vendors.
Comparable vendors cannot be other
vendors that meet the above-50-percent
criterion.
To achieve the cost neutrality
requirements, section 203(e)(10) of
Public Law 108–265 requires State
agencies that authorize above-50percent vendors to distinguish between
these vendors and regular vendors when
establishing vendor peer groups,
competitive price criteria, and allowable
reimbursement levels. In determining
competitive prices for WIC foods and
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71713
establishing allowable reimbursement
levels, State agencies would be required
to compare above-50-percent vendors
with regular vendors, i.e., vendors that
set their prices based on market forces
and that compete for non-WIC
customers. Since the WIC Program
receives a finite amount of funding
annually to serve as many participants
as this funding allows, it is necessary for
each State agency to implement a
system that ensures foods are acquired
at the most economical cost consistent
with participant access needs. Clearly,
reducing the costs to the program of
vendors that have historically charged
high prices for supplemental foods is
imperative. Consistent with section
203(e)(10) of Public Law 108–265, this
rule reflects the fact that State agencies
have clear authority not to authorize any
above-50-percent vendors.
As set forth in section 203(e)(10) of
Public Law 108–265, this rule allows
FNS to exempt a State agency, under
certain conditions, from the requirement
to establish a vendor peer group system.
It would also allow State agencies to
exempt from competitive price criteria
and allowable reimbursement levels
pharmacies that supply only exempt
infant formula or medical foods under
the program; non-profit vendors that
derive more than 50 percent of their
revenue from food sales from WIC food
instruments; and non-profit vendor
applicants that are likely to meet the
above-50-percent criterion.
Implementation of This Interim Rule
Section 203(e)(10) of Public Law 108–
265 requires State agencies to
implement the provisions included in
this interim rule by December 30, 2005.
Therefore, State agencies must take all
steps that are necessary, including
compliance with any applicable State
rulemaking or legislative requirements,
in order to establish policies to comply
with the requirements of this rule by
December 30, 2005. To facilitate
implementation of the interim rule, this
preamble addresses comments and
questions that State agencies have
presented regarding the requirements to
establish vendor peer groups,
competitive price criteria, and allowable
reimbursement levels. This preamble
also discusses criteria for developing
effective vendor peer groups and for
obtaining an exemption from the vendor
peer group requirement. It also clarifies
the meaning of key concepts, such as
‘‘comparable vendors,’’ and describes
appropriate ways to identify above-50percent vendors.
This preamble recognizes that
applying competitive pricing techniques
to contain food costs remains a
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challenge for some State agencies.
Recently, several State agencies have
conducted formal analyses of their
competitive pricing systems and, as a
result, are in the process of planning or
implementing changes to enhance
system performance. FNS believes that
State agencies will continue learning
and adopting more efficient ways of
containing food costs through
competitive pricing systems. Therefore,
this preamble offers principles to assist
State agencies in assessing the
performance of their competitive pricing
systems as they make modifications to
comply with the mandatory changes
covered by this interim rule.
Vendor Peer Group System
General Requirement
Section 203(e)(10)(A) of Public Law
108–265 added section 17(h)(11)(A) to
the CNA to require each State agency to
establish a vendor peer group system,
except in certain circumstances. This
interim rule incorporates the legislative
requirement into § 246.12(g)(4) of the
WIC regulations. A vendor peer group
system is a means of classifying
authorized vendors into groups based
on common characteristics that affect
food prices. The purpose of peer groups
is to facilitate the application of
competitive price criteria at vendor
authorization and during the food
instrument redemption process. When a
vendor peer group system is properly
constructed, the prices that vendors
within a peer group charge for WIC
foods will be more similar internally
than they are to the prices charged by
other peer groups; and the peer group
system should account for most of the
food price variations. A State agency
that did not have a vendor peer group
system at the time Public Law 108–265
was enacted in June 2004 must
implement such a system by December
30, 2005.
Many State agencies already have a
vendor peer group system. The structure
and use of peer groups varies widely.
Vendor peer groups are often
established based on a combination of
two factors—vendor size and vendor
location. Vendor size may be
determined through a variety of factors,
such as total business volume, WIC
business volume, square footage of
store, number of cash registers (or point
of sale devices), or type of store (e.g.,
supermarket, grocery store, convenience
store, military commissary, nonprofit
co-op, or pharmacy). Vendor location is
often divided into geographic categories,
such as urban, suburban, and rural,
which may also include a number of
subcategories within the State. Some
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State agencies use three criteria in
establishing peer groups.
Some State agencies use peer groups
to set the competitive price range for
WIC foods, assess whether a vendor
applicant’s prices are competitive, and
to establish maximum reimbursement
levels for WIC food instruments. Others
use vendor peer groups to assess the
competitiveness of a vendor applicant’s
prices, but they do not limit
reimbursements based on a vendor’s
peer group. Instead, these State agencies
apply a single statewide maximum
reimbursement level for each food
instrument type to all peer groups.
Section 246.12(g)(4) of the interim rule,
in implementing section 17(h)(11)(A)(i)
of the CNA, clarifies that a State agency
must establish competitive price criteria
and allowable reimbursement levels that
are applicable to each peer group.
Because characteristics of the retail
grocery marketplace vary from State to
State, this interim rule continues to
allow State agencies broad latitude in
establishing peer groups. To ensure that
vendor peer group systems continue to
be effective, § 246.12(g)(4)(ii) of this rule
requires State agencies to assess their
peer groupings at least every three years
and to modify them as necessary. It also
indicates that a State agency may
change the peer group into which it
places a vendor whenever it determines
that such action is warranted.
Specific Requirements
Section 17(h)(11)(A)(III) of the CNA
requires a State agency that chooses to
authorize for-profit vendors that derive
or are expected to derive more than 50
percent of their annual revenue from
food sales from WIC food instruments to
distinguish between the above-50percent vendors and regular retail
vendors for cost containment purposes.
Accordingly, § 246.12(g)(4)(i) of this rule
requires a State agency that chooses to
authorize any above-50-percent vendors
to distinguish between these vendors
and regular vendors in its peer group
system. In meeting this requirement, a
State agency may establish separate peer
groups for above-50-percent vendors or
place them in peer groups with regular
vendors, but establish distinct
competitive price criteria and allowable
reimbursement levels for the above-50percent vendors within the peer groups.
Both approaches require a State agency
to compare the prices of above-50percent vendors against the prices of
regular retail vendors for vendor
selection and reimbursement purposes.
A State agency’s vendor peer group
system must meet this requirement
unless the State agency chooses not to
authorize any above-50-percent vendors.
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In the past, State agencies that
authorized a specific type of vendor
known as WIC-only stores have tended
to place them into separate peer groups
where their prices were compared with
other WIC-only stores. This practice
generally has resulted in the payment of
higher prices to WIC-only vendors than
to regular retail vendors. In many
instances, payment of higher prices to
WIC-only vendors was unnecessary
because other competitively-priced
vendors were accessible to WIC
participants. In implementing this rule,
a State agency that authorizes any
above-50-percent vendors would be
required to determine whether it is more
effective, from a cost containment
perspective, to group them with regular
retail vendors than by themselves, and
if so, how to group them with regular
vendors without inflating the peer
group’s prices.
Some State agencies have expressed
the view that grouping above-50-percent
vendors with regular vendors would
increase a State agency’s ability to
monitor their prices; provide an
incentive for such vendors to offer
competitive prices; and help a State
agency hold them to the same pricing
standard as regular retail vendors. State
agency arguments against this approach
include the likelihood that the prices of
above-50-percent vendors would be too
high to allow them to be grouped with
regular vendors. State agencies also
thought that above-50-percent vendors
would skew the average prices for the
peer group. Section 246.12(g)(4)(i) of
this interim rule states that State
agencies must ensure that the prices of
above-50-percent vendors do not inflate
the competitive price criteria and
allowable reimbursement levels
applicable to each peer group.
When a State agency assigns above50-percent vendors to a peer group with
regular vendors, it must use the prices
of the regular vendors within the peer
group to establish the competitive price
criteria and allowable reimbursement
level for the above-50-percent vendors.
If a State agency assigns above-50percent vendors to separate peer groups,
the State agency may not reimburse
them at a higher level than that for peer
groups consisting of comparable regular
vendors.
In identifying vendors that are
comparable to above-50-percent
vendors, the State agency must consider
geographic area; however, the State
agency has the discretion to determine
how much weight to give to geographic
considerations. The State agency may
interpret comparability differently for
regular retail vendors than for above-50percent vendors. For example, a State
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agency might determine that geographic
location and number of cash registers
adequately define peer groups for
regular vendors, but that it must utilize
an additional criterion, such as WIC
sales volume, to identify stores that are
comparable to the above-50-percent
vendors.
Identifying Above-50-Percent Vendors
In order to comply with requirements
of section 17(h)(11)(A)(III) of the CNA
with regard to above-50-percent
vendors, § 246.12(g)(4)(i) of this interim
rule requires each State agency to
determine on an annual basis whether
any authorized vendors meet the more
than 50 percent criterion and whether
each new vendor applicant is expected
to meet it. In making its determination,
the State agency would be required to
consider a vendor’s annual revenue
from the sale of food items. Under this
rule, revenue from the sale of food items
means the sum of all payments
(including, cash, Food Stamp Program
and WIC redemptions, and credit/debit
transactions) received by the vendor for
the sale of foods that can be purchased
under the Food Stamp Program (FSP).
Currently, there is no standard
definition of ‘‘food sales’’ used in the
retail food industry. Since
approximately 85 percent of current
WIC vendors are authorized by the Food
Stamp Program, most vendors are
familiar with the eligible food items and
there would be a consistent definition of
food sales between WIC and the FSP.
Vendors that utilize scanning
equipment during the checkout process
are able to flag foods that are eligible for
purchase with food stamp benefits and,
thus, to capture the total sales amount.
Eligible food sales include sales of
foods intended for home preparation
and consumption, including meat, fish,
and poultry; bread and cereal products;
dairy products; and fruits and
vegetables. Items such as condiments
and spices, coffee, tea, cocoa, and
carbonated and noncarbonated drinks
may be included in food sales when
they are offered for sale along with the
abovementioned foods. Items that
cannot be purchased using food stamp
benefits include, but are not limited to,
hot foods and food that will be eaten in
the store. This rule does not require that
a vendor be authorized by the Food
Stamp Program.
State agencies must use the following
approach to identify above-50-percent
vendors. State agencies may use
additional methods, if approved by
FNS.
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1. Current Vendors
To determine whether a currently
authorized vendor meets the more than
50 percent criterion, the State agency
must calculate WIC redemptions as a
percent of the vendor’s total foods sales
for the same period. If WIC redemptions
are more than 50 percent of the total
food sales, the vendor must be deemed
to be an above-50-percent vendor. As an
initial step in identifying above-50percent vendors, the State agency
should compare each vendor’s WIC
redemptions to FSP redemptions for the
same period. If more than one WIC State
agency authorizes a particular vendor,
then each State agency must obtain and
add the WIC redemptions for each State
agency that authorizes the vendor to
derive the total WIC redemptions. Most
WIC vendors also have FSP
authorization and, consequently, have
FSP redemptions. If FSP redemptions
exceed WIC redemptions, no further
assessment would be required. The
vendor clearly would not be an above50-percent vendor.
For vendors whose WIC redemptions
exceed their FSP redemptions, further
assessment would be required. The
State agency should ask these vendors
to provide the total amount of revenue
obtained from the sale of foods that
could be purchased using food stamp
benefits. The State agency should
request documentation (such as tax
documents or other verifiable
documentation) to support the amount
of food sales claimed by the vendor.
After evaluating the documentation
received from the vendor, the State
agency must calculate WIC redemptions
as a percent of total food sales and
classify the vendor as meeting or not
meeting the more than 50 percent
criterion.
For vendors that are not authorized by
the FSP, the State agency should clarify
the types of foods that may be included
in food sales, using the list of eligible
and ineligible food items that applies to
FSP retailers. The State agency should
request and evaluate verifiable
documentation on the store’s revenue
from food sales and classify the vendor
as appropriate.
2. Vendor Applicants
As part of the vendor application
process, the State agency must ask
vendor applicants whether they expect
to derive more than 50 percent of their
annual revenue from the sale of food
items from transactions involving WIC
food instruments. This question applies
whether or not the State agency chooses
to authorize above-50-percent vendors.
Vendor applicants include a new store
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71715
location for any ownership entity that
currently has a WIC authorized store, as
well as an entirely new vendor
applicant. If the vendor applicant’s
answer is ‘‘yes,’’ no further assessment
would be necessary. The State agency
would treat this vendor as likely to meet
the more than 50 percent criterion, if the
vendor were authorized.
The State agency would further assess
all other vendor applicants using the
following indicators to determine
whether they would be expected to meet
the more than 50 percent criterion if
authorized. First, the State agency must
calculate WIC redemptions as a percent
of total food sales in existing WICauthorized stores owned by the vendor
applicant. Secondly, the State agency
must calculate or request from the
vendor applicant the percentage of
anticipated food sales by type of
payment, i.e., cash, FSP, WIC, and
credit/debit card. Thirdly, the State
agency must request and review
inventory invoices to determine if the
vendor will offer for sale on a
continuous basis a variety of meats,
poultry or fish; breads or cereals;
vegetables or fruits; and dairy products.
Fourthly, the State agency must
determine whether WIC authorization is
required in order for the store to open
for business. To the extent possible, the
State agency should validate
information received from the vendor
applicant against other data sources.
Use of the percent of anticipated food
sales by payment type provides
information on WIC as a percentage of
total food sales. Having a variety of
foods other than supplemental foods
would indicate that the vendor has or
expects to have non-WIC sales. If the
vendor is already operating a viable
business without WIC transactions, this
might indicate that the vendor will not
be dependent upon WIC as a primary
source of revenue. These indicators
should provide the State agency with
sufficient information on which to base
its assessment of a vendor applicant. At
its discretion, the State agency may use
additional data sources and
methodologies.
The State agency must maintain
documentation indicating the basis for
its determination as to whether a
current vendor or vendor applicant
meets or is expected to meet the more
than 50 percent criterion. Section
246.12(g)(4)(i) of the interim rule
requires the State agency to assess the
accuracy of its determination within six
months of authorizing the new vendor
to determine whether the vendor should
have been authorized, and/or to ensure
that the State agency is applying the
appropriate competitive price criteria
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and allowable reimbursement level to
the new vendor. If necessary, the State
agency would terminate the vendor
agreement or reassign the vendor to the
appropriate peer group based on this
assessment.
Acceptable Vendor Peer Group
Methodologies
Structuring an effective vendor peer
group system involves an ongoing
process of monitoring the prices
vendors charge for supplemental foods
and adjusting the peer groups as needed
for better cost containment. FNS
believes State agencies should not view
peer groups as permanent or fixed
designations; rather, they should be
prepared to modify the vendor peer
group structure when needed based on
price data (i.e., shelf prices, bid prices,
food instrument redemption data, and
market surveys) and other information.
For example, a State agency that fails
to distinguish between different types of
vendors (e.g., chain stores, large
independent stores, and small
neighborhood grocery stores) in a
particular geographic area might be
overlooking pricing variations or
characteristics that are apparent when
these vendors are further classified by
type or size of store. While a State
agency might find it easier to manage
peer groups constructed solely on the
basis of geographic location, creating
peer groups that further differentiate
between vendors could improve cost
containment by allowing the State
agency to replace a single high
allowable reimbursement level for a
geographic area with several lower
allowable reimbursement levels tailored
to the prices of each subgroup of
vendors in the area. A State agency
should consider the effectiveness of
such alternative approaches in
implementing a vendor peer group
system.
Available information on the effective
design of vendor peer groups for cost
containment purposes suggests that
State agencies could benefit from
applying two principles to this process.
1. Peer Group Criteria
A State agency should use a sufficient
number of criteria to differentiate
between vendors and account for
variations in price. Criteria used by one
State agency may not have the same
effect when used by another State
agency. Available data suggest that State
agencies benefit from using geographic
location as a criterion in establishing
peer groups, and that the use of two or
more criteria is preferable to using a
single criterion. Therefore,
§ 246.12(g)(4)(ii) of the interim rule
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requires a State agency to use at least
two criteria in establishing peer groups,
one of which must be a measure of
geographic location. Under
§ 246.12(g)(4)(ii), a State agency may
receive FNS approval to use a single
criterion to establish vendor peer
groups. FNS approval will be based on
a State agency’s demonstration that the
use of a single criterion significantly
accounts for variations in prices among
vendors, and that using a second
criterion would not further contain food
costs. The State agency’s peer group
criteria, including its criteria for
identifying above-50-percent vendors
and vendors that are comparable to
above-50-percent vendors, are not
subject to administrative review under
§ 246.18(a)(1)(iii) of the interim rule.
The public has an opportunity to
comment on these criteria as part of the
State Plan process; thus interested
parties should use this process to
provide input. FNS must review and
approve peer group-related criteria as
part of the State Plan process.
2. Periodic Assessment of Peer Group
Structure
To ensure that vendor peer groups
remain effective, § 246.12(g)(4)(ii) of this
interim rule requires the State agency to
assess its peer groupings at least every
three years and make adjustments as
necessary. This process would include
using statistical methods to verify the
appropriateness of the peer group
criteria and the methodology for
establishing competitive price. The
State agency is encouraged to work with
its vendor advisory group in this
process.
Exemptions From Peer Group
Requirements
In accordance with section
17(h)(11)(A)(ii) of the CNA, the interim
rule (§ 246.12(g)(4)(v)) establishes two
conditions under which FNS may grant
a State agency an exemption from the
peer group requirements. The first
condition applies to a State agency that
elects not to authorize any above-50percent vendors. The State agency must
demonstrate to FNS that establishing a
vendor peer group system would be
inconsistent with efficient and effective
operation of the program, or that its
alternative cost containment system
would be as effective as a peer group
system.
The second condition for an
exemption applies to a State agency that
authorizes above-50-percent vendors.
The WIC redemptions of above-50percent vendors authorized by the State
agency must be less than five percent of
the State agency’s total WIC
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redemptions (dollars) in the year
preceding a year in which the
exemption is effective. By law, the State
agency must demonstrate that its
alternative vendor cost containment
system would be as effective as a vendor
peer group system and would not result
in higher costs if program participants
transact their food instruments at above50-percent vendors rather than at
regular vendors.
