About the eligibility requirements of the current child nutrition assistance cadre of programs as they exist today . I think the important thing when youre talking about reducing errors and improper payment which is i think we all agree is a very important endeavor is to create a culture where a culture of compliance with the rules. We want the rules to be followed. I dont think the rules themselves are the problem i think its helping people understand them and there are lots of different people involved in the system. Its families when theyre filling out applications, its schools when theyre running programs, its states when theyre administering them. So i think that kind of day in and day out work is whats most important to reduce errors and reduce improper payments in the program. I would second that and also add its important to as a former president once famously stated, its important to not only trust but verify. I would add to that and say its important to trust and verify in a meaningful manner. We found through our work that the verification process could be strengthened in several important ways. And its and i think that will serve the reduced improper payments rate and help drive that number down. Although i should add as miss neuberger responded on the counting side of the equation over 700 million the improper payments estimate is due to simple accounting errors at the School District level. So i think thats an area that could be addressed as well through Technology Better training. Theres some important ways they could drive that number down to enhance the operations of the program. So do you believe that more state and or local input on establishing eligibility requirements could be helpful in cutting down on some of the incorrect reimbursement rates . Well, personally i think theres two ways to go at it. You have to first explore the potential of Data Analytics and computer matching to help simplify the process, make it more efficient and you can do that in a more at the state agency level without getting down to the School District level. But at the School District level, again i think there needs to be greater awareness about how to fill out applications completely, the need to periodically do spot checks of what people are reporting. So i think you have to approach it in a multifaceted manner. Centrally at the state agency level as well as the School Districts as miss neuberger pointed out, though, theyre not as well equipped to do their own rigorous verification. One of the things that does make the School Meal Programs easier to understand and administer now is that they do have one set of rules that applies across the country. And that is an important simplification and source of fairness and i think its important to consult with districts and states about what will work to help the programs run more smoothly and more accurately in their areas. But thats not the same as considering changing the eligibility rules or other program rules. Do you think that categorical eligibility for school meals ought to be eliminated . No. Thats basically the source of tremendous simplification. I mean thats what allows families who are already getting snap benefits where theres a very rigorous eligibility determination, their income levels are going to be at or below the levels that are already set within the school meal program. So basically thats a tremendous simplification right now. So which ones if thats true then which ones should be utilized the most . Right now any place in the country is allowed to use data from the snap program or tanf cash assistance. There are other categories like children that are homeless or in costar care, they can be automatically eligible. Medicaid is only available for use in seven states right now and so thats a potential thats theres Untapped Potential there where additional states could benefit from utilizing that data. Okay. All right, my time has expired mr. Chairman, i thank this panel and look forward to the testimony from the next one. Thanks. Senator stabenow . Thank you mr. Chairman. I just want to do a quick followup, mr. Lord. You were talking about how as relates to simplification but also making sure we are rigorous in our in oversight standards and so on you indicated this snap program has a smaller error rate, which it does one of the smallest in the federal government in terms of overall errors and that theres a larger error rate in the food program. So if we were going more in the direction of tying it to snap Community Eligibility which has saved a lot of money in michigan and been very effective, is that what you were suggesting . Looking at snap which actually has more rigorous oversight lower error rate, and tying it to that might actually establish both goals of simplification and also tightening things up . That was yeah, thats what i was suggesting and i was citing the omb figures on their estimated improper payments. There is some degree of imprecision with it, but that alone suggests snap, even though there are some errors in the program, when you rely on that method to enroll people in school meals its its actually less. Because i think its below 3 if i remember right right now. So thats actually the low esther or are rate of anything we have in agriculture programs. Its around 3 and again the School NationalSchool Lunch Programs 15. 25 . So much higher. So i think thats an interesting thing for us to highlight thank you very much. One last point. In our report even though we know we did note that if you are deemed categorically eligible for a program through programs such as snap, though, under the current verification process, youre excluded completely from verification so our point was you may want to subject some of those eligible applications to scrutiny. Thanks very much. Senator klobuchar . We had a hearing on patent reform which was quite exciting or i would have been here earlier. Thank you chairman roberts and Ranking Member stabenow for holding this important hearing. Child Nutrition Programs in advance of our work to reauthorize the program. I worked hard in the last reauthorization to strengthen local wellness policies, to update the nutrition standards for Child Care Centers and afterschool programs and also to ensure that vending machines and a la carte choices wouldnt undercut Good Nutrition and the sale of junk foods. We all know how important schools are to our kids inu tradition. Im proud of the work that we have done in the bill and i think we know that weve seen some improvement but i think we also know that there are problems ahead if we dont continue this work to make sure the kids get the most nutritious meals possible when theyre at school. The 2010 reauthorization of child Nutrition Programs specified that usda conduct a review of food items provided by under the wic program at least every ten years based on the institute of medicine recommendations. Some have argued that the review process should be expedited in certain circumstances. Miss neuberger, does the current review timeline keep pace with scientific advances on the nutritional quality of fruits and vegetables and what can be done to improve the process . Theres a review under way right now, so i want to make sure everybodys aware of that. That is working as planned. And the rule is actually that the review has to happen at least every ten years, but it can happen more often than that if theres reason. So if there were important changes in dietary recommendations that might warrant a more frequent review. But i think the rule thats in place makes sense. Okay. Very good. And its been estimated by the journal of Health Economics that nearly 20 of annual medical spending in the u. S. Is obesity related. How does