1. Request for Exemption
A State agency that believes it meets
either of the conditions for an
exemption may request from FNS an
exemption from the vendor peer group
system requirement. A State agency
proposing an alternative cost
containment system must support its
request with a detailed description of
the alternative cost containment system,
including documentation that compares
the potential costs and benefits of a peer
group system with the costs and benefits
of the State agency’s alternative cost
containment system. Justifications based
solely on insufficient time or resources
to implement a vendor peer group
system would not be acceptable. If the
State agency elects to authorize any
above-50-percent vendors, the State
agency’s alternative cost containment
system justification must include a
detailed description of how the State
agency will establish competitive price
criteria and allowable reimbursement
levels for above-50-percent vendors as
compared to regular vendors. The
justification must include the average
payments that the State agency would
make to above-50-percent vendors and
to regular vendors for either the
standard food packages or the most
frequently issued food instrument types
for women, infants, and children.
Rather than presenting an alternative
cost containment system, a State agency
that elects not to authorize any above50-percent vendors may request an
exemption from the vendor peer group
system requirement by providing a
detailed explanation of why
implementation of a peer group system
would be inconsistent with the efficient
and effective operation of the program
in the State. The State agency’s
explanation might address such factors
as the number of WIC participants
served, the degree of variability in food
prices and types of vendors, the number
of vendors authorized, the State
agency’s average food package costs,
and previous experience with a vendor
peer group system.
If the State agency seeks an exemption
because payments to above-50-percent
vendors comprise less than five percent
of total WIC redemptions, the State
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agency’s submission to FNS must also
include redemption data. The data must
include the total dollar amount of all
WIC redemptions and the dollar amount
and percentage of WIC redemptions
attributable to above-50-percent vendors
in the fiscal year preceding the year for
which an exemption is sought.
FNS will review the information
submitted by the State agency and
determine whether the State agency
qualifies for an exemption. A State
agency that obtains an exemption from
the peer group requirement still must
establish competitive pricing criteria for
vendor selection and allowable
reimbursement levels.
2. Term of Exemption
An exemption from the peer group
requirement would remain in effect
until the State agency no longer meets
the conditions in § 246.12(g)(4)(v) on
which the exemption was based (e.g.,
redemptions to above-50-percent
vendors comprise more than five
percent of the total annual WIC
redemptions); until FNS notifies the
State agency that it has revoked the
exemption for cause; or for three years,
whichever occurs first. During the
period of the exemption, the State
agency must provide to FNS annually
documentation that it either authorizes
no above-50-percent vendors or that
such vendors’ redemptions continue to
represent less than five percent of total
WIC redemptions, depending on the
terms of the exemption.
Competitive Pricing
General Requirement
The use of price criteria in vendor
authorization and reauthorization is a
primary mechanism in vendor cost
containment. In accordance with section
17(h)(11)(B) of the CNA, § 246.12(g)(4)
of this rule requires the State agency to
establish competitive price criteria for
each peer group for the selection of
vendors for participation in the
program. Competitive price criteria
allow the State agency to determine
whether the prices charged by a vendor
applicant are competitive with prices
charged by other vendors. In
determining whether a vendor
applicant’s prices are competitive, the
State agency is required to consider
either the vendor’s shelf prices or the
prices the vendor bid for supplemental
foods, which may not exceed the
vendor’s shelf prices.
The competitive pricing requirement
in section 17(h)(11)(B) of the CNA
largely restates the requirement
established by section 203(l) of the
Goodling Act (Pub. L. 105–336) and
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implemented through the WIC Food
Delivery Rule at § 246.12(g)(3)(i). WIC
regulations, as amended by the WIC
Food Delivery Rule, require the State
agency to apply a competitive price
criterion during the vendor selection
process by comparing the prices a
vendor applicant charges for
supplemental foods to the prices
charged by other vendor applicants and
authorized vendors. State agencies have
implemented this provision in different
ways. For example, some use historical
data, such as average prices of redeemed
food instruments, to establish dollar
limits against which they evaluate a
vendor applicant’s prices. Other State
agencies use the prices for WIC food
items submitted by a vendor applicant
to calculate the amount the applicant
would charge for a standard
combination of WIC foods or for
selected WIC food packages. They then
compare this result with what other
vendor applicants and currently
authorized vendors in the same peer
group would charge for the same foods
or food packages. Some State agencies
apply multiple criteria when assessing
the competitiveness of a vendor
applicant’s prices, for example,
requiring a vendor’s prices to be within
a certain percentage of the average food
instrument redemption prices of
authorized vendors in its peer group
and within a certain percentage of the
average retail price for individual WIC
foods.
The competitive price range also
varies among State agencies. State
agencies that compare a vendor
applicant’s prices against an average
redemption price for selected food
instruments or against average prices for
individual WIC foods have allowed the
applicant’s prices to exceed the peer
group average by amounts ranging from
5 percent to 30 percent. In addition,
State agencies differ regarding whether
they consider factors such as
transportation costs or current
wholesale costs of WIC foods when
assessing a vendor applicant’s prices.
Under this interim rule State agencies
retain flexibility in establishing
competitive price selection criteria. FNS
encourages State agencies, in
implementing this rule, to re-examine
the standards that they use to assess the
prices of vendor applicants and
currently authorized vendors to
determine if they are paying competitive
prices for supplemental foods. In this
process, State agencies should ensure
that they are paying the lowest prices
for WIC foods by authorizing vendors
whose prices fall at the lower end of the
State agency’s competitive range and
that are needed to ensure participant
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71717
access to WIC foods. Section
246.12(g)(1) of the WIC regulations has
been amended to clarify the cost
containment emphasis in addition to
authorizing an appropriate number and
distribution of vendors in order to
ensure participant access to
supplemental foods and effective State
agency management, oversight, and
review of its authorized vendors. This
requirement, in combination with the
competitive pricing requirement, should
enable the State agency to select a
vendor population that is manageable
both administratively and from a cost
perspective.
Specific Requirements
In accordance with section
17(h)(11)(B) of the CNA, this interim
rule requires State agencies to establish
and apply appropriate competitive price
criteria in keeping with several specific
requirements.
1. Participant Access
Under § 246.12(g)(4) of this rule, the
State agency must consider participant
access by geographic area in
establishing competitive price criteria.
This means that the State agency may
not deny authorization to a vendor that
is needed to ensure participant access to
supplemental foods because that
vendor’s prices do not meet the
competitive price criteria for the
vendor’s peer group. The assumption is
that there are no alternative vendors in
the area with prices that meet the State
agency’s competitive price selection
criteria and that, bearing in mind where
participants typically shop, there is no
other practical way to provide WIC
foods. In such instances, FNS would
encourage the State agency to negotiate
with the vendor, if possible, to secure
lower prices for WIC participants than
the prices the vendor charges other
customers. The authorization of vendors
whose prices exceed the competitive
price selection criteria, but that are
needed for participant access, should be
the exception and not the rule. The
State agency has sole discretion to make
participant access determinations. The
validity or appropriateness of the State
agency’s participant access criteria and
the State agency’s participant access
determinations are not subject to appeal
(§ 246.18(a)(1)(iii)(B)).
2. Vendors that Meet the More-than-50Percent Criterion
If a State agency chooses to authorize
above-50-percent vendors,
§ 246.12(g)(4)(i) of the interim rule
requires the State agency to establish
distinct competitive price selection
criteria for such vendors. To comply
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with the competitive pricing
requirement in section 17(h)(11)(B) of
the CNA, the State agency would not
necessarily have to achieve lower
program costs when food instruments
are transacted at above-50-percent
vendors, rather than at regular retail
vendors. The State agency would,
however, be required to demonstrate to
FNS that its competitive price criteria
and allowable reimbursement levels for
above-50-percent vendors do not result
in average payments per food
instrument that are higher than average
payments per food instrument to
comparable vendors that do not meet
the more-than-50-percent criterion. In
addition, competitive price criteria may
not result in higher total food costs if
participants use their food instruments
at above-50-percent vendors rather than
at regular vendors. This means that the
total payments to above-50-percent
vendors for supplemental foods may not
exceed the total amount that the State
agency would have paid to regular
vendors for the same types and
quantities of supplemental foods.
To determine whether a State agency
is meeting the requirement that above50-percent vendors do not result in
higher food costs than regular vendors,
the State agency must compare the
average cost per food instrument
redeemed at above-50-percent vendors
to the average cost per food instrument
redeemed at regular vendors. The State
agency must compute statewide average
redemption amounts for each type of
food instrument redeemed or for each
distinct combination of foods on
redeemed food instruments, depending
on whether or not the State agency uses
standardized food instrument types. The
average cost per food instrument must
be weighted to reflect the relative
proportion of food instruments
redeemed by each vendor peer group.
By using a weighted average, the State
agency takes into account the frequency
with which vendors redeem food
instruments of varying redemption
amounts. If a State agency makes more
payments to vendors that offer the
lowest prices for WIC foods, a weighted
average will reflect this fact more than
a simple average. The weighted average
correlates with WIC participants’
shopping patterns by giving the most
weight to redemption prices of stores
with the largest number of WIC
transactions. The following charts
display the weighted average
redemption amounts for an infant
formula food instrument (type ABC)
redeemed by regular vendors and above50-percent vendors.
Chart 1: Weighted Average
Redemption Amounts for Regular
Vendors
CHART 1.—WEIGHTED AVERAGE REDEMPTION AMOUNTS FOR REGULAR VENDORS
Average redemption
amount (dollars)
FI Type ABC
Peer group number
1
2
3
4
Number and percent of
redeemed food instruments
Type ABC
Number
Weight
%
...........................................................................................................................................
...........................................................................................................................................
...........................................................................................................................................
...........................................................................................................................................
$ 81.51
111.56
113.89
110.93
8,481
54,748
217,684
758,175
0.82
4.99
21.01
73.18
0.008
0.050
0.210
0.732
Total ..............................................................................................................................
........................
1,036,088
100.00
1.000
Weighted average redemption amount .......................................................................................................................................................
$113.66
Simple average of all 1,036,088 redemption amounts ...............................................................................................................................
$108.26
CHART 2.—WEIGHTED AVERAGE REDEMPTION AMOUNTS FOR ABOVE-50-PERCENT VENDORS
Average redemption
amount (dollars)
FI Type ABC
Peer group number
1
2
3
4
...........................................................................................................................................
...........................................................................................................................................
...........................................................................................................................................
...........................................................................................................................................
Number
%
0.000
0.003
0.068
0.928
Total .............................................................................................................................. ........................
150,112
100.00
Weighted average redemption amount .......................................................................................................................................................
Simple average of all 150,112 redemption amounts ..................................................................................................................................
1.000
$128.38
$127.35
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the corresponding weight, adding these
individual sums, and dividing this total
by the sum of the weights used in the
calculation.) In Chart 1 the weighted
average redemption amount of $113.66
for food instrument ABC redeemed by
regular vendors is $5.40 more than the
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43
513
10,242
139,314
Weight
0.03
0.34
6.82
92.81
The weighted average redemption
amounts for food instrument type ABC
shown in the preceding charts were
calculated using a standard statistical
formula. (The formula derives the
weighted average by multiplying each
food instrument redemption amount by
$130.68
128.94
125.09
127.96
Number and percent of
redeemed food instruments
Type ABC
simple average redemption amount of
$108.26. The weighted average more
accurately reflects the cost of these food
instruments to the State agency than
does the simple average. The weighted
average indicates that the State agency
paid substantially more food
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instruments at higher redemption prices
than at lower prices. In Chart 2 the
weighted average redemption amount of
$128.38 for food instrument ABC
redeemed by above-50-percent vendors
exceeds the simple average redemption
amount by $1.03. In this instance the
difference between the simple average
and the weighted average cost of food
instrument ABC is not as large as it was
for the same food instrument redeemed
by regular vendors because 93 percent
of the food instruments were redeemed
by vendors in the same peer group.
There was also less variation in the
individual food instrument redemption
amounts. The weighted average captures
the impact of this redemption pattern.
Charts 1 and 2 show the disparity in
payments for infant formula made to
regular vendors and above-50-percent
vendors. When State agencies
implement competitive price criteria
and allowable reimbursement levels as
required in this interim rule, weighted
average redemption amounts of food
instruments redeemed by above-50percent vendors should not exceed
weighted average redemption amounts
for the same food instruments redeemed
by regular vendors. In general, for
above-50-percent vendors to not result
in higher costs to the program than
regular vendors, the State agency’s
payments to these vendors should
resemble payments to regular vendors in
dollar amount and distribution among
peer groups. A State agency that
consistently reimburses above-50percent vendors at or near the highest
food instrument redemption amounts,
while reimbursing most regular vendors
at lower levels, would have difficulty
meeting the cost neutrality requirement
that above-50-percent vendors not result
in higher costs to the program than
regular vendors. If the average food
instrument cost for above-50-percent
vendors does not exceed the average
food instrument cost for all regular
vendors, then the State agency has
assurance that above-50-percent vendors
do not cost the program more than
regular vendors. The average food
instrument cost for above-50-percent
vendors need not be less than that for
regular vendors. The average costs may
be equal or statistically equivalent.
A State agency must monitor average
redemption amounts at least quarterly,
and more frequently for newlyauthorized above-50-percent vendors,
and if necessary adjust payment levels,
recoup excess payments, or take other
actions to ensure compliance.
Appropriate action may include
terminating vendor agreements with
above-50-percent vendors whose prices
are least competitive, unless a vendor is
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needed to ensure participant access to
WIC foods. If FNS determines that a
State agency has failed to meet the
requirements in § 246.12(g)(4)(i)(A) to
ensure that above-50-percent vendors do
not result in higher costs to the program
than if participants redeem their food
instruments at regular vendors, FNS
will establish a claim against the State
agency to recover excess food funds
expended and will require appropriate
remedial action.
3. Maintaining Competitive Prices After
Authorization
In amending section 17(h)(11) of the
CNA, Public Law 108–265 retained the
requirement that State agencies
establish procedures to ensure that a
retail store selected for participation in
the WIC Program does not increase its
prices subsequent to selection to levels
that would make the store ineligible for
selection. Section 246.12(g)(4)(iii) of the
interim rule contains this legislative
requirement, which also applies to State
agencies under current regulations. To
meet the requirement, the State agency
must hold authorized vendors
accountable for maintaining prices at a
level consistent with the selection
criteria applied to the vendors at
authorization. For example, if a vendor’s
prices must be within a certain range of
the peer group’s average shelf prices in
order for the vendor to be authorized,
then the vendor’s prices must remain
within this range subsequent to
authorization. By using competitive
price criteria to establish allowable
payment levels for redeemed food
instruments, State agencies can ensure
that vendors remain eligible for
selection. They also avoid excessive
payments for food instruments with
prices that are below a statewide not-toexceed amount, but outside of the
competitive price range for the vendor’s
peer group. A vendor’s failure to remain
price competitive is cause for
termination of the vendor agreement,
even if actual payments to the vendor
are within the not-to-exceed amount.
One example of a failure to remain price
competitive would occur if a vendor, or
vendors, raised the price for a WIC food
with no basis in wholesale price or
handling costs.
Currently, State agencies use different
approaches to monitor the food prices of
vendors subsequent to redemption.
Some are more rigorous than others,
particularly in terms of whether the
State agency reviews shelf prices or
redemption data to assess a vendor’s
continued compliance with the
competitive price selection criteria, and
the action the State agency takes if it
determines that a vendor is not meeting
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71719
the competitive price selection criteria.
Some State agencies require authorized
vendors to submit shelf price surveys at
regular intervals during the year; others
collect price data during store visits.
Some State agencies collect price data
on all WIC foods; others collect price
data only on selected foods and/or from
a subset of authorized vendors. At least
one State agency monitors prices on a
monthly basis to determine if vendors
still meet selection criteria; others have
no clearly defined protocol for assessing
continued compliance with competitive
price criteria. State agencies with EBT
systems can monitor prices of
individual WIC foods using data
scanned into the system at the point of
sale. State agencies vary in the extent to
which they monitor wholesale price
fluctuations and can anticipate and
estimate the impact of these fluctuations
on WIC food prices and food instrument
redemption amounts.
Acceptable Competitive Price Selection
Methodologies
State agencies are acutely aware of the
staff time and other costs involved in
administering their vendor cost
containment system. They look for ways
to streamline procedures and reduce the
level of effort and paperwork required
for vendor selection, without
compromising the system’s
effectiveness. Investing careful and
thoughtful effort in improving the
selection of vendors based on
competitive price can yield substantial
cost savings. Some ways to enhance
current competitive price selection
approaches are outlined in this section.
1. Standards for Evaluating Vendors’
Prices
Setting appropriate quantitative
standards for determining whether a
vendor’s prices are competitive is
critical. The State agency develops these
standards by reviewing the prices of
applicant and authorized vendors and
price data from the larger retail
marketplace. The standards should not
be so flexible or loose that no vendor is
denied authorization; rather they should
influence vendor participation by
allowing the State agency to
differentiate between store prices.
Allowing a small range of variation in
prices produces a better standard than
allowing a wide range of variation. State
agency standards preferably should be
expressed in terms of the number of
standard deviations above the mean
redemption amount (or other amount
used for determining competitive price),
rather than as a percentage, unless the
percentage is linked to the standard
deviation.
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2. Linking Competitive Price
Determinations to Participant Access
Requirements
Authorizing a sufficient number of
vendors in appropriate locations
throughout the State is critical to
competitive price selection. Although a
State agency is not required to limit the
number of vendors it will authorize, it
has the authority to do so and should
use information on the number of
vendors required to ensure participant
access to WIC foods when establishing
competitive prices. For example, if a
State agency has 100 vendor applicants,
including currently authorized vendors
in a particular geographic area, but only
needs 80 vendors to ensure participant
access, then the State agency should
determine competitive prices based on
the 80 stores with the lowest prices. The
State agency need not authorize the
twenty additional stores. However, if
the State agency has the administrative
resources to manage the additional
vendors, it may choose to give these
vendors the opportunity to submit new
price lists for consideration.
Some State agencies can improve
their methodologies for determining
competitive price by improving their
participant access criteria, including
participant-to-vendor ratios. Having
participant-to-vendor ratios that are too
low could result in a State agency
authorizing higher-priced stores for
participant access reasons. If enough of
these higher-priced stores are
authorized in a geographic area, they
will inflate the competitive price criteria
used to select and reimburse vendors.
Having a high participant-to-vendor
ratio, that is based on a realistic
assessment of the capacity of vendors to
serve WIC participants, could increase
competition for WIC authorization and
result in more competitive prices.
When a particular vendor (or small
number of vendors) that is needed to
ensure participant access has prices that
are higher than the State agency’s
competitive price criteria, the State
agency should treat this vendor as an
exception, and exclude the vendor’s
prices from its calculation of
competitive price criteria in order to
avoid raising the competitive range for
all vendors.
3. Monitoring Shelf Prices After
Authorization
At least every six months following
authorization, the State agency must
collect and review vendors’ shelf prices.
FNS believes that State agencies should
not rely on redemption data alone to
ensure that vendors have not,
subsequent to authorization, raised their
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prices to a level that would exceed the
competitive price selection criteria
under which they were authorized.
Monitoring of shelf prices should help
the State agency interpret changes in
average redemption amounts of food
instruments. A State agency could also
use shelf price data to detect partial
redemptions and possible overcharging.
In monitoring prices, the State agency
should observe the overall rate of
increase in prices within and between
peer groups, and whether any vendors
have increased their prices at a higher
rate than other vendors in their peer
group during the monitoring period.
State agencies should identify methods
of collecting price data that are least
burdensome, such as the use of
electronic data collection via the
Internet or an electronic spreadsheet;
random sampling of vendors and/or
WIC food items; and allowing vendors
to submit only those prices that have
changed or will change.
Allowable Reimbursement Levels
General Requirements
Section 17(h)(11)(C) of the CNA
requires State agencies to establish
allowable reimbursement levels for
supplemental foods for each vendor
peer group, taking into consideration
participant access in a geographic area.
Allowable reimbursement levels ensure
that payments to vendors in the peer
group reflect competitive retail prices,
and that the State agency does not
reimburse a vendor for supplemental
foods at a level that would make the
vendor ineligible for authorization
under its competitive price selection
criteria.
Since October 1, 2002, WIC
regulations have required State agencies
to establish price limitations on the
amount they pay vendors. State agencies
typically refer to the price limits as
maximum values or not-to-exceed
amounts for redeemed food instruments.
State agencies currently establish these
amounts in different ways. These
include, but are not limited to, the use
of a rolling average redemption price for
each food instrument type; an average
redemption price for each food
instrument for a fixed period of time;
the average of the highest prices charged
by vendors in the peer group for a
particular WIC food; the highest price
charged by a vendor in the peer group
for a particular food instrument type;
and average prices charged by a selected
group of the smallest vendors in the
State increased by a designated percent.
One State agency uses the prices that
vendors bid for supplemental foods to
establish a maximum reimbursement
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amount per food instrument type. FNS
believes that basing maximum
reimbursement levels on the highest
prices charged by some or all vendors in
a peer group does not effectively contain
costs. While this rule allows State
agencies to continue using different
approaches to establish allowable
reimbursement levels, it directs State
agencies to choose among the more
effective approaches.
Because food price data available to
State agencies can lag behind changes in
the retail marketplace, many State
agencies allow for price increases in
setting allowable reimbursement limits
in order to minimize the number of
rejected food instruments. Under
section 17(h)(11)(C)(ii) of the CNA, State
agencies may continue the practice of
factoring wholesale price fluctuations
into the calculation of allowable
reimbursement levels. Section
246.12(h)(3)(viii) of the interim rule
incorporates this provision. Section
17(h)(11)(D) of the CNA also gives State
agencies the option of exempting from
competitive price criteria and allowable
reimbursement levels pharmacies that
supply only exempt infant formula and
medical foods under the program and
non-profit vendors that meet or are
likely to meet the more than 50 percent
criterion. This option also is reflected in
§ 246.12(g)(4)(iv) and 246.12(h)(3)(viii)
of the interim rule.
Under § 246.12(g)(4)(iv) of this rule, a
State agency that chooses to exempt a
non-profit vendor from competitive
price criteria and/or allowable
reimbursement levels must have a
compelling reason for doing so. The
State agency must notify FNS, in
writing, prior to granting this
exemption. The State agency’s
notification must indicate the reason for
the exemption (e.g., the vendor is
needed to ensure participant access), the
benefits to the program of exempting the
non-profit vendor from the competitive
price criteria and/or allowable
reimbursement levels, and how the
State agency will establish an
appropriate reimbursement level for the
non-profit vendor. State agencies are not
required to notify FNS of exemptions of
non-profit health and/or human service
agencies or organizations that provide
supplemental foods to WIC participants.
Specific Requirement
Section 246.12(h)(3)(viii) of this rule
requires the State agency to consider
participant access in a geographic area
in establishing allowable reimbursement
levels. A State agency must set
allowable reimbursement levels that
allow WIC participants to purchase all
of the foods prescribed on the food
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instrument from any authorized vendor.
This requirement does not mean that the
State agency must print a statewide
maximum reimbursement level on the
food instrument or set maximum
reimbursement levels based on the
highest supplemental food prices among
authorized vendors. Rather, the
requirement to consider participant
access makes this a priority in
establishing allowable reimbursement
levels. It works in tandem with the
competitive price criteria requirement to
contain costs and while meeting
participants’ needs.
Acceptable Approaches To Establishing
and Using Allowable Reimbursement
Levels
1. Current Price Limitation Methods
Under current regulations, State
agencies use food instrument
redemption procedures to ensure that
each vendor is not paid more than the
price limitations applicable to the
vendor. The following examples
illustrate how State agencies should link
competitive price criteria and allowable
reimbursement levels. Since they
describe methods currently used by
State agencies, the examples do not
embody all of the requirements and
recommendations of this interim rule
(such as using standard deviations
rather than percentages to define the
competitive range).
• Scenario #1: At authorization, a vendor’s
price for each WIC food item may not exceed
the average shelf prices of other authorized
vendors in the peer group by more than five
percent. The State agency sets the maximum
payment for any food instrument at five
percent above the average cost of the peer
group for the specific food items on the food
instrument, or at five percent above the
vendor’s reported shelf prices, whichever is
less. To allow for wholesale price
fluctuations, the State agency sets food
instrument not-to-exceed amounts in its
redemption system at 110 percent above the
average food instrument prices. It generates
a monthly report that identifies all food
instruments redeemed for prices between 105
and 110 percent of the peer group’s average
prices by food instrument type. The State
agency follows up with the vendors after
evaluating the information on these food
instruments.
• Scenario #2: The State agency authorizes
any qualified vendor with prices at or below
the average redemption amount for selected
food instruments redeemed by the peer
group. The State agency’s redemption system
sets the maximum allowable reimbursement
level for each type of WIC check and for each
peer group based on a statistical formula that
uses the average redemption prices of
vendors in the peer group during the
preceding three months, known as a rolling
average. Maximum allowable reimbursement
levels do not include an inflation factor. If
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the price on a food instrument exceeds the
maximum allowable reimbursement level,
the State agency pays the vendor the
maximum allowable reimbursement amount.
2. Printing Maximum Reimbursement
Amounts on Food Instruments
Currently, some State agencies print
maximum allowable reimbursement (or
not-to-exceed) amounts on all of their
food instruments; some print maximum
amounts on most, but not all food
instruments; others do not print
maximum amounts on any food
instruments. Under this rule, State
agencies may continue using any of
these approaches as long as printed
maximum reimbursement amounts do
not prohibit the State agency from
applying the allowable reimbursement
levels established for each peer group,
which may be lower than the printed
maximum. State agencies that print
statewide not-to-exceed amounts on
food instruments should notify vendors
in the vendor agreement, vendor
handbook, and training sessions, that
they will be held to a peer group
maximum reimbursement level that is
linked to the competitive price criteria
applied to the vendor at authorization.
3. Calculating Average Payments per
Food Instrument
If a State agency authorizes above-50percent vendors, it must ensure that
average payments per food instrument
to such vendors do not exceed average
payments per food instrument to
comparable vendors. When calculating
average payments per food instrument,
the State agency must include either all
food instruments redeemed by all
authorized vendors or a representative
sample (constructed using appropriate
sampling techniques) of the redeemed
food instruments. To calculate the
average payments per food instrument,
a State agency should add the
redemption amounts for all redeemed
food instruments of the same type and
divide the total by the number of food
instruments of that type. If the State
agency does not use pre-determined
types of food instruments, it should
calculate the average payment to above50-percent vendors and regular vendors
for each food item or distinct
combination of foods prescribed on the
food instrument. For comparison
purposes, the State agency may
calculate average payments per food
instrument for above-50-percent
vendors and comparable groups of
regular vendors.
Cost Containment Certification
If a State agency elects to authorize
any above-50-percent vendors, section
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17(h)(11)(E) of the CNA requires the
State agency to demonstrate to FNS that
its competitive price criteria and
allowable reimbursement levels do not
result in average payments per food
instrument to these vendors that are
higher than average payments per food
instrument to comparable vendors that
do not meet the more than 50 percent
criterion. Accordingly, § 246.12(g)(4)(vi)
of the rule requires a State agency that
authorizes above-50-percent vendors to
submit to FNS every three years
information which indicates that the
State agency has an effective
methodology for establishing
competitive price criteria and allowable
reimbursement levels. The information
provided by the State agency will
include data on the average payments
per food instrument to above-50-percent
vendors as compared to regular vendors,
submitted in accordance with guidance
developed by FNS.
If FNS determines, based on its
review of the information provided by
the State agency and any other relevant
data, that the requirements of
§ 246.12(g)(4)(vi) have been met, FNS
will certify that the State agency’s
competitive price criteria and allowable
reimbursement levels do not result in
higher average payments per food
instrument for above-50-percent
vendors than for other comparable
vendors. If the State agency’s
methodology for establishing
competitive price criteria and allowable
reimbursement levels fails to meet the
requirements in § 246.12(g)(4)(i) of the
interim rule, FNS will disapprove the
State agency’s request to authorize
above-50-percent vendors.
Limitation on Private Rights of Action
As required by section 17(h)(11)(F) of
the CNA, the competitive pricing
provisions of this interim rule do not
create a private right of action.
Individuals do not have the right to seek
administrative or judicial redress for the
standards set by the State agency with
respect to vendor selection criteria and
cost containment provisions. Section
246.12(g)(4)(vii) of this interim rule
reflects this limitation on the private
rights of action.
State Plan
Section 203(e)(10)(B) of Public Law
108–265 amends section 17(f) of the
CNA to require a State agency to include
in the State Plan a description of its
vendor peer group system, competitive
price criteria, and allowable
reimbursement levels that demonstrates
that the State agency is in compliance
with the cost containment provisions in
section 17(h)(11) of the CNA.
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Accordingly, § 264.4 of the interim rule
incorporates this requirement.
In § 246.4(a)(14)(xv) of the interim
rule, the State Plan also must include
information on non-profit above-50percent vendors that the State agency
has exempted from competitive price
criteria and allowable reimbursement
levels under § 246.12(g)(4)(iv); a
justification and documentation
supporting the State agency’s request for
an exemption from the vendor peer
group requirement in § 246.12(g)(4), if
applicable; and, if the State agency
authorizes any above-50-percent
vendors, information required by FNS to
determine whether the State agency’s
vendor cost containment system meets
the requirements in § 246.12(g)(4)(i).
List of Subjects in 7 CFR Part 246
Food assistance programs, Food
donations, Grant programs—Social
programs, Infants and children,
Maternal and child health, Nutrition
education, Public assistance programs,
WIC, Women.
I Accordingly, 7 CFR part 246 is
amended as follows:
PART 246—SPECIAL SUPPLEMENTAL
NUTRITION PROGRAM FOR WOMEN,
INFANTS AND CHILDREN
1. The authority citation for part 246
continues to read as follows:
I
Authority: 42 U.S.C. 1786.
2. In § 246.2:
a. Add in alphabetical order the
definitions of Above-50-percent
vendors, Food sales, and Vendor peer
group system; and
I b. Remove the reference
‘‘§ 246.12(g)(3)’’ from the definition of
Vendor selection criteria and add in its
place the reference ‘‘§ 246.12(g)(3) and
(g)(4)’’.
The additions read as follows:
I
I
§ 246.2
Definitions.
Above-50-percent vendors means
vendors that derive more than 50
percent of their annual food sales
revenue from WIC food instruments,
and new vendor applicants expected to
meet this criterion under guidelines
approved by FNS.
*
*
*
*
*
Food sales means sales of all Food
Stamp Program eligible foods intended
for home preparation and consumption,
including meat, fish, and poultry; bread
and cereal products; dairy products;
fruits and vegetables. Food items such
as condiments and spices, coffee, tea,
cocoa, and carbonated and
noncarbonated drinks may be included
in food sales when offered for sale along
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with foods in the categories identified
above. Food sales do not include sales
of any items that cannot be purchased
with food stamp benefits, such as hot
foods or food that will be eaten in the
store.
*
*
*
*
*
Vendor peer group system means a
classification of authorized vendors into
groups based on common characteristics
or criteria that affect food prices, for the
purpose of applying appropriate
competitive price criteria to vendors at
authorization and limiting payments for
food to competitive levels.
*
*
*
*
*
I 3. In § 246.4:
I a. Remove the reference
‘‘§ 246.12(g)(3)’’ and from paragraph
(a)(14)(ii) and add in its place the
reference ‘‘§ 246.12(g)(3) and (g)(4)’’.
I b. Revise the heading and the first
sentence of paragraph (a)(14)(x); and
I c. Add new paragraphs (a)(14)(xv) and
(a)(14)(xvi).
The revision and additions read as
follows:
§ 246.4
State plan.
(a) * * *
(14) * * *
(x) Infant formula cost containment.
A description of any infant formula cost
containment system.* * *
*
*
*
*
*
(xv) Vendor cost containment. A
description of the State agency’s vendor
peer group system, competitive price
criteria, and allowable reimbursement
levels that demonstrates that the State
agency is in compliance with the cost
containment provisions in
§ 246.12(g)(4); information on non-profit
above-50-percent vendors that the State
agency has exempted from competitive
price criteria and allowable
reimbursement levels in
§ 246.12(g)(4)(iv); a justification and
documentation supporting the State
agency’s request for an exemption from
the vendor peer group requirement in
§ 246.12(g)(4), if applicable; and, if the
State agency authorizes any above-50percent vendors, information required
by FNS to determine whether the State
agency’s vendor cost containment
system meets the requirements in
§ 246.12(g)(4)(i).
(xvi) Other cost containment systems.
A description of any other food cost
containment systems (such as juice and
cereal rebates and food item
restrictions).
*
*
*
*
*
I 4. In § 246.12:
I a. Revise paragraph (g)(1);
I b. Remove paragraph (g)(3)(i) and
redesignate paragraphs (g)(3)(ii) through
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(g)(3)(iv) as paragraphs (g)(3)(i) through
(g)(3)(iii);
I c. Redesignate paragraphs (g)(4)
through (g)(8) as paragraphs (g)(5)
through (g)(9), and add a new paragraph
(g)(4); and
I d. Add six sentences to the end of
paragraph (h)(3)(viii).
The revision and additions read as
follows:
§ 246.12
Food delivery systems.
*
*
*
*
*
(g) * * *
(1) General. The State agency must
authorize an appropriate number and
distribution of vendors in order to
ensure the lowest practicable food
prices consistent with adequate
participant access to supplemental
foods and to ensure effective State
agency management, oversight, and
review of its authorized vendors.
*
*
*
*
*
(4) Vendor selection criteria:
competitive price. The State agency
must establish a vendor peer group
system and distinct competitive price
criteria and allowable reimbursement
levels for each peer group. The State
agency must use the competitive price
criteria to evaluate the prices a vendor
applicant charges for supplemental
foods as compared to the prices charged
by other vendor applicants and
authorized vendors, and must authorize
vendors selected from among those that
offer the program the most competitive
prices. The State agency must consider
a vendor applicant’s shelf prices or the
prices it bids for supplemental foods,
which may not exceed its shelf prices.
In establishing competitive price criteria
and allowable reimbursement levels, the
State agency must consider participant
access by geographic area.
(i) Vendors that meet the above-50percent criterion. Vendors that derive
more than 50 percent of their annual
food sales revenue from WIC food
instruments, and new vendor applicants
expected to meet this criterion under
guidelines approved by FNS, are
defined as above-50-percent vendors.
Each State agency annually must
implement procedures approved by FNS
to identify authorized vendors and
vendor applicants as either above-50percent vendors or regular vendors. The
State agency must receive FNS
certification of its vendor cost
containment system under section
246.12(g)(4)(vi) prior to authorizing any
above-50-percent vendors. The State
agency that chooses to authorize any
above-50-percent vendors:
(A) Must distinguish these vendors
from other authorized vendors in its
peer group system or its alternative cost
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containment system approved by FNS
by establishing separate peer groups for
above-50-percent vendors or by placing
above-50-percent vendors in peer
groups with other vendors and
establishing distinct competitive price
selection criteria and allowable
reimbursement levels for the above-50percent vendors;
(B) Must reassess the status of new
vendors within six months after
authorization to determine whether or
not the vendors are above-50-percent
vendors, and must take necessary
follow-up action, such as terminating
vendor agreements or reassigning
vendors to the appropriate peer group;
(C) Must compare above-50-percent
vendors’ prices against the prices of
vendors that do not meet the above-50percent criterion in determining
whether the above-50-percent vendors
have competitive prices and in
establishing allowable reimbursement
levels for such vendors; and
(D) Must ensure that the prices of
above-50-percent vendors do not inflate
the competitive price criteria and
allowable reimbursement levels for the
peer groups or result in higher total food
costs if program participants transact
their food instruments at above-50percent vendors rather than at other
vendors that do not meet the above-50percent criterion. To comply with this
requirement, the State agency must
compare the average cost of each type of
food instrument redeemed by above-50percent vendors against the average cost
of the same type of food instrument
redeemed by regular vendors. The
average cost per food instrument must
be weighted to reflect the relative
proportion of food instruments
redeemed by each category of vendors
in the peer group system. The State
agency must compute statewide average
costs per food instrument at least
quarterly to monitor compliance with
this requirement. If average payments
per food instrument for above-50percent vendors exceed average
payments per food instrument to regular
vendors, then the State agency must
take necessary action to ensure
compliance, such as adjusting payment
levels, recouping excess payments, or
terminating vendor agreements with
above-50-percent vendors whose prices
are least competitive and that are not
needed to ensure participant access.
Where EBT systems are in use, it may
be more appropriate to compare prices
of individual WIC food items to ensure
that average payments to above-50percent vendors do not exceed average
payments for the same food item to
comparable vendors. If FNS determines
that a State agency has failed to ensure
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that above-50-percent vendors do not
result in higher costs to the program
than if participants transact their food
instruments at regular vendors, FNS
will establish a claim against the State
agency to recover excess food funds
expended and will require remedial
action.
(ii) Implementing effective peer
groups. The State agency’s methodology
for establishing a vendor peer group
system must include the following:
(A) At least two criteria for
establishing peer groups, one of which
must be a measure of geography, such
as metropolitan or other statistical areas
that form distinct labor and products
markets, unless the State agency
receives FNS approval to use a single
criterion;
(B) Routine collection and monitoring
of vendor shelf prices at least every six
months following authorization; and
(C) Assessment of the effectiveness of
the peer groupings and competitive
price criteria at least every three years
and modification, as necessary, to
enhance system performance. The State
agency may change a vendor’s peer
group whenever the State agency
determines that placement in an
alternate peer group is warranted.