this factor into the decision about how we reauthorize this bill . Either of you can answer that. I think weve talked earlier both Programs School meals and wic have tremendous benefits in terms of helping children achieve the health and Development Outcomes youd like to see as well as better preparing them for learning. So they are critical investments, particularly for lowincome children who may not have access to adequate nutrition elsewhere to help them develop properly, stay healthy, and be ready to learn at school. Okay, thank you. Could you comment also on the potential cuts to the child Nutrition Programs under the fiscal 2016 budget resolution that weve just been talking about on the floor miss neuberger . Broadly speaking we would be very concerned about the consequences for lowincome families in that agreement. Thats not specific to these programs but across the programs that low income families rely on when theyre struggling to feed kids or make ends meet. And one last thing back to the wic program that we just talked about. You know it plays a critically Important Role in promoting the health of pregnant and postpartum mothers as well as Young Children. The continued success of the program is contingent on sound cost control and i understand that states that are given flexibility to develop their own food list based on usdas minimum standards and get some of the states leave lower cost products off the list of approved foods. Without dictating to states their wic food list, how can we incentivize states to consider cost controls when determining approved food items . Just to be clear, wic is a federal program. Most of the rules are federal. There are certain areas where theres state flexibility. States have a builtin incentive to contain costs in wic because they have limits . Because they get a limited amount of money so the more efficiently they can use the money the more people they can serve and thats been very motivating motivating. Wic is a very costeffective program. Wic costs have increased at about half the rate of inflation over time. Its a very sound investment and states have played an important part in that. So the way the program is structured really contributes to that incentive structure. Thank you very much. Mr. Chairman lord did you want to add anything for any of these questions . Not on wic, no, senator. Okay, very good. Thank you very much and im glad youre here. Its a very important topic and, as i said, the last bill with senator stabenow was involved in, i know senator roberts on the committee and now leading the committee i think was very important and weve made some Great Strides and we need to continue improvement in the nutrition standards. Thank you to both of you. Senator . Thank you mr. Chairman. Miss neuberger or mr. Lord, i want to look back at the program. Im from North Carolina. I was speaker of the house down there, worked a lot with the various school systems. We have 115 of them in North Carolina and they seem to be both for and against the Food Nutrition Program in terms that they like the outcome but they didnt like the overhead or they didnt necessarily like how the regulations required them to implement it. That the level of details involved. Has there been any work done on trying to figure out how we can if were measuring outcomes, and thats a question i had for you, mr. Lord. I know youre going through the gao is going through the verification process making sure that people who are entitled to it get it and those who dont, dont. But what about the more fundamental question of the baseline when this program started, the year over year improvement and outcomes which, at the end of the day, is Childrens Health and making sure that theyre fed. Are we measuring those in a scientific way and identifying best practices and intervening when theyre compliant with the program but not producing positive outcomes . Well i know miss knewberger is probably more well versed on that but in terms of the Outcome Measures for the verification process, that was one of our suggests to usda. Theyve recently started collecting a lot of good information on socalled forcause verification process. But they mix it together with other reporting so its unclear to us what the outcomes of all the efforts to conduct forcause verifications. And those are reviews of questionable applications so at least in that one area im very familiar with. Theres broad agreement they need to do a better job in looking at Outcome Measures in that area. Thats verification related and perhaps miss neuberger can come in on the broader nutritional outcomes. Miss neuberger . Sure. Theres generally quite a lot of research on the positive benefits of these programs in particular, for example, children who eat breakfast at school have been shown to have fewer academic issues less absence and tardiness and better performance at schools. So thats a clear area where theres a strong tie between participating in the meal programs and kind of educational outcomes youd like to see in school. One question i have, i dont know if its anecdotal or something that we need to look more at but you hear the stories of putting im not going to pick a vegetable because i always make a segment of agriculture mad when i do. But lets say a vegetable that for whatever reason kids dont like yet and theyre concerned that their ear satsyre satisfying the letter of the regulation but that goes into the trash. Do we have data to get that beyond anecdotal where they may be Something Else to put on the plate to make sure that the Young Persons belly is full and better using the things that were putting on their plate . I hope that youll ask that question in the second panel because you have some program operators. Im going to i just dont know if im going to be here. There is research on the extent to which children are eating the meals. This is not an area that i focus on so its not my expertise but it has shown that there is less way waste under the new rules than there was previously and theres certainly always room for improvement but its important to know things seem to be moving in the right direction in terms of figuring out how to get kids to eat. I think thats one of the concerns expressed by a lot of the people. I met with some members of the School Board Association and superintendents association. That seems to be a concern that they have expressed and i think its an area we need to look at. And the next program i hope im here so i can brag a little bit on our farmtoschool initiatives in North Carolina because weve been very aggressive and its beneficial, we need to do more of it. Convince those kids Brussel Sprouts are good, particularly when they know where they came from. But im going to hold and allow us to move us to the next panel and reserve my questions for that panel. Thank you. Senator tillis, ive been known to eat a brussel sprout or two but always with cheese on them. [ laughter ] mines with bacon. Well, with bacon and cheese it might work out but i have problems with the cheese but we dont want to go there. Senator heitkamp . Thank you, mr. Chairman. Thank you for this important hearing, making sure our children have every opportunity to succeed is something i think the entire committee believes in and this is a good place to start when were talking about child nutrition and basically giving them the opportunity to grow up healthy and learn throughout the day. Nutrition standards set in the health and hungry kids act is an important first step to help creating a healthier and more prepared next generation. But we should also make sure that the schools have the tools they need to provide healthy meals. In north dakota, 100 of our schools, im proud to say, are meeting the