(iii) Subsequent price increases. The
State agency must establish procedures
to ensure that a vendor selected for
participation in the program does not,
subsequent to selection, increase prices
to levels that would make the vendor
ineligible for authorization.
(iv) Exceptions to competitive price
criteria. The State agency may except
from the competitive price criteria and
allowable reimbursement levels
pharmacy vendors that supply only
exempt infant formula and/or WICeligible medical foods, and non-profit
vendors for which more than 50 percent
of their annual revenue from food sales
consists of revenue derived from WIC
food instruments. A State agency that
elects to exempt non-profit vendors
from competitive price criteria and/or
allowable reimbursements levels must
notify FNS, in writing, at least 30 days
prior to the effective date of the
exemption. The State agency’s
notification must indicate the reason for
the exemption, including whether the
vendor is needed to ensure participant
access, why other vendors that are
subject to competitive price criteria and
allowable reimbursement levels cannot
provide the required supplemental
foods, the benefits to the program of
exempting the non-profit vendor from
the competitive price criteria and/or
allowable reimbursement levels, the
criteria the State agency used to assess
the competitiveness of the non-profit
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71723
vendor’s prices, and how the State
agency will determine the
reimbursement level for the non-profit
vendor. This notification requirement
does not apply to State agency contracts
and agreements with non-profit health
and/or human service agencies or
organizations.
(v) Exemptions from the vendor peer
group system requirement. With prior
written approval from FNS, a State
agency may use a vendor cost
containment approach other than a peer
group system if it meets certain
conditions. A State agency that obtains
an exemption from the peer group
requirement still must establish
competitive pricing criteria for vendor
selection and allowable reimbursement
levels. An exemption from the peer
group requirement would remain in
effect until the State agency no longer
meets the conditions on which the
exemption was based, until FNS revokes
the exemption, or for three years,
whichever occurs first. During the
period of the exemption, the State
agency must provide annually to FNS
documentation that it either authorizes
no above-50-percent vendors, or that
such vendors’ redemptions continue to
represent less than five percent of total
WIC redemptions, depending on the
terms of the exemption. The conditions
for obtaining an exemption from the
vendor peer group system are as
follows:
(A) The State agency chooses not to
authorize any vendors that derive more
than 50 percent of their revenue from
food sales from WIC food instruments,
and the State agency demonstrates to
FNS that establishing a vendor peer
group system would be inconsistent
with efficient and effective operation of
the program, or that its alternative cost
containment system would be as
effective as a peer group system; or
(B) The State agency determines that
food instruments redeemed by vendors
that meet the above-50-percent criterion
comprise less than five percent of the
total WIC redemptions in the State in
the fiscal year prior to a fiscal year in
which the exemption is effective; and
the State agency demonstrates to FNS
that its alternative vendor cost
containment system would be as
effective as a vendor peer group system
and would not result in higher costs if
program participants redeem food
instruments at vendors that meet the
above-50-percent criterion rather than at
vendors that do not meet this criterion.
(vi) Cost containment certification. If
a State agency elects to authorize any
above-50-percent vendors, the State
agency must submit information, in
accordance with guidance provided by
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FNS, to demonstrate that its competitive
price criteria and allowable
reimbursement levels do not result in
average payments per food instrument
to these vendors that are higher than
average payments per food instrument
to comparable vendors that are not
above-50-percent vendors. To calculate
average payments per food instrument,
the State agency must include either all
food instruments redeemed by all
authorized vendors or a representative
sample of the redeemed food
instruments. The State agency must add
the redemption amounts for all
redeemed food instruments of the same
type and divide the sum by the number
of food instruments of that type. If the
State agency does not designate food
instruments by type, it must calculate
the average payment for each distinct
combination of foods prescribed on the
food instrument. The State agency may
calculate average payments per food
instrument type for groups of vendors
that meet the above-50-percent criterion
and comparable vendors, or the State
agency may calculate average payments
for each food instrument type for each
vendor. State agencies with EBT
systems must compare the average cost
of each WIC food purchased by
participants at above-50-percent
vendors with the average cost of each
food purchased from comparable
vendors. If FNS determines, based on its
review of the information provided by
the State agency and any other relevant
data, that the requirements in this
paragraph have been met, FNS will
certify that the State agency’s
competitive price criteria and allowable
reimbursement levels established for
above-50-percent vendors do not result
in higher average payments per food
instrument (or higher costs for each WIC
food item in EBT systems). If the State
agency’s methodology for establishing
competitive price criteria and allowable
reimbursement levels fails to meet the
requirement of this section regarding
average food instrument payments to
above-50-percent vendors, FNS will
disapprove the State agency’s request to
authorize above-50-percent vendors. At
least every three years following initial
certification, the State agency must
submit information which demonstrates
that it continues to meet the
requirements of this section relative to
average payments to above-50-percent
vendors. FNS may require annual
updates of selected food instrument
redemption data.
(vii) Limitation on private rights of
action. The competitive pricing
provisions of this paragraph do not
create a private right of action based on
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facts that arise from the impact or
enforcement of these provisions.
*
*
*
*
*
(h) * * *
(3) * * *
(viii) * * * As part of the redemption
procedures, the State agency must
establish and apply limits on the
amount of reimbursement allowed for
food instruments based on a vendor’s
peer group and competitive price
criteria. In setting allowable
reimbursement levels, the State agency
must consider participant access in a
geographic area and may include a
factor to reflect fluctuations in
wholesale prices. In establishing
allowable reimbursement levels for
above-50-percent vendors the State
agency must ensure that
reimbursements do not result in higher
food costs than if participants transacted
their food instruments at vendors that
are not above-50-percent vendors, or in
higher average payments per food
instrument to above-50-percent vendors
than average payments to comparable
vendors. The State agency may make
price adjustments to the purchase price
on food instruments submitted by the
vendor for redemption to ensure
compliance with the allowable
reimbursement level applicable to the
vendor. A vendor’s failure to remain
price competitive is cause for
termination of the vendor agreement,
even if actual payments to the vendor
are within the maximum reimbursement
amount. The State agency may exempt
vendors that supply only exempt infant
formula and/or WIC-eligible medical
foods and non-profit above-50-percent
vendors from the allowable
reimbursement limits.
*
*
*
*
*
5. In § 246.18, redesignate paragraphs
(a)(1)(iii)(B) through (a)(1)(iii)(G) as
paragraphs (a)(1)(iii)(C) through
(a)(1)(iii)(H) and add a new paragraph
(a)(1)(iii)(B) to read as follows:
I
§ 246.18 Administrative review of State
agency actions.
(a) * * *
(1) * * *
(iii) * * *
(B) The validity or appropriateness of
the State agency’s vendor peer group
criteria and the criteria used to identify
vendors that are above-50-percent
vendors or comparable to above-50percent vendors;
*
*
*
*
*
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Dated: November 22, 2005.
Kate Coler,
Deputy Under Secretary, Food, Nutrition, and
Consumer Services.
Note: This appendix will not be published
in the Code of Federal Regulations.
Appendix: Regulatory Impact Analysis
1. Title: 7 CFR 246: Special Supplemental
Nutrition Program for Women, Infants, and
Children (WIC): Vendor Cost Containment
2. Action:
(a) Nature: Interim Rule
(b) Need: This rule is needed to implement
the vendor cost containment provisions of
the Child Nutrition and WIC Reauthorization
Act of 2004, Public Law 108–265. Overall,
the WIC program must ensure that program
foods are acquired at the most competitive
prices consistent with ensuring reasonable
program participant access. This rule
requires WIC State agencies to operate
vendor management systems that effectively
contain food costs by ensuring that prices
paid for supplemental foods are competitive.
The rule also responds to data which indicate
that WIC food expenditures increasingly
include payments to a type of vendor whose
prices are not governed by the market forces
that affect most retail grocers. This rule
incorporates new statutory requirements for
State agencies to use in evaluating vendor
applicants’ prices during the vendor
selection process and when paying vendors
for supplemental foods following
authorization.
(c) Affected Parties: The program affected
by this rule is the Special Supplemental
Nutrition Program for Women, Infants, and
Children (WIC). The parties affected by this
regulation are the USDA’s Food and
Nutrition Service (FNS), State agencies that
administer the WIC Program, and retail
vendors that are authorized to accept WIC
food instruments.
Effects: The following analysis describes
the potential economic impact of this interim
final regulation. Due to the importance of
keeping food costs competitive and using
program funds to serve recipients as
effectively as possible, in section 501(b) of
Pub. L. 108–265, Congress provided authority
to implement these changes on an interim
final basis. The changes in this rule are
significant to the costs or overall operations
to the program. The potential effects of these
changes are highlighted below.
Discussion: Over the past five years, the
Special Supplemental Nutrition Program for
Women, Infants, and Children (WIC) has
experienced an increase in the number of
vendors whose prices are not governed by
market forces, and as a result are generally
higher than the prices of other authorized
vendors. These stores, often referred to as
‘‘WIC-only’’ stores, stock only WIC food
items and serve only WIC customers; thus
they operate outside the commercial retail
market. Because WIC is a discretionary grant
program, the continued growth of WIC-only
stores could drive up food costs and
compromise the program’s ability to respond
to the nutritional needs of at-risk women and
children, unless effective cost-containment
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measures are instituted by State agencies. In
addition, this rule is intended to cause
greater focus on cost containment for WIC
food from all sources with the expectation
that it is likely to lead to food cost savings
which can be used to serve more eligibles.
Under the WIC retail food delivery system
in most states, participants receive food
instruments that they use to purchase
specific food items that have been prescribed
for them. They generally can purchase these
items at any authorized retailer, regardless of
the shelf price of these foods. As a result,
participants are indifferent to the prices
stores charge for WIC foods. In the past this
has not been a problem for program costs,
since to maintain a wide customer base,
commercial retail food stores need to
maintain competitive prices to maintain their
business with price-sensitive non-WIC
customers, usually the preponderance of
their customers. The emergence and growth
of WIC-only stores has been problematic
because these stores are not constrained by
the need to maintain a wide customer base;
WIC participants are their customer base. The
growth of these stores, an increase from about
800 stores in 18 States in 2000 to over 1,200
stores in 20 States in 2004, appears to have
increased WIC food costs. It is estimated that
in 2004 WIC-only vendors represented about
2.5 percent of all WIC vendors but comprised
nearly 12 percent of total WIC redemptions.1
While current WIC regulations have
required all State agencies to use vendor
authorization and reimbursement policies to
control the costs paid to authorized vendors,
FNS and Congress have become increasingly
concerned that the WIC program cannot
afford the prices charged by WIC-only stores.
For example, FNS sent a letter to the State
of California (the State with the most WIConly stores) imposing a temporary
moratorium on the authorization of new WIC
vendors in California unless the vendors
have a history of competitive prices or are
needed to ensure participant access to WIC
foods. In the FY 2005 appropriations act for
USDA, Congress prohibited all State agencies
from authorizing any new stores that derive
more than 50 percent of their annual food
sales revenue from WIC food instruments,
unless such stores are needed for participant
access.2 Additionally, FNS sent a letter to all
State Health Officers requesting them to
review WIC vendor selection policies to
ensure that only those vendors who offer
competitive prices receive WIC
authorization. In addition to concerns about
WIC-only pricing, it is the intent of Congress
and USDA that more competitive food
pricing be achieved.
The Child Nutrition and WIC
Reauthorization Act of 2004 (Pub. L. 108–
265) included new legislative requirements
to strengthen vendor cost containment by
requiring State agencies to implement a
vendor peer group system, competitive price
criteria, and allowable reimbursement levels
in a manner that ensures the WIC Program
1 Data on the number, location and redemptions
of WIC-only stores is reported to FNS annually in
The Integrity Profile (TIP).
2 Pub. L. 108–447, Consolidated Appropriations
Act, 2005.
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pays competitive prices for supplemental
foods. This rule implements the vendor cost
containment provisions of this Act. The main
provisions of the rule can be grouped into
three categories: peer group requirements for
all vendors, requirements on vendors that
derive more than 50 percent of their annual
food sales revenue from WIC food
instruments, and exemptions from the
requirements of the rule.
Competitive Price Requirements
• For all vendors, State agencies are
required to create peer groups, establish
competitive price criteria for peer groups,
and set allowable reimbursement levels for
each peer group. Additionally, State agencies
are required to collect and monitor shelf
price data at least every 6 months and assess
the effectiveness of peer groupings and
competitive price criteria at least every three
years.
• Peer groups are required to be based on
at least two criteria, one of which must be
geography. The second peer group criterion
is not specified and is left to the discretion
of the State agency to decide.
• State agencies must establish price
criteria that (1) ensure prices charged by
vendor applicants are competitive with
prices charged by other vendors and (2)
consider vendor’s shelf prices or vendor’s bid
prices, which may not exceed shelf prices.
State agencies must also consider participant
access by geographic area in establishing
competitive price criteria and establish
procedures to ensure authorized vendors do
not raise prices to levels that would make
them ineligible for selection.
• The rule requires State agencies to
establish allowable reimbursement levels for
each vendor peer group that ensure that
payments to vendors in peer groups reflect
competitive prices and ensure that no
vendors receive reimbursement at a level that
would make them ineligible for authorization
under the competitive price criteria
requirements. State agencies may include a
factor to reflect wholesale price fluctuations
and consider participant access in a
geographic area in establishing such levels.
Above-50-Percent Vendors
• The rule contains additional provisions
regarding vendors who derive more than 50
percent of their food sales from WIC
redemptions (above-50-percent vendors).
State agencies must distinguish these
vendors from other vendors in the peer group
system—either by using separate peer groups
or by using distinct competitive price criteria
and allowable reimbursement levels for
above-50-percent vendors that are grouped
with regular vendors.
• Moreover, State agencies must ensure
that use of these vendors 1) does not result
in higher food costs than if participants used
regular vendors and 2) does not result in
higher average payments per food instrument
than if participants used comparable
vendors. It interprets this requirement to
mean that above-50-percent vendors must be
cost neutral to the program, and that average
payments to above-50-percent vendors for
each type of redeemed food instrument may
not exceed average payments to regular
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71725
vendors for the same type of food
instruments.
Exemptions
• Additionally, the rule allows for two
types of exemptions from the requirements.
State agencies can be exempt from the peer
group system requirement and State agencies
can exempt certain vendors from competitive
price criteria and allowable reimbursement
levels.
Peer Group System Exemptions
• To be exempted from the peer group
system requirement, a State agency must
elect not to authorize any above-50-percent
vendors and demonstrate that compliance
with the peer group system requirement is
inconsistent with effective operation of the
program or that an alternative cost
containment system would be as effective.
• Alternately, a State agency can also be
exempt from the peer group system
requirement if it derived less than 5 percent
of its total WIC sales in the prior year from
above-50-percent vendors and demonstrates
that an alternative cost containment system
would be as effective as a vendor peer group
system and would not result in higher food
costs if participants transact food instruments
at above-50-percent vendors, rather than at
other vendors.
Exemptions From Competitive Price Criteria
and Allowable Reimbursement Levels:
• State agencies can exempt vendors from
competitive price criteria and allowable
reimbursement levels, if they are pharmacies
that supply only exempt infant formula or
medical foods, or if they are non-profit
above-50-percent vendors or non-profit
vendor applicants likely to meet the above50-percent criterion.
Costs: This rule places new requirements
on State agencies; therefore, the cost
implications of this rule relate primarily to
administrative burden for States agencies.
These cost implications are partially
dependent on the current practices of State
agencies relative to the requirements of the
rule. A discussion of these costs follows.
Administrative Burden
In order to comply with this rule, State
agencies will need to make changes in their
vendor cost containment systems. Some State
agencies may already be in full or partial
compliance with the rule, while others may
demonstrate that they meet the conditions for
an exemption from the vendor peer group
requirement. For State agencies that are not
already in full compliance, there may be
costs associated with forming or restructuring
peer groups, establishing competitive prices
and allowable reimbursement levels for those
peer groups, monitoring shelf prices, and
evaluating payments to above-50-percent
vendors.
Peer Groups
Under the new rule, State agencies will be
required to establish peer groups that utilize
at least two peer grouping criteria, one of
which is geography. State agencies that
already have peer groups that meet this
requirement will incur no costs to comply
with this provision of the regulation.
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Additionally, State agencies that already
have peer groups of some type will incur
fewer costs than State agencies that do not
have any peer groups in place. Complete data
about current practices used in all State
agencies are not available, but the extent to
which some State agencies use peer groups
and how many will be affected by this
provision can be gauged from data that 32
State agencies provided FNS in September
2004. The main findings from this data are
displayed below in Table 1.
TABLE 1.—CURRENT USE OF PEER GROUPS IN 32 STATE AGENCIES, AS REPORTED TO FNS IN SEPTEMBER 2004
Number
of State
agencies
Currently uses a peer group system ...........................................................................................................................................................
Uses two or more criteria for peer groups ...........................................................................................................................................
Geography is one of the peer group criteria ........................................................................................................................................
Peer groups are being developed ...............................................................................................................................................................
Based on this data, it appears that as many
as 77 of the 89 state agencies could incur
some level of costs to develop peer groups
consistent with this rule.3
Some of these State agencies may not have
in-house resources to do the analysis
necessary to group vendors into peer groups
and would have to contract out. One State
agency that has used an outside contractor
paid about $130,000 for their peer group
analysis, not including the cost of overtime
in local agencies to gather the data necessary
for the analysis.
Evaluating Peer Groups
In addition to developing peer groups,
State agencies are also required to evaluate
the effectiveness of these peer groups. The
cost of doing so may depend on the
availability and capability of staff in State
agencies to evaluate the peer groups.
Assuming that State agencies that currently
have peer groups in place assess the
effectiveness of their peer groups, evaluating
peer groups will not result in any new costs.
Based on the data provided above, up to 64
State agencies could incur some level of cost
to conduct statistical analysis to determine
whether their peer groups are having the
desired and expected effect. State agencies
may not have the staff capabilities, time, and
resources to do this analysis and may need
to work with outside contractors to complete
this work.
25
22
12
3
Establishing Competitive Price Levels and
Allowable Reimbursement Levels
Additionally, the extent that State agencies
currently use peer groups to determine
competitive price criteria or allowable
reimbursement levels will impact their costs.
While many of the State agencies that
provided data to FNS had peer group systems
in place, these peer groups were not always
utilized in the manner required in this rule.
The majority of the reporting State agencies
with peer groups did not use peer groups to
determine competitive price criteria or
allowable reimbursement levels in the
manner specified in the rule (See Table 2).
TABLE 2.—PEER GROUPS USED FOR COMPETITIVE PRICE LEVELS AND ALLOWABLE REIMBURSEMENT LEVELS AS
REPORTED BY 32 STATE AGENCIES IN SEPTEMBER 2004
Number
of State
agencies
Currently has a peer group system .............................................................................................................................................................
Peer group is used to set allowable reimbursement level ...................................................................................................................
Peer group is used to determine competitive price criteria .................................................................................................................
Current peer group system is structured according to rule (i.e. one criteria is geography) .......................................................................
Peer group is used to set allowable reimbursement level ...................................................................................................................
Peer group is used to determine competitive price criteria .................................................................................................................
25
14
17
12
8
7
This suggests that although many of the
State agencies that have peer groups may not
incur significant costs to establish peer group
systems, they may incur additional costs to
craft the use of these peer groups in
compliance with the rule. Looking more
closely at the State agencies with peer groups
that are structured according to the rule (two
criteria, one being geography) in Table 2, it
appears that even some of these State
agencies will incur some costs complying
with this rule.
The costs of complying will be composed
of the staff time necessary to calculate the
optimal competitive price level and
allowable reimbursement levels for each peer
group, the time required to disseminate this
information to the vendors, and the time and
effort required to enforce and monitor the
application of these criteria. For State
agencies that do not have the staff resources
to assess and, if necessary, modify
competitive price criteria and allowable
reimbursement levels, this work will need to
be contracted, which could pose a significant
expense to State agencies. Any costs incurred
will be higher during the start-up period, but
other USDA-sponsored research suggests that
the on-going administrative costs of costcontainment practices can be quite low on a
per participant basis.4
Lastly, the stipulation that State agencies
must set allowable reimbursement levels at
the peer group level may cause more food
instruments to be rejected for exceeding the
allowable reimbursement levels. State
agencies may need to develop new
administrative procedures to manage these
issues and may incur some administrative
costs in doing so.
3 All calculations in this document are based on
89 State agencies, but it is important to note three
State agencies currently use a direct distribution or
home delivery system exclusively and could be
exempt from the provisions set forth in this rule.
Direct distribution and home delivery systems are
also used in parts of an additional eight State
agencies.
4 U.S. Department of Agriculture, Economic
Research Service, Assessment of WIC Cost-
Containment Practices: Final Report, by John A.
Kirlin, Nancy Cole, and Christopher Logan. ERS
project representative: Phil Kaufman. E–FAN No.
(03–005) 342 pp, February 2003.
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Monitoring Shelf Prices
In addition to stipulating how peer groups
should be structured and utilized, the rule
also specifies that State agencies must
monitor shelf prices at least every six
months. The cost impact of monitoring shelf
prices every six months is dependent on
current State monitoring practices. These
practices are outlined below in Table 3.
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71727
TABLE 3.—SUMMARY OF STATE MONITORING OF VENDOR SHELF PRICES AS REPORTED TO FNS IN MAY 2005
[57 Agencies responding, including 5 ITOs]
Number of
State
agencies
reporting
Percent of
State
agencies
reporting
(percent)
4
5
15
18
5
10
7.0
8.8
26.3
31.6
8.8
17.5
Frequency of Data Collection:
Only at authorization ....................................................................................................................................................
Annually ........................................................................................................................................................................
Semiannually ................................................................................................................................................................
Quarterly .......................................................................................................................................................................
Monthly .........................................................................................................................................................................
Other .............................................................................................................................................................................
Of the 57 State agencies that provided data
to FNS, about 67 percent currently monitor
shelf prices at least semiannually, if not more
frequently. The requirements of the new rule
will likely result in no significant change
from costs that they currently incur. For the
remaining 33 percent of State agencies and
an unknown number of those for which FNS
lacks data on frequency of shelf price
collection, additional monitoring costs may
be incurred. It is estimated that 89 State
agencies and 45,000 vendors will be affected
by this provision, incurring an estimated
total of 90,178 burden hours annually. The
majority of these burden hours (90,000) will
be borne by vendors. Applying appropriate
wage rates to these burden hours result in a
cost of nearly $1.4 million for vendors and
about $5,500 for State agencies.5
Evaluating Above-50 Percent-Vendors
Beyond developing peer groups, State
agencies will have to determine whether a
vendor derives more than 50 percent of its
annual food sales revenue from WIC food
instruments. In order to determine whether a
vendor is an above-50-percent vendor, State
agencies are required to consider a vendor’s
annual revenue from the food sales, defined
in the rule as the sum of all payments
received by the vendor for the sale of all
foods that would be eligible items under the
Food Stamp Program (FSP). Currently, WIC
vendors are not required to report annual
food sales to State agencies. It is unclear how
many State agencies collect this data. State
agencies that do not already collect this data
will incur new costs in order to comply with
this rule. Vendors also are likely to incur
administrative costs to provide annual food
sales data to State agencies. It is estimated
that 89 State agencies and 45,000 vendors
will be affected by this provision, incurring
an estimated total of 45,178 burden hours to
complete this task annually. Again, as above,
the bulk of these costs will be incurred by
vendors (45,000). Applying appropriate wage
rates to these burden hours results in a cost
of about $.7 million for vendors and about
$5,500 for State agencies.6
For current vendors, once State agencies
have data on the annual sales of all FSP
eligible foods, they will need to calculate
WIC redemptions as a percent of a vendor’s
total food sales for the same period. If WIC
redemptions are more than 50 percent of total
food sales, the vendor is then deemed an
above-50-percent vendor. The preamble of
the rule states that as an initial step in this
process, State agencies should compare each
vendor’s WIC redemptions to FSP
redemptions for the same period and for
those vendors whose WIC redemptions
exceed their FSP redemptions, conduct
further assessment using the total amount of
revenue obtained from the sale of FSP
eligible foods. After evaluating the total
revenue obtained from the sale of FSP
eligible foods, the State agency should
calculate WIC redemptions as a percent of
total food sales and classify the vendor as an
above-50-percent vendor if appropriate.
To help States determine how many of
these vendors might exist, FNS compared
fiscal year 2004 WIC redemptions to annual
Food Stamp (FS) redemptions as reported in
the FS database (STARS). Stores in which
WIC sales exceeded FS sales were identified
as potentially being above-50-percent
vendors. Table 4 displays how many of the
over 42,000 WIC vendors that are also Food
Stamp vendors appear to have WIC sales that
exceed 50 percent of total annual food sales.
TABLE 4.—NUMBER OF WIC AND FS AUTHORIZED VENDORS FOR WHICH WIC SALES MAY CONSTITUTE MORE THAN 50
PERCENT OF TOTAL FOOD SALES, FY 2004
Number of
State
agencies
Percent of
State
agencies
Number of
vendors
Percent of
all vendors
59
66.3%
5,177
11.5%
Potential Above-50-Percent WIC Vendors ..............................................................................
Source: FNS Administrative Data. A listing of potential WIC and FS authorized above-50-percent vendors was generated by matching data reported to FNS in 2004 in The Integrity Profile (TIP) system and the FS STARS database. There are 89 State Agencies and about 45,000 WIC
authorized vendors.
This analysis shows that at least 59 of the
89 WIC State agencies may have above-50percent vendors. The total number of
potential above-50-percent vendors identified
through this match (5,177) is 11.5 percent of
all vendors. However, while these stores may
be above-50-percent WIC vendors because
they have annual WIC sales that exceed FS
sales, these stores may have non-WIC and
non-FS sales that are larger than their WIC
or FS sales, and so may not qualify as above50-percent vendors upon further
investigation.
In addition to these 5,177 vendors, there
are about 3,000 additional WIC vendors that
do not have FS authorization or that could
not be matched with the FS authorization
number in STARS. Most of the stores that
states currently identify as WIC-only vendors
fall into this category. Therefore, at least
5 U.S. Department of Labor, Bureau of Labor
Statistics. ‘‘May 2004 National Occupational and
Employment Wage Estimates’’ and ‘‘Employer Costs
for Employee Compensation, March 2005.’’
6 U.S. Department of Labor, Bureau of Labor
Statistics. ‘‘May 2004 National Occupational and
Employment Wage Estimates’’ and ‘‘Employer Costs
for Employee Compensation, March 2005.’’
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about 1,200 of these 3,000 stores may be
above-50-percent vendors.
Combining the information on potential
above-50-percent vendors from FNS’ match
of WIC and FSP authorized stores and the
self-identified WIC-only vendors provides an
estimate of how many vendors potentially
have WIC redemptions that are more than 50
percent of their total food sales. Currently,
there are about 1,200 WIC-only vendors in 20
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State Agencies. Together, this means that
about 6,400 vendors in 64 State agencies are
potentially above-50-percent vendors, since
all but 5 of the 20 State agencies with WIConly vendors had other stores that were
potentially above-50-percent vendors.
Consequently, between 1,200 and 8,200
vendors could be identified as having WIC
redemptions that are more than 50 percent of
total food sales.
State agencies must ask new vendor
applicants if they expect to derive more than
50 percent of their annual revenue from the
sale of food items from transactions involving
WIC food instruments. If the vendor
applicant responds ‘‘yes’’, the State agency
does not need to do any further verification
and should treat this vendor as an above-50percent vendor. The preamble specifies that
all other vendor applicants should be
assessed to determine whether they are likely
to meet the more than 50 percent criteria. To
do so, State agencies should calculate WIC
redemptions as a percent of total food sales
in any existing WIC-authorized stores owned
by the vendor applicants, calculate the
percentage of anticipated food sales by type
of payment, request and review inventory
invoices to determine if a variety of foods
will be offered for sale on a continuous basis,
and determine whether WIC authorization is
necessary for the store to open for business.
Since we do not have data on the number of
stores that apply for WIC authorization in
any given year, we cannot estimate the
impact of this provision of the rule.
State agencies will also have to determine
how to place above-50-percent vendors in
peer groups so that these vendors do not
result in WIC paying more to these vendors
than to comparable vendors. State agencies
must develop and apply a definition of
comparable vendors and may incur costs
defending their application of comparable
vendor criteria for the above-50-percent
vendors. However, under the rule, neither the
validity nor the appropriateness of the State
agency’s vendor peer group criteria or the
criteria used to identify above-50-percent
vendors and comparable vendors would be
subject to appeal by a vendor.
The rule requires FNS to certify that the
State agency’s competitive price criteria and
allowable reimbursement levels do not result
in higher average payments per food
instrument for above-50-percent vendors
than for other comparable vendors. This
certification will entail reviewing
information provided by the State agency and
other relevant data to determine that the
requirements have been met. FNS will need
to do this potentially for at least 64 of the
State agencies identified above, if not all 89
State agencies, without additional resources.
In summary, most of the administrative
burden/costs of this rule will be incurred at
the State level. As outlined above, some State
agencies will be affected less than others
because they already have a peer group
system that is based on the criteria specified
in the rule, while others may incur
significant, one-time start up costs because
they will need to develop peer groups,
competitive price levels, and allowable
reimbursement levels for the peer groups.
Some vendors will incur administrative costs
to provide State agencies with total food sales
information annually and to submit shelf
prices semiannually. Most of these costs are
difficult to determine given the current data
that we have, but it is important to note that
many State agencies already do this work
within their existing NSA funds and the NSA
allocations will not change to provide
additional funds to administer the program
with these new requirements.
Benefits: The WIC Program will benefit
from the provisions of this rule by reducing
unnecessary food expenditures, which
increases the potential to serve more eligible
women, infants, and children for the same
cost. This rule should have the effect of
ensuring that payments to vendors,
particularly vendors that derive more than 50
percent of their annual food sales from WIC
food instruments, reflect competitive prices
for WIC foods.
To estimate the rule’s cost savings, FNS
estimated the annual difference in food
instrument redemption values between WIConly versus non-WIC-only stores. FNS
reviewed redemption data from 12 State
agencies that have 97 percent of the ‘‘WIConly’’ vendors. Since State agencies currently
are in the process of identifying above-50percent vendors (and thus do not have data
available on such vendors), FNS relied on
data on stores that stock only WIC food items
and serve only WIC customers; these stores
are primarily self-identified as WIC-only.
State agencies provided data on their total
food redemptions, WIC-only store food
redemptions, the total number of vendors
and number of WIC-only vendors, and the
average redemption values of the five most
frequently redeemed WIC food instruments
in September 2004.7
Using these data, FNS examined the cost
differential between the average redemption
amounts for the five food instruments most
frequently redeemed at non-WIC-only and
WIC-only vendors (see column labeled ‘‘Ratio
of Average Redemption Amounts of NonWIC-Only to WIC-Only Vendors’’ in Table 5
below). By applying the average cost ratio for
these five food instruments to all
redemptions for WIC-only vendors, FNS
determined what the redemptions would
have been at WIC-only vendors if the prices
were the same as those at non-WIC-only
vendors. The resulting cost savings was about
$6 million monthly, $75 million annually, or
about $377 million (assuming no inflation)
over the course of five years for the 12 States.
Table 5 summarizes this analysis.
It is also worth considering that the
number of WIC-only stores had been growing
rapidly before the California moratorium, the
FY 2005 appropriations act, and Pub. L. 108–
265. It is reasonable to project that there
could be substantially more of these highcost stores in the program absent these
measures and this rule. If the number of
stores continued to grow at the rate they were
growing, the excess costs (and thus potential
savings) could be far greater than what is
estimated here. From this perspective, our
cost savings estimate may be lower than what
would occur if these limitations on the
growth of WIC-only stores had not been
imposed.
TABLE 5.—POTENTIAL COST SAVINGS BY IMPLEMENTING RULE
[Dollars in millions]
Total redemptions
(Sept. 2004)
State
Estimated
non-WIC-only
redemptions
(Sept. 2004)
$5.99
4.79
97.33
18.53
3.49
9.67
3.17
12.56
4.51
43.51
$5.73
3.59
66.47
16.40
3.38
9.29
2.86
11.46
4.14
37.49
1 ...........................................................................
2 ...........................................................................
3 ...........................................................................
4 ...........................................................................
5 ...........................................................................
6 ...........................................................................
7 ...........................................................................
8 ...........................................................................
9 ...........................................................................
10 .........................................................................
7 September 2004 was deemed to be a
representative month because there were no
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Estimated
WIC-only redemptions
(Sept. 2004)
Ratio of average redemption
amounts of
non-WIConly to WIConly vendors
Total redemptions if
all at nonWIC-only
level
Monthly
cost savings
.82
.75
.87
.81
.80
.80
1.19
.67
.78
.83
$5.94
4.50
93.27
18.13
3.47
9.59
3.23
12.20
4.43
42.52
$.05
.29
4.06
.40
.02
.08
¥.06
.36
.08
1.00
$.26
1.20
30.86
2.13
.11
.38
.31
1.10
.37
6.02
significant or unusual spikes in food prices during
that month.
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71729
TABLE 5.—POTENTIAL COST SAVINGS BY IMPLEMENTING RULE—Continued
[Dollars in millions]
Ratio of average redemption
amounts of
non-WIConly to WIConly vendors
Monthly
cost savings
Estimated
non-WIC-only
redemptions
(Sept. 2004)
11 .........................................................................
12 .........................................................................
6.85
14.44
6.78
13.22
.07
1.22
.69
1.02
6.83
1.24
.02
¥.03
Total .......................................................
$210.40
$167.59
$42.81
....................
$204.11
$6.27
State
Estimated
WIC-only redemptions
(Sept. 2004)
Total redemptions if
all at nonWIC-only
level
Total redemptions
(Sept. 2004)
Source: States reported total redemptions to FNS and calculated non-WIC-only and WIC-only redemptions. All other figures calculated by FNS
based on this and other data supplied by the States.
This analysis assumes that September 2004
is a representative month and can be used to
calculate annual cost savings. It also assumes
that the mix of items within each redemption
and the rate of full versus partial
redemptions are the same for both vendor
types. However, there is some evidence that
WIC-only stores require full redemption of
vouchers, resulting in higher redemption
values compared with other vendors. This
could overstate the impact of the rule. This
analysis also excludes State agencies with
smaller numbers of WIC-only stores and does
not account for any impact on other types of
vendors, which would tend to make this
estimate lower than what actual savings
might be. To realize some level of savings,
State agencies would need to develop
effective peer group systems. As noted below,
there is uncertainty about the degree to
which State agencies will be able to develop
such systems initially, given the data
collection and analysis needed.
Uncertainty: Because the vendor peer
group provisions in the Child Nutrition and
WIC Reauthorization Act of 2004 and this
rule provide for some flexibility in
implementation, and because there is a wide
degree of variation in food prices and current
vendor cost containment practices across
State agencies, the impact of many of the
provisions of this rule is uncertain.
Uncertainties include the administrative
burden State agencies will incur and the
savings that can be realized nationally or in
any State agency. The major uncertainties for
administrative burden were discussed
previously in the analysis; the following is a
discussion of the uncertainties regarding
program savings.
Program Savings
Peer Groups
Three issues introduce uncertainty
regarding the impact of peer groups, as
defined in the rule, on program costs. These
issues center on the requirements for
including geography as one of the criteria,
choosing a second peer group criteria, and
establishing an effective peer group. These
issues are outlined below.
Peer groups must be based on two criteria,
one of which is geography. A state-sponsored
analysis of WIC peer group practices suggest
that geography is an important criterion for
defining peer groups, but the findings also
suggest that the way geography is defined
and applied also matters.8 For example,
study findings show that in some cases,
grouping geographic entities (i.e., cities and
counties) by price level was more effective
than relying on contiguous geographic
groupings, such as administrative program
areas or geographic regions. Additionally,
rule of thumb definitions of geography, such
as one major metropolitan area versus the
rest of the State, may result in geographic
peer groups that are too large and
heterogeneous to be effective. Conversely,
using the county as the measure of geography
might result in peer groups that are too small
and whose average price is influenced by the
prices of a single outlying vendor.
Additionally, the measure selected for the
second peer group criterion could influence
the effectiveness of the peer group structure.
FNS’s preliminary analysis of redemption
data in two large States suggests that
measures of sales volume (number of
registers, market share, amount of
redemptions) seem to have a bigger effect on
price than type of ownership (sole
proprietorship, partnership, corporation), but
that no one measure of sales volume is
consistently the best measure to group
vendors once broken down by geography.
To examine different scenarios, FNS
obtained data from two large State agencies
and developed hypothetical peer groups
based on geographic area, number of
registers, and monthly redemption amounts
for vendors. Four sets of hypothetical peer
groups were developed. All four used the
same geographic criterion for the first
criterion. For two sets of peer groups, the
second criterion was based on the number of
registers. For the other two sets of peer
groups, the second criterion was based on the
WIC redemption amounts for the vendor. The
peer groups were formed by analyzing the
distribution of number of registers or amount
of WIC redemptions and dividing the
vendors such that the same number of
vendors fell into each of the five groups.
Average prices for each group were
calculated and tested to ensure they were
statistically different from each other. In each
scenario below, the two types of peer groups
are compared (number of registers versus
WIC redemptions) based on the method used
to calculate the groups. For scenario one, the
peer groups were calculated excluding the
WIC-only vendors in the State data file. For
scenario two, the peer groups were calculated
including all vendors in the file. Analysis on
average price was calculated for all non-WIConly vendors since WIC-only vendors are
most likely to be above-50-percent vendors
and as such, could be put into separate peer
groups under the rule.
Tables 6 and 7 below compare the mean
price for a food instrument using two
different second criteria. For comparison
purposes, only the range of categories in one
geographic grouping is displayed here.
TABLE 6.—SCENARIO 1, MEAN PRICE OF FOOD INSTRUMENT, GROUPINGS BASED ON NON-WIC ONLY VENDORS
2nd Peer
group
criterion
Number of registers
WIC redemption amounts
Mean price
of food
instrument
Number of registers
Group
1 ...................
1 to 3 ...................................................................
8 State of Texas, Department of Health, Bureau of
Nutrition Services, Retailer Peer Grouping Study for
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$3.5316
WIC redemption amounts
Up to $3,835 .......................................................
Competitive Pricing: Deliverable 3, NonCommercial Vendor Recommendations. Prepared
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$3.5404
by Burger, Carroll and Associates, December 30,
2003.
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TABLE 6.—SCENARIO 1, MEAN PRICE OF FOOD INSTRUMENT, GROUPINGS BASED ON NON-WIC ONLY VENDORS—
Continued
2nd Peer
group
criterion
Number of registers
WIC redemption amounts
Mean price
of food
instrument
Number of registers
Group
2
3
4
5
...................
...................
...................
...................
4 to 7 ...................................................................
8 to 10 .................................................................
11 to 12 ...............................................................
13 or more ...........................................................
In scenario 1, all but one of the group
averages are statistically equal, regardless of
whether the number of registers or monthly
WIC redemption amounts is used as the
second peer group criterion. This result
suggests that it would not matter which
3.5116
3.3428
3.3368
3.3082
WIC redemption amounts
$3,836 to $130,318 .............................................
$130,319 to $1,943,825 ......................................
$1,943,826 to $3,205,592 ...................................
$3,205,593 or more .............................................
measure is used as the second criterion; both
would have about the same outcome. But,
when the same characteristics are applied to
all vendors (scenario 2), the average prices in
almost all of the categories are statistically
different, indicating that the groupings are
Mean price
of food
instrument
3.5172
3.3051
3.3885
3.2293
different from one another and may result in
different outcomes. It is obviously difficult to
definitively assess the effect of the peer
groups when there is so much variation in
how peer groups could be defined and how
the vendors could be grouped.
TABLE 7.—SCENARIO 2, MEAN PRICE OF FOOD INSTRUMENT, GROUPINGS BASED ON ALL VENDORS
2nd Peer
group
criterion
Number of registers
WIC redemption amounts
Mean price
of food instrument
Number of registers
Group
1
2
3
4
5
...................
...................
...................
...................
...................
1 to 2 ...................................................................
3 to 5 ...................................................................
6 to 9 ...................................................................
10 to 12 ...............................................................
13 or more ...........................................................
Further, the rule provides State agencies
considerable flexibility and few specific
requirements for constructing peer groups.
The rule focuses more on the intended
outcome (i.e., cost neutrality of above-50percent vendors) than on how State agencies
achieve this outcome. FNS assumes that State
agencies will perform sufficient analysis and
will select the most effective criteria to
contain vendor costs. The inability or failure
of State agencies to do so could undermine
or minimize the success of this rule. For
example, State agencies will need to prevent
peer groups from having wide price variation
or non-normal distributions, or from being so
large or so small that they are ineffective.
Since State agencies could choose a
strategy that is effective or ineffective for
their particular needs and characteristics,
and since an effective strategy for one State
agency may not be an effective strategy for
another State agency, the impact of the
vendor peer group requirement on cost
savings is uncertain. If implemented
effectively, the peer group requirement as
specified in the rule should ensure that
above-50-percent vendors do not result in
higher costs to the program than regular
vendors.
Establishing Competitive Price Criteria and
Allowable Reimbursement Levels
The degree to which cost savings can be
achieved also depends on the effectiveness of
a state’s method for assessing the prices of
new vendor applicants relative to others in
a peer group. Currently, many states either
apply a percentage or a standard deviation
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$3.5418
3.5119
3.4337
3.3064
3.3082
WIC redemption amounts
Up to $5,628 .......................................................
$5,628 to $80,442 ...............................................
$80,443 to $1,872,819 ........................................
$1,872,820 to $2,973,459 ...................................
$2,973,460 or more .............................................
measure to set a maximum competitive price
criteria or a maximum reimbursement level.
For example, some states may set their
competitive price criteria at 5 percent above
the average peer group price and others may
set their competitive price criteria at 1 or 2
standard deviations above the average peer
group price.
Either method could control costs
effectively depending on the size of the peer
group, the distribution of prices within that
peer group and the percentage or number of
standard deviations applied. For example, a
standard deviation measure might be more
effective in a peer group of a given size with
a relatively small distribution of prices. But,
a percentage might be more effective in a
peer group with a relatively large
distribution. Consequently, State agencies
have been given flexibility to determine their
competitive price criteria.
2. Alternatives: This rule implements the
vendor peer group provisions of the Child
Nutrition and WIC Reauthorization Act of
2004, which FNS believes is an effective
means of controlling WIC food costs. While
this Act mandates that States establish peer
groups, competitive price criteria and
allowable reimbursement levels and states
that these requirements must result in the
outcome of paying above-50-percent vendors
no more than regular vendors, the Act does
not specify particular criterion for peer
groups or acceptable methods of setting
competitive price criteria and allowable
reimbursement levels. FNS considered
mandating specific means of developing peer
groups, competitive price criteria and
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Mean price
of food instrument
$3.5395
3.5131
3.3539
3.3669
3.2293
allowable reimbursement levels in order to
ensure that the outcome of this legislation
was achieved.
However, given States’ responsibility to
manage WIC as a discretionary grant program
and the varying market conditions in each
state, FNS believes that states need flexibility
to develop their own peer groups,
competitive price criteria and allowable
reimbursement levels. At the October 2004
meeting that FNS convened to gain input for
this rule, States indicated that they needed
the ability to design cost containment
practices that would be effective in their own
markets and would ensure participant access.
In addition, there is little information about
the effectiveness of particular cost
containment practices in the variety of
markets represented by the 89 state agencies.
Mandating more specific means of
developing peer groups, competitive price
criteria and allowable reimbursement levels
could have unintended, negative
consequences on participant access, food
costs and administrative burden.
As States gain experience and the results
of their vendor cost containment practices
become apparent, FNS may develop further
regulations and guidance to improve
achievement of the WIC vendor cost
containment goals of the Child Nutrition and
WIC Reauthorization Act of 2004. In the
interim, FNS believes that the current rule
will substantially accomplish the goal of the
Act of containing food costs and ensuring
that above-50-percent vendors do not result
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in higher costs to the program than regular
vendors.
[FR Doc. 05–23365 Filed 11–28–05; 8:45 am]
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Agencies
[Federal Register Volume 70, Number 228 (Tuesday, November 29, 2005)]
[Rules and Regulations]
[Pages 71708-71731]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 05-23365]
[[Page 71707]]
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Part III
Department of Agriculture
-----------------------------------------------------------------------
Food and Nutrition Service
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7 CFR Part 246
Special Supplemental Nutrition Program for Women, Infants and Children
(WIC): Vendor Cost Containment; Interim Rule
Federal Register / Vol. 70, No. 228 / Tuesday, November 29, 2005 /
Rules and Regulations
[[Page 71708]]
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DEPARTMENT OF AGRICULTURE
Food and Nutrition Service
7 CFR Part 246
RIN 0584-AD71
Special Supplemental Nutrition Program for Women, Infants and
Children (WIC): Vendor Cost Containment
AGENCY: Food and Nutrition Service, USDA.
ACTION: Interim rule.
-----------------------------------------------------------------------
SUMMARY: This interim rule amends the regulations governing the Special
Supplemental Nutrition Program for Women, Infants and Children (WIC) to
strengthen vendor cost containment. The rule incorporates into program
regulations new legislative requirements that affect the selection,
authorization, and reimbursement of retail vendors. These requirements
are contained in the Child Nutrition and WIC Reauthorization Act of
2004, enacted on June 30, 2004. The rule reflects the statutory
provisions that require State agencies to implement a vendor peer group
system, competitive price criteria, and allowable reimbursement levels
in a manner that ensures that the WIC Program pays authorized vendors
competitive prices for supplemental foods. It also requires State
agencies to ensure that vendors that derive more than 50 percent of
their annual food sales revenue from WIC food instruments do not result
in higher food costs to the program than do other vendors. The intent
of these provisions is to maximize the number of eligible women,
infants, and children served with available Federal funding.
DATES: Effective Date: This rule is effective December 29, 2005.
Implementation Date: State agencies must implement the provisions
of this rule no later than December 30, 2005.
Comment Date: To be assured of consideration, comments on this
interim rule must be received by the Food and Nutrition Service (FNS)
on or before November 29, 2006.
ADDRESSES: FNS invites interested persons to submit comments on this
interim rule. Comments may be submitted by any of the following
methods:
Mail: Send comments to Patricia Daniels, Director,
Supplemental Food Programs Division, Food and Nutrition Service, USDA,
3101 Park Center Drive, Room 528, Alexandria, Virginia 22302, (703)
305-2746.
Web Site: Go to https://www.fns.usda.gov/wic. Follow the
online instructions for submitting comments through the link at the
Supplemental Food Programs Division Web site.
E-Mail: Send comments to WICHQ-SFPD@fns.usda.gov. Include
Docket ID Number 0584-AD71, Vendor Cost Containment Interim Rule, in
the subject line of the message.
Federal eRulemaking Portal: Go to https://
www.regulations.gov. Follow the online instructions for submitting
comments.
All comments submitted in response to this interim rule will be
included in the record and will be made available to the public. Please
be advised that the substance of the comments and the identities of the
individuals or entities submitting the comments will be subject to
public disclosure. All written submissions will be available for public
inspection at the address above during regular business hours (8:30
a.m. to 5 p.m.), Monday through Friday.
FNS also plans to make the comments publicly available by posting a
copy of all comments on the FNS Web site at https://www.fns.usda.gov/
wic.
FOR FURTHER INFORMATION CONTACT: Debra Whitford, Chief of the Policy
and Program Development Branch, Supplemental Food Programs Division, at
the address indicated above or at (703) 305-2746, during regular
business hours (8:30 a.m.-5 p.m.), Monday through Friday.
SUPPLEMENTARY INFORMATION:
Executive Order 12866
This rule has been determined to be Significant and was reviewed by
the Office of Management and Budget under Executive Order 12866.
Regulatory Impact Analysis
As required for all rules that have been designated as Significant
by the Office of Management and Budget, a Regulatory Impact Analysis
was developed for the WIC Vendor Cost Containment Interim Rule. A
complete copy of the Impact Analysis appears in the appendix to this
rule.
Need for Action
This action is needed to implement the vendor cost containment
provisions of the Child Nutrition and WIC Reauthorization Act of 2004,
Public Law 108-265. The rule requires WIC State agencies to operate
vendor management systems that effectively contain food costs by
ensuring that prices paid for supplemental foods are competitive. The
rule also responds to data which indicate that WIC food expenditures
increasingly include payments to a type of vendor whose prices are not
governed by the market forces that affect most retail grocers. As a
result, the prices charged by these vendors tend to be higher than
those of other retail grocery stores participating in the program. To
ensure that the program pays competitive prices, this rule codifies the
new statutory requirements for State agencies to use in evaluating
vendor applicants' prices during the vendor selection process and when
paying vendors for supplemental foods following authorization.
While the Child Nutrition and WIC Reauthorization Act mandates that
States establish peer groups, competitive price criteria and allowable
reimbursement levels and states that these requirements must result in
the outcome of paying above-50-percent vendors no more than regular
vendors, the Act does not specify particular criteria for peer groups
or acceptable methods of setting competitive price criteria and
allowable reimbursement levels. FNS considered mandating specific means
of developing peer groups, competitive price criteria and allowable
reimbursement levels in order to ensure that the outcome of this
legislation was achieved. However, given State agencies' responsibility
to manage WIC as a discretionary grant program, the varying retail food
market conditions in each State, and the wide variations in current
vendor cost containment systems operated by State agencies, FNS
believes that State agencies need flexibility to develop their own peer
groups, competitive price criteria and allowable reimbursement levels.
Thus, the rule gives State agencies flexibility to design cost
containment practices that would be effective in their own markets and
would ensure adequate participant access. In addition, there is little
information about the effectiveness of particular cost containment
practices in the variety of markets represented by the 89 State
agencies. Mandating more specific means of developing peer groups,
competitive price criteria and allowable reimbursement levels could
have unintended, negative consequences on participant access, food
costs and administrative burden.
As State agencies gain experience and the results of their vendor
cost containment practices become apparent, FNS may develop further
regulations and guidance to improve WIC vendor cost containment. In the
interim, FNS believes that the current rule will substantially
accomplish the goal of the Act of containing food costs and ensuring
that above-50-percent vendors
[[Page 71709]]
do not result in higher costs to the program than regular vendors.
As noted previously, FNS believes that State agencies need
flexibility to develop their own peer groups, competitive price
criteria and allowable reimbursement levels. Given State agencies'
responsibility to manage WIC as a discretionary grant program, the
varying retail food market conditions in each State, the wide
variations in current vendor cost containment systems operated by State
agencies, the limited amount of information about the effectiveness of
particular cost containment practices in the variety of markets
represented by the 89 State agencies, and the need to minimize
administrative burden, this is the most appropriate approach for the
interim final rule.
In order to better assess the effectiveness of specific cost
containment strategies, FNS will be collecting and analyzing data from
State agencies, in anticipation of issuing a final rule. This will
enable the agency to analyze the effect of particular vendor peer group
systems, competitive price criteria, and allowable reimbursement levels
on WIC food prices, participant access, the vendor community and a
range of other measures. FNS will also be collecting information on
administrative burden associated with the new requirements. This will
enable FNS to identify and consider a reasonable number of regulatory
alternatives when considering the final rule and adopt the most cost-
effective or least burdensome alternative that achieves the objectives
of the rule. While we expect the final rule to be promulgated within
three years, it is important that sufficient time be allowed to assess
the impacts of this interim final rule before moving to alter any of
its provisions.
Benefits
The WIC Program will benefit from the provisions of this rule by
reducing unnecessary food expenditures, which increases the potential
to serve more eligible women, infants, and children for the same cost.
The rule should have the effect ensuring that payments to vendors,
particularly vendors that derive more than 50 percent of their annual
food sales revenue from WIC food instruments reflect competitive prices
for WIC foods. Currently, the WIC Program pays vendors whose food sales
consist primarily of WIC transactions substantially more for
supplemental foods than it pays other authorized vendors. Under this
rule, State agencies that choose to authorize these vendors will
demonstrate that payments to them do not exceed the competitive prices
paid to other vendors. FNS conservatively estimates that implementation
of the rule will result in a cost savings of approximately $75 million
annually.
Costs
In order to comply with this rule, State agencies will need to make
one-time changes in their vendor cost containment systems. Some State
agencies may already be in full or partial compliance with the rule,
while others may demonstrate that they meet the conditions for an
exemption from the vendor peer group system requirement. Many State
agencies, particularly those that choose to authorize vendors that rely
predominantly on WIC food instruments for food sales revenue, will
incur additional costs and administrative burden to achieve compliance
with its provisions. These costs are associated with establishing or
restructuring vendor peer groups, revising competitive price criteria
and allowable reimbursement levels for those peer groups, collecting
and monitoring vendor shelf prices for supplemental foods, and
evaluating payments to vendors. Variations in State agency vendor
management systems and staffing resources make it difficult to derive a
cost estimate. State agencies will not receive additional funds to
administer the program with these new requirements.
Some WIC vendors, particularly smaller stores that are not also
authorized by the Food Stamp Program, may incur costs to compile data
on their total annual food sales. State agencies will require this data
in order to determine, as required by law, whether a vendor derives
more than 50 percent of their total annual food sales revenue from WIC
food instruments.
Regulatory Flexibility Act
This rule has been reviewed with regard to the requirements of the
Regulatory Flexibility Act (5 U.S.C. 601-612). FNS does not believe
this rule will have a significant economic impact on a substantial
number of small entities. With the high degree of State flexibility
allowable under this rule, small entities will be impacted differently
in each State depending upon how that State chooses to meet the
requirements set forth here. It is therefore not feasible to accurately
estimate the rule's impact on small entities. As FNS is concerned about
these impacts, we plan to collect data on the implementation of this
interim final rule and the options States select in order to better
assess the impact for the final rulemaking and the Final Regulatory
Flexibility Analysis and publish it for comments.
In fulfilling the intent of the Child Nutrition and WIC
Reauthorization Act of 2004, the rule may have a significant economic
impact on a small number of vendors that have been authorized to
participate in the WIC Program. These vendors tend to be smaller
grocery stores that serve WIC participants exclusively or
predominantly, have a large volume of WIC transactions, and are not
subject to the retail market forces that keep food prices at
competitive levels. In accordance with the law, the rule requires that
State agencies implement effective competitive price criteria in
selecting and reimbursing vendors, including assurance that payments to
vendors that derive more than 50 percent of their annual food sales
revenue from WIC food instruments do not result in higher food costs to
the program than other vendors. Only those vendors that are able to
meet competitive pricing requirements will be able to continue
participating in the program. Currently FNS estimates that between
three and four percent of the approximately 45,000 authorized vendors
will need to make changes in the prices that they offer the WIC Program
in order to be deemed competitive.
Public Law 104-4
Title II of the Unfunded Mandates Reform Act of 1995 (UMRA), Public
Law 104-4, establishes requirements for Federal agencies to assess the
effects of their regulatory actions on State, local and tribal
governments and the private sector. Under section 202 of the UMRA, FNS
generally must prepare a written statement, including a cost benefit
analysis, for proposed and final rules with ``Federal mandates'' that
may result in expenditures by State, local or tribal governments, in
the aggregate, or the private sector, of $100 million or more in any
one year. When such a statement is needed for a rule, section 205 of
the UMRA generally requires FNS to identify and consider a reasonable
number of regulatory alternatives and adopt the most cost-effective or
least burdensome alternative that achieves the objectives of the rule.
This interim rule contains no Federal mandates (under the
provisions of Title II of the UMRA) for State, local and tribal
governments or the private sector of $100 million or more in any one
year. Thus, the rule is not subject to the requirements of sections 202
and 205 of the UMRA.
[[Page 71710]]
Executive Order 12372
The Special Supplemental Nutrition Program for Women, Infants and
Children (WIC) is listed in the Catalog of Federal Domestic Assistance
under 10.557. For the reasons set forth in the final rule in 7 CFR part
3015, subpart V and related Notice (48 FR 29115), this program is
included in the scope of Executive Order 12372, which requires
intergovernmental consultation with State and local officials.
Federalism Summary Impact Statement
Executive Order 13132 requires Federal agencies to consider the
impact of their regulatory actions on State and local governments.
Where such actions have federalism implications, agencies are directed
to provide a statement for inclusion in the preamble to the regulations
describing the agency's considerations in terms of the following three
categories called for under section (6)(b)(2)(B) of Executive Order
13132.
Prior Consultation With State Officials
State agencies have expressed concerns and shared information
regarding implementation of the new vendor cost containment legislative
requirements. Because the WIC Program is a State-administered,
federally funded program, our regional offices have formal and informal
discussions with State agencies on an ongoing basis regarding program
implementation and policy issues. This arrangement allows State
agencies to raise questions and provide comments that form the basis
for many of the implementation detail decisions in this and other WIC
Program rules. Following the enactment of Public Law 108-265, several
regional offices convened meetings with State WIC staff that included
discussion of the vendor cost containment provisions of this law. As a
result of these meetings, FNS continues to receive State agency
requests for policy guidance on the vendor cost containment
requirements. These questions have helped us make the rule responsive
to State agency concerns.
In addition, in October 2004, the Supplemental Food Programs
Division (SFPD) convened a meeting of WIC State agency representatives,
USDA headquarters and regional office staff, and an outside expert on
competitive pricing systems, to obtain more information on State
agencies' current vendor cost containment systems. During the meeting,
participants identified salient issues that State agencies are likely
to confront in implementing the new competitive pricing requirements.
Following the meeting, FNS received input from additional State
agencies on their current competitive pricing policies, as well as from
representatives of retail grocers.
Nature of Concerns and the Need To Issue This Rule
State agencies have inquired about the intent of the vendor cost
containment provisions, particularly as amended by Public Law 108-265.
They have asked whether these provisions require State agencies to
improve the effectiveness of their competitive pricing systems, or
whether they primarily address the competitiveness of prices charged by
a comparatively small number of stores that derive their revenue from
WIC food instruments predominantly and that generally charge higher
prices than other authorized vendors. State agencies also have
requested clarification of the term ``comparable vendors;'' guidance on
how to determine a vendor's revenue from food sales; criteria for
developing effective vendor peer groups and for obtaining an exemption
from the vendor peer group requirement; and criteria for identifying,
grouping, and setting allowable reimbursement levels for stores that
are likely to derive more than 50 percent of their annual revenue from
food sales from WIC transactions. Some State agencies have expressed
concern over the potential cost of implementing changes to their
automated systems for editing and payment of WIC food instruments. Many
have indicated that the regulations should allow them maximum
flexibility to define the competitive pricing approaches that best suit
their individual circumstances.
Extent to Which We Will Meet Those Concerns
FNS has considered the impact of this interim rule on WIC State and
local agencies. This rule makes changes required by law that became
effective October 1, 2004. Through the rulemaking process, FNS has
attempted to balance the need for State agencies to meet the new
competitive pricing requirements against the administrative challenges
that State agencies are likely to encounter in meeting them. These
challenges include the commitment of adequate resources to configuring
vendor peer groups and allowable reimbursement methodologies, ongoing
monitoring of vendors' prices, and maintaining competitive pricing over
time.
There is limited information available on proven competitive
pricing approaches. Variations in State agency vendor populations,
geography, and other characteristics also preclude the use of a
standardized approach. Therefore, this rule sets forth principles to
guide State agency efforts, while allowing State agencies the
flexibility to meet the legislative requirements through a variety of
acceptable approaches. The inclusion of competitive pricing principles
in this interim rule responds to State agency requests for criteria for
developing effective peer groups and allowable reimbursement levels, so
that foods can be purchased at the lowest prices consistent with
maintaining adequate participant access to vendors.
Executive Order 12988
This rule has been reviewed under Executive Order 12988, Civil
Justice Reform, and is intended to have preemptive effect with respect
to any State or local laws, regulations or policies which conflict with
its provisions, otherwise impede its full implementation, or result in
any delay of implementation of provisions beyond the statutory
implementation date established in the Child Nutrition and WIC
Reauthorization Act of 2004, Public Law 108-265. Section 203(e)(10) of
Public Law 108-265 amends section 17(h) of the Child Nutrition Act of
1966 by adding the new paragraph 17(h)(11) which specifies that the
State agencies shall comply with the provisions of the paragraph not
later than 18 months after the date of enactment. Since the amendment
was enacted on June 30, 2004, State agencies must be in compliance by
December 30, 2005. This rule is not intended to have retroactive effect
unless so specified in the DATES paragraph of this preamble. Prior to
any judicial challenge to the provisions of this rule or the
application of its provisions, all applicable administrative procedures
must be exhausted.
Civil Rights Impact Analysis
FNS has reviewed this interim rule in accordance with Departmental
Regulation 4300-4, ``Civil Rights Impact Analysis,'' to identify and
address any major civil rights impacts the rule might have on
minorities, women, and persons with disabilities. FNS has determined
that the rule's intent and provisions will not adversely affect access
to WIC services by eligible persons. All data available to FNS indicate
that protected individuals have the same opportunity to participate in
the WIC Program as non-protected individuals. FNS specifically
prohibits State and local government agencies that administer the WIC
Program from engaging in actions that discriminate based on race,
color, national origin, sex, age or disability. Section 246.8 of the
WIC regulations (7
[[Page 71711]]
CFR part 246) indicates that Department of Agriculture regulations on
non-discrimination (7 CFR parts 15, 15a and 15b) and FNS instructions
ensure that no person shall on the grounds of race, color, national
origin, age, sex, or disability, be excluded from participation in, be
denied benefits of, or be otherwise subjected to discrimination under
the Program.
Discrimination in any aspect of program administration is
prohibited by Department of Agriculture regulations on non-
discrimination (7 CFR parts 15, 15a, and 15b), the Age Discrimination
Act of 1975 (Pub. L. 94-135), the Rehabilitation Act of 1973 (Pub. L.
93-112, section 504), and title VI of the Civil Rights Act of 1964 (42
U.S.C. 2000d). Enforcement action may be brought under any applicable
Federal law. Title VI complaints shall be processed in accordance with
7 CFR part 15. Where State agencies have options, and they choose to
implement a particular provision, they must implement it in such a way
that it complies with the Sec. 246.8 of the WIC regulations.
Paperwork Reduction Act
The Paperwork Reduction Act of 1995 (44 U.S.C. Chap. 35; see 5 CFR
1320) requires that the Office of Management and Budget (OMB) approve
all collections of information by a Federal agency before they can be
implemented. Respondents are not required to respond to any collection
of information unless it displays a current valid OMB control number.
This interim rule contains new information collections that are subject
to review and approval by the Office of Management and Budget. FNS is
submitting for public comment the information collection burden that
would result from the implementation of the provisions in this rule.
Comments are invited on: (a) Whether the proposed collection of
information is necessary for the proper performance of the functions of
the agency, including whether the information shall have practical
utility; (b) the accuracy of the agency's estimate of the burden of the
proposed collection of information, including the validity of the
methodology and assumptions used; (c) ways to enhance the quality,
utility, and clarity of the information to be collected; and (d) ways
to minimize the burden of the collection of information on those who
are to respond, including use of appropriate automated, electronic,
mechanical, or other technological collection techniques or other forms
of information technology.
Comments may be sent to Debra R. Whitford, Chief, Policy and
Program Development Branch, Supplemental Food Programs Division, Food
and Nutrition Service, U.S. Department of Agriculture, 3101 Park Center
Drive, Room 522, Alexandria, Virginia 22302. Comments may also be
submitted via the FNS Web site at https://www.fns.usda.gov/wic, by
following the online instructions. In all cases, please label your
comments as ``Proposed Collection of Information: WIC Vendor Cost
Containment Interim Rule.'' All written comments will be open for
public inspection at the office of the Food and Nutrition Service
during regular business hours (8:30 a.m. to 5 p.m. Monday through
Friday) at 3101 Park Center Drive, Room 522, Alexandria, Virginia
22302. All responses to this notice will be summarized and included in
the request for OMB approval. All comments will be a matter of public
record.
OMB Number: 0584-0043.
Expiration Date: March 31, 2007.
Type of Request: Revision of a currently approved collection.
Abstract: The information collection and reporting burden
associated with this interim rule meets new vendor cost containment
requirements contained in the Child Nutrition and WIC Reauthorization
Act of 2004, Public Law 108-265. These requirements affect the
selection, authorization, and reimbursement of WIC vendors. The rule
requires State agencies to report on a number of factors so that FNS
can meet the goals of effectively containing food costs by ensuring
that the WIC Program pays competitive prices for WIC foods and
providing guidance to State agencies on best competitive pricing
practices. These include new State Plan components, collection of
information to identify vendors that derive more than 50 percent of
their food sales revenue from WIC food instruments, and collection of
vendor shelf prices for WIC foods. FNS deems this information
collection and reporting burden to be necessary in order to fulfill the
legislative requirements and ensure State agency compliance with the
interim rule.
Section 246.4(a)(14)(xv) is a new section on vendor cost
containment. It requires a State agency to include in the State Plan a
description of the vendor peer group system and allowable reimbursement
levels that demonstrates that the State agency is in compliance with
WIC cost containment provisions. The vendor peer group description will
include the criteria used to classify vendors into groups, the number
and types of vendors in each peer group, identification of peer groups
with vendors that derive more than 50 percent of their annual food
sales revenue from WIC food instruments and comparable vendor peer
groups, and the competitive price criteria and maximum reimbursement
levels applicable to each peer group. The State Plan also must include
the information specified in Sec. 246.12(g)(4)(iv) of the interim rule
on non-profit vendors that the State agency plans to exempt from the
competitive price criteria and allowable reimbursement levels that are
applicable to other vendors. State agencies seeking an exemption from
the vendor peer group requirement based on the conditions stated in
Sec. 246.12(g)(4)(v) of the interim rule must submit a justification
with documentation supporting their request. The justification will
consist largely of a detailed description of how the State agency's
alternative vendor cost containment system operates, with shelf price
and/or redemption data to demonstrate that the system is as effective
as a vendor peer group system. Under Sec. 246.12(g)(4)(vi) of the
rule, State agencies that authorize vendors that derive more than 50
percent of their annual food sales revenue from WIC food instruments
must describe their methodology for ensuring that average payments per
food instrument to such vendors do not exceed average payments per food
instrument to comparable vendors in order to obtain vendor cost
containment certification. To demonstrate that their competitive price
criteria and allowable reimbursement levels meet regulatory
requirements, State agencies will provide the following data for
selected food instruments redeemed by vendors that derive more than 50
percent of their annual food sales from WIC food instruments and
regular vendors: The number of food instruments redeemed; average food
instrument redemption amounts and standard deviations by peer group;
and the average variance in redemption amounts; the total dollar amount
of WIC redemptions by peer group; and statewide weighted average
redemption prices to demonstrate whether vendors that derive more than
50 percent of their annual food sales from WIC food instruments
resulted in higher costs than would have occurred if participants had
used other vendors. State agencies using EBT systems must make similar
comparisons between the prices paid to vendors that derive more than 50
percent of their annual food sales revenue from WIC food instruments
and the prices paid to comparable vendors. FNS will require annual
updating of selected food
[[Page 71712]]
instrument redemption data.--874 hours
Section 246.12(g)(4)(i) requires a State agency to collect annual
food sales data from authorized vendors and vendor applicants in order
to identify the vendors that derive, or that may be expected to derive,
more than 50 percent of their food sales revenue from WIC food
instruments. A State agency that elects to authorize vendors that meet
the above-50-percent criterion must identify these vendors annually
using a methodology approved by FNS. A State agency that chooses not to
authorize such vendors must use an approved methodology to identify
vendor applicants that would be expected to meet the more than 50
percent criterion if authorized.--45,178 hours.
Section 246.12(g)(4)(ii)(B) requires State agencies to collect the
shelf prices for WIC-approved foods from authorized retail vendors
twice annually. In meeting this requirement, a State agency may limit
data collection to prices that have changed from a vendor's previous
submission. A State agency also may collect prices from a random sample
of authorized vendors and/or for selected supplemental foods.--90,178
hours.
Respondents: WIC State agencies and vendors.
Estimated Number of Respondents: 89 State agencies and 45,000
vendors.
Estimate of Burden: Estimates of the information collection and
reporting burden contained in this interim rule are detailed below.
Estimated Annual Reporting Burden
----------------------------------------------------------------------------------------------------------------
Estimated
Estimated average Estimated
Section of interim rule number of Data collections or reports burden annual
respondents required annually hours per burden
response hours
----------------------------------------------------------------------------------------------------------------
246.4(a)(14)(xv)
Description of vendor peer 89 1............................... 4 356
group system and allowable
reimbursement levels; average
redemption amounts for selected
food instruments.
Notification of exemption 5 1............................... 1 5
of non-profit vendors.
Request for exemption from 30 1--every three years............ 8 80
vendor peer group requirement.
Information required for 65 1--every three years............ 8 173
certification of vendor cost ........... 1............................... ........... ...........
containment system and to monitor 65 4 260
ongoing compliance with
certification requirements.
246.12(g)(4)(i)........................ 89 1............................... 2 178
45,000 1............................... 1 45,000
246.12(g)(4)(ii)(B).................... 89 2............................... 1 178
45,000 2............................... 1 90,000
------------
Burden hours due to program changes ........... ................................ ........... 136,230
Total adjustments *.................... ........... ................................ ........... 203
Currently Approved WIC Reporting and ........... ................................ ........... 2,817,091
Recordkeeping Burden Hours.
Total Proposed WIC Reporting and ........... ................................ ........... 2,953,524
Recordkeeping Burden Hours.
----------------------------------------------------------------------------------------------------------------
* Adjustments are due to an increase in the number of State agencies from 88 to 89.
FNS also plans an information collection to assess the impact of
this regulation on State agencies at a later time.
Government Paperwork Elimination Act
FNS is committed to compliance with the Government Paperwork
Elimination Act (GPEA), which requires Government agencies to provide
the public the option of submitting information or transacting business
electronically to the maximum extent possible. This interim rule
encourages WIC State agencies to collect data from retail vendors using
electronic methods.
Good Cause Determination
As discussed above, section 203(e)(10) of the Child Nutrition and
WIC Reauthorization Act of 2004, Public Law 108-265, contained
provisions that significantly impact vendor cost containment in the WIC
Program, particularly the costs of vendors that derive more than 50
percent of their food sales revenue from WIC food instruments. Section
501 of Public Law 108-265 requires that guidance to implement section
203(e)(10) of the law be issued as soon after the date of enactment as
practicable, and authorizes the issuance of interim final regulations.
Therefore, Under Secretary Eric M. Bost has determined, in accordance
with 5 U.S.C. 553(b), that prior notice and comment would be
unnecessary, and that good cause exists for making this rule effective
without first publishing a proposed rule.
Background
Retail vendors make a major contribution to the success of the WIC
Program by providing supplemental foods to program participants as an
extension of their normal business practices. FNS recognizes that State
agencies must balance multiple objectives when authorizing vendors,
i.e., they must ensure adequate participant access to supplemental
foods; maintain effective program management within available
administrative resources; and pay reasonable food costs. Therefore,
State agencies have broad authority to authorize only those vendors
needed to best serve these objectives. Since WIC is best served if
foods are purchased for the lowest prices, while maintaining reasonable
access for program participants, this authority includes eliminating
vulnerability to excessive food payments by applying competitive price
methods during and following vendor selection, so the State agency can
serve the maximum number of participants with limited funding.
Major amendments to the WIC Program regulations governing food
delivery systems were last published on December 29, 2000, at 65 FR
83248. These amendments, referred to as the WIC Food Delivery Systems
Rule, established mandatory vendor selection, training, and monitoring
requirements to strengthen State agency vendor management systems and
prevent abuse of the program. The WIC Food Delivery
[[Page 71713]]
Systems Rule implemented provisions of the William F. Goodling Child
Nutrition Reauthorization Act of 1998, Public Law 105-336 (which
amended the Child Nutrition Act of 1966, 42 U.S.C. 1786), that required
State agencies to identify high-risk vendors, conduct compliance buys
on high-risk vendors, and consider food prices in the selection of
vendors. State agencies were required to implement the provisions of
the WIC Food Delivery Systems Rule no later than October 1, 2002.
The use of a price criterion in the vendor selection process has
been a critical first step in ensuring that the WIC Program pays
competitive prices for supplemental foods. Appropriate application of
this criterion, coupled with price limitations on the amount that the
State agency will pay vendors subsequent to authorization, is essential
to successful food cost containment. The WIC Food Delivery Systems Rule
authorized State agencies to make price adjustments to the purchase
price on food instruments submitted by the vendor for redemption to
ensure compliance with the price limitations applicable to the vendor.
The Child Nutrition and WIC Reauthorization Act of 2004 (Pub. L.
108-265) amended the Child Nutrition Act of 1966 (CNA) to reinforce and
strengthen the use of competitive price criteria and price limitations
for vendor cost containment. It expanded the competitive pricing
requirement of the WIC Food Delivery Systems Rule to address the
application of competitive pricing methods to vendors that derive their
revenue from food sales predominantly, if not exclusively, from WIC
food instruments. The prices that such stores (often referred to as
``WIC-only stores'') charge for supplemental foods are generally higher
than prices of other authorized retailers. Recent trends showing an
annual increase in the number of WIC-only stores and in the percentage
of the total WIC redemptions that they receive were a primary factor in
the development of the vendor cost containment provisions of Public Law
108-265. Congress intended that the authorization of WIC-only stores
should not result in higher food costs than if program participants
used their food instruments in regular grocery stores.
Section 203(e)(10) of Public Law 108-265 amended section 17(h)(11)
of the CNA to address the emergence of such vendors in the WIC Program
because of their potential adverse impact on the future cost of the
program particularly if these trends continue. The vendor cost
containment provisions of this interim rule will promote sound
stewardship of taxpayer dollars; help ensure that the WIC Program
continues to rely on market forces to contain food costs; and protect
the program's ability to serve the greatest number of eligible women,
infants, and children.
Overview of the New Vendor Cost Containment Requirements
In accordance with section 203(e)(10) of Public Law 108-265, this
interim rule requires State agencies to implement competitive pricing
systems that foster financial integrity and the most efficient use of
their food funds. When State agencies craft these systems properly,
they will not pay higher prices than necessary for supplemental foods.
While State agencies have the discretion to determine many of the
details of their competitive pricing approaches, section 203(e)(10) of
Public Law 108-265 now requires them to establish a vendor peer group
system, and competitive price criteria and allowable reimbursement
levels for each vendor peer group. Previously, the use of peer groups
in competitive pricing systems was optional under Sec. 246.12(g)(4)(i)
of the WIC regulations.
This rule also implements new legislative requirements for State
agencies that choose to authorize for-profit vendors that derive more
than 50 percent of their revenue from food sales from WIC food
instruments. It requires State agencies to ensure that vendors that
meet, and vendor applicants that are expected to meet, the more than 50
percent criterion are cost neutral to the program. (Note: This preamble
will refer to vendors that meet or are expected to meet the more than
50 percent criterion as ``above-50-percent vendors.'') The first cost
neutrality requirement in section 203(e)(10) of Public Law 108-265 is
that payments to above-50-percent vendors may not result in higher food
costs than if program participants purchased their WIC foods at regular
vendors. The second cost neutrality requirement is that average
payments per food instrument to above-50-percent vendors may not be
higher than average payments per food instrument to comparable vendors.
Comparable vendors cannot be other vendors that meet the above-50-
percent criterion.
To achieve the cost neutrality requirements, section 203(e)(10) of
Public Law 108-265 requires State agencies that authorize above-50-
percent vendors to distinguish between these vendors and regular
vendors when establishing vendor peer groups, competitive price
criteria, and allowable reimbursement levels. In determining
competitive prices for WIC foods and establishing allowable
reimbursement levels, State agencies would be required to compare
above-50-percent vendors with regular vendors, i.e., vendors that set
their prices based on market forces and that compete for non-WIC
customers. Since the WIC Program receives a finite amount of funding
annually to serve as many participants as this funding allows, it is
necessary for each State agency to implement a system that ensures
foods are acquired at the most economical cost consistent with
participant access needs. Clearly, reducing the costs to the program of
vendors that have historically charged high prices for supplemental
foods is imperative. Consistent with section 203(e)(10) of Public Law
108-265, this rule reflects the fact that State agencies have clear
authority not to authorize any above-50-percent vendors.
As set forth in section 203(e)(10) of Public Law 108-265, this rule
allows FNS to exempt a State agency, under certain conditions, from the
requirement to establish a vendor peer group system. It would also
allow State agencies to exempt from competitive price criteria and
allowable reimbursement levels pharmacies that supply only exempt
infant formula or medical foods under the program; non-profit vendors
that derive more than 50 percent of their revenue from food sales from
WIC food instruments; and non-profit vendor applicants that are likely
to meet the above-50-percent criterion.
Implementation of This Interim Rule
Section 203(e)(10) of Public Law 108-265 requires State agencies to
implement the provisions included in this interim rule by December 30,
2005. Therefore, State agencies must take all steps that are necessary,
including compliance with any applicable State rulemaking or
legislative requirements, in order to establish policies to comply with
the requirements of this rule by December 30, 2005. To facilitate
implementation of the interim rule, this preamble addresses comments
and questions that State agencies have presented regarding the
requirements to establish vendor peer groups, competitive price
criteria, and allowable reimbursement levels. This preamble also
discusses criteria for developing effective vendor peer groups and for
obtaining an exemption from the vendor peer group requirement. It also
clarifies the meaning of key concepts, such as ``comparable vendors,''
and describes appropriate ways to identify above-50-percent vendors.
This preamble recognizes that applying competitive pricing
techniques to contain food costs remains a
[[Page 71714]]
challenge for some State agencies. Recently, several State agencies
have conducted formal analyses of their competitive pricing systems
and, as a result, are in the process of planning or implementing
changes to enhance system performance. FNS believes that State agencies
will continue learning and adopting more efficient ways of containing
food costs through competitive pricing systems. Therefore, this
preamble offers principles to assist State agencies in assessing the
performance of their competitive pricing systems as they make
modifications to comply with the mandatory changes covered by this
interim rule.
Vendor Peer Group System
General Requirement
Section 203(e)(10)(A) of Public Law 108-265 added section
17(h)(11)(A) to the CNA to require each State agency to establish a
vendor peer group system, except in certain circumstances. This interim
rule incorporates the legislative requirement into Sec. 246.12(g)(4)
of the WIC regulations. A vendor peer group system is a means of
classifying authorized vendors into groups based on common
characteristics that affect food prices. The purpose of peer groups is
to facilitate the application of competitive price criteria at vendor
authorization and during the food instrument redemption process. When a
vendor peer group system is properly constructed, the prices that
vendors within a peer group charge for WIC foods will be more similar
internally than they are to the prices charged by other peer groups;
and the peer group system should account for most of the food price
variations. A State agency that did not have a vendor peer group system
at the time Public Law 108-265 was enacted in June 2004 must implement
such a system by December 30, 2005.
Many State agencies already have a vendor peer group system. The
structure and use of peer groups varies widely. Vendor peer groups are
often established based on a combination of two factors--vendor size
and vendor location. Vendor size may be determined through a variety of
factors, such as total business volume, WIC business volume, square
footage of store, number of cash registers (or point of sale devices),
or type of store (e.g., supermarket, grocery store, convenience store,
military commissary, nonprofit co-op, or pharmacy). Vendor location is
often divided into geographic categories, such as urban, suburban, and
rural, which may also include a number of subcategories within the
State. Some State agencies use three criteria in establishing peer
groups.
Some State agencies use peer groups to set the competitive price
range for WIC foods, assess whether a vendor applicant's prices are
competitive, and to establish maximum reimbursement levels for WIC food
instruments. Others use vendor peer groups to assess the
competitiveness of a vendor applicant's prices, but they do not limit
reimbursements based on a vendor's peer group. Instead, these State
agencies apply a single statewide maximum reimbursement level for each
food instrument type to all peer groups. Section 246.12(g)(4) of the
interim rule, in implementing section 17(h)(11)(A)(i) of the CNA,
clarifies that a State agency must establish competitive price criteria
and allowable reimbursement levels that are applicable to each peer
group.
Because characteristics of the retail grocery marketplace vary from
State to State, this interim rule continues to allow State agencies
broad latitude in establishing peer groups. To ensure that vendor peer
group systems continue to be effective, Sec. 246.12(g)(4)(ii) of this
rule requires State agencies to assess their peer groupings at least
every three years and to modify them as necessary. It also indicates
that a State agency may change the peer group into which it places a
vendor whenever it determines that such action is warranted.
Specific Requirements
Section 17(h)(11)(A)(III) of the CNA requires a State agency that
chooses to authorize for-profit vendors that derive or are expected to
derive more than 50 percent of their annual revenue from food sales
from WIC food instruments to distinguish between the above-50-percent
vendors and regular retail vendors for cost containment purposes.
Accordingly, Sec. 246.12(g)(4)(i) of this rule requires a State agency
that chooses to authorize any above-50-percent vendors to distinguish
between these vendors and regular vendors in its peer group system. In
meeting this requirement, a State agency may establish separate peer
groups for above-50-percent vendors or place them in peer groups with
regular vendors, but establish distinct competitive price criteria and
allowable reimbursement levels for the above-50-percent vendors within
the peer groups. Both approaches require a State agency to compare the
prices of above-50-percent vendors against the prices of regular retail
vendors for vendor selection and reimbursement purposes. A State
agency's vendor peer group system must meet this requirement unless the
State agency chooses not to authorize any above-50-percent vendors.
In the past, State agencies that authorized a specific type of
vendor known as WIC-only stores have tended to place them into separate
peer groups where their prices were compared with other WIC-only
stores. This practice generally has resulted in the payment of higher
prices to WIC-only vendors than to regular retail vendors. In many
instances, payment of higher prices to WIC-only vendors was unnecessary
because other competitively-priced vendors were accessible to WIC
participants. In implementing this rule, a State agency that authorizes
any above-50-percent vendors would be required to determine whether it
is more effective, from a cost containment perspective, to group them
with regular retail vendors than by themselves, and if so, how to group
them with regular vendors without inflating the peer group's prices.
Some State agencies have expressed the view that grouping above-50-
percent vendors with regular vendors would increase a State agency's
ability to monitor their prices; provide an incentive for such vendors
to offer competitive prices; and help a State agency hold them to the
same pricing standard as regular retail vendors. State agency arguments
against this approach include the likelihood that the prices of above-
50-percent vendors would be too high to allow them to be grouped with
regular vendors. State agencies also thought that above-50-percent
vendors would skew the average prices for the peer group. Section
246.12(g)(4)(i) of this interim rule states that State agencies must
ensure that the prices of above-50-percent vendors do not inflate the
competitive price criteria and allowable reimbursement levels
applicable to each peer group.
When a State agency assigns above-50-percent vendors to a peer
group with regular vendors, it must use the prices of the regular
vendors within the peer group to establish the competitive price
criteria and allowable reimbursement level for the above-50-percent
vendors. If a State agency assigns above-50-percent vendors to separate
peer groups, the State agency may not reimburse them at a higher level
than that for peer groups consisting of comparable regular vendors.
In identifying vendors that are comparable to above-50-percent
vendors, the State agency must consider geographic area; however, the
State agency has the discretion to determine how much weight to give to
geographic considerations. The State agency may interpret comparability
differently for regular retail vendors than for above-50-percent
vendors. For example, a State
[[Page 71715]]
agency might determine that geographic location and number of cash
registers adequately define peer groups for regular vendors, but that
it must utilize an additional criterion, such as WIC sales volume, to
identify stores that are comparable to the above-50-percent vendors.
Identifying Above-50-Percent Vendors
In order to comply with requirements of section 17(h)(11)(A)(III)
of the CNA with regard to above-50-percent vendors, Sec.
246.12(g)(4)(i) of this interim rule requires each State agency to
determine on an annual basis whether any authorized vendors meet the
more than 50 percent criterion and whether each new vendor applicant is
expected to meet it. In making its determination, the State agency
would be required to consider a vendor's annual revenue from the sale
of food items. Under this rule, revenue from the sale of food items
means the sum of all payments (including, cash, Food Stamp Program and
WIC redemptions, and credit/debit transactions) received by the vendor
for the sale of foods that can be purchased under the Food Stamp
Program (FSP). Currently, there is no standard definition of ``food
sales'' used in the retail food industry. Since approximately 85
percent of current WIC vendors are authorized by the Food Stamp
Program, most vendors are familiar with the eligible food items and
there would be a consistent definition of food sales between WIC and
the FSP. Vendors that utilize scanning equipment during the checkout
process are able to flag foods that are eligible for purchase with food
stamp benefits and, thus, to capture the total sales amount.
Eligible food sales include sales of foods intended for home
preparation and consumption, including meat, fish, and poultry; bread
and cereal products; dairy products; and fruits and vegetables. Items
such as condiments and spices, coffee, tea, cocoa, and carbonated and
noncarbonated drinks may be included in food sales when they are
offered for sale along with the abovementioned foods. Items that cannot
be purchased using food stamp benefits include, but are not limited to,
hot foods and food that will be eaten in the store. This rule does not
require that a vendor be authorized by the Food Stamp Program.
State agencies must use the following approach to identify above-
50-percent vendors. State agencies may use additional methods, if
approved by FNS.
1. Current Vendors
To determine whether a currently authorized vendor meets the more
than 50 percent criterion, the State agency must calculate WIC
redemptions as a percent of the vendor's total foods sales for the same
period. If WIC redemptions are more than 50 percent of the total food
sales, the vendor must be deemed to be an above-50-percent vendor. As
an initial step in identifying above-50-percent vendors, the State
agency should compare each vendor's WIC redemptions to FSP redemptions
for the same period. If more than one WIC State agency authorizes a
particular vendor, then each State agency must obtain and add the WIC
redemptions for each State agency that authorizes the vendor to derive
the total WIC redemptions. Most WIC vendors also have FSP authorization
and, consequently, have FSP redemptions. If FSP redemptions exceed WIC
redemptions, no further assessment would be required. The vendor
clearly would not be an above-50-percent vendor.
For vendors whose WIC redemptions exceed their FSP redemptions,
further assessment would be required. The State agency should ask these
vendors to provide the total amount of revenue obtained from the sale
of foods that could be purchased using food stamp benefits. The State
agency should request documentation (such as tax documents or other
verifiable documentation) to support the amount of food sales claimed
by the vendor. After evaluating the documentation received from the
vendor, the State agency must calculate WIC redemptions as a percent of
total food sales and classify the vendor as meeting or not meeting the
more than 50 percent criterion.
For vendors that are not authorized by the FSP, the State agency
should clarify the types of foods that may be included in food sales,
using the list of eligible and ineligible food items that applies to
FSP retailers. The State agency should request and evaluate verifiable
documentation on the store's revenue from food sales and classify the
vendor as appropriate.
2. Vendor Applicants
As part of the vendor application process, the State agency must
ask vendor applicants whether they expect to derive more than 50
percent of their annual revenue from the sale of food items from
transactions involving WIC food instruments. This question applies
whether or not the State agency chooses to authorize above-50-percent
vendors. Vendor applicants include a new store location for any
ownership entity that currently has a WIC authorized store, as well as
an entirely new vendor applicant. If the vendor applicant's answer is
``yes,'' no further assessment would be necessary. The State agency
would treat this vendor as likely to meet the more than 50 percent
criterion, if the vendor were authorized.
The State agency would further assess all other vendor applicants
using the following indicators to determine whether they would be
expected to meet the more than 50 percent criterion if authorized.
First, the State agency must calculate WIC redemptions as a percent of
total food sales in existing WIC-authorized stores owned by the vendor
applicant. Secondly, the State agency must calculate or request from
the vendor applicant the percentage of anticipated food sales by type
of payment, i.e., cash, FSP, WIC, and credit/debit card. Thirdly, the
State agency must request and review inventory invoices to determine if
the vendor will offer for sale on a continuous basis a variety of
meats, poultry or fish; breads or cereals; vegetables or fruits; and
dairy products. Fourthly, the State agency must determine whether WIC
authorization is required in order for the store to open for business.
To the extent possible, the State agency should validate information
received from the vendor applicant against other data sources.
Use of the percent of anticipated food sales by payment type
provides information on WIC as a percentage of total food sales. Having
a variety of foods other than supplemental foods would indicate that
the vendor has or expects to have non-WIC sales. If the vendor is
already operating a viable business without WIC transactions, this
might indicate that the vendor will not be dependent upon WIC as a
primary source of revenue. These indicators should provide the State
agency with sufficient information on which to base its assessment of a
vendor applicant. At its discretion, the State agency may use
additional data sources and methodologies.
The State agency must maintain documentation indicating the basis
for its determination as to whether a current vendor or vendor
applicant meets or is expected to meet the more than 50 percent
criterion. Section 246.12(g)(4)(i) of the interim rule requires the
State agency to assess the accuracy of its determination within six
months of authorizing the new vendor to determine whether the vendor
should have been authorized, and/or to ensure that the State agency is
applying the appropriate competitive price criteria
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and allowable reimbursement level to the new vendor. If necessary, the
State agency would terminate the vendor agreement or reassign the
vendor to the appropriate peer group based on this assessment.
Acceptable Vendor Peer Group Methodologies
Structuring an effective vendor peer group system involves an
ongoing process of monitoring the prices vendors charge for
supplemental foods and adjusting the peer groups as needed for better
cost containment. FNS believes State agencies should not view peer
groups as permanent or fixed designations; rather, they should be
prepared to modify the vendor peer group structure when needed based on
price data (i.e., shelf prices, bid prices, food instrument redemption
data, and market surveys) and other information.
For example, a State agency that fails to distinguish between
different types of vendors (e.g., chain stores, large independent
stores, and small neighborhood grocery stores) in a particular
geographic area might be overlooking pricing variations or
characteristics that are apparent when these vendors are further
classified by type or size of store. While a State agency might find it
easier to manage peer groups constructed solely on the basis of
geographic location, creating peer groups that further differentiate
between vendors could improve cost containment by allowing the State
agency to replace a single high allowable reimbursement level for a
geographic area with several lower allowable reimbursement levels
tailored to the prices of each subgroup of vendors in the area. A State
agency should consider the effectiveness of such alternative approaches
in implementing a vendor peer group system.
Available information on the effective design of vendor peer groups
for cost containment purposes suggests that State agencies could
benefit from applying two principles to this process.
1. Peer Group Criteria
A State agency should use a sufficient number of criteria to
differentiate between vendors and account for variations in price.
Criteria used by one State agency may not have the same effect when
used by another State agency. Available data suggest that State
agencies benefit from using geographic location as a criterion in
establishing peer groups, and that the use of two or more criteria is
preferable to using a single criterion. Therefore, Sec.
246.12(g)(4)(ii) of the interim rule requires a State agency to use at
least two criteria in establishing peer groups, one of which must be a
measure of geographic location. Under Sec. 246.12(g)(4)(ii), a State
agency may receive FNS approval to use a single criterion to establish
vendor peer groups. FNS approval will be based on a State agency's
demonstration that the use of a single criterion significantly accounts
for variations in prices among vendors, and that using a second
criterion would not further contain food costs. The State agency's peer
group criteria, including its criteria for identifying above-50-percent
vendors and vendors that are comparable to above-50-percent vendors,
are not subject to administrative review under Sec. 246.18(a)(1)(iii)
of the interim rule. The public has an opportunity to comment on these
criteria as part of the State Plan process; thus interested parties
should use this process to provide input. FNS must review and approve
peer group-related criteria as part of the State Plan process.
2. Periodic Assessment of Peer Group Structure
To ensure that vendor peer groups remain effective, Sec.
246.12(g)(4)(ii) of this interim rule requires the State agency to
assess its peer groupings at least every three years and make
adjustments as necessary. This process would include using statistical
methods to verify the appropriateness of the peer group criteria and
the methodology for establishing competitive price. The State agency is
encouraged to work with its vendor advisory group in this process.
Exemptions From Peer Group Requirements
In accordance with section 17(h)(11)(A)(ii) of the CNA, the interim
rule (Sec. 246.12(g)(4)(v)) establishes two conditions under which FNS
may grant a State agency an exemption from the peer group requirements.
The first condition applies to a State agency that elects not to
authorize any above-50-percent vendors. The State agency must
demonstrate to FNS that establishing a vendor peer group system would
be inconsistent with efficient and effective operation of the program,
or that its alternative cost containment system would be as effective
as a peer group system.
The second condition for an exemption applies to a State agency
that authorizes above-50-percent vendors. The WIC redemptions of above-
50-percent vendors authorized by the State agency must be less than
five percent of the State agency's total WIC redemptions (dollars) in
the year preceding a year in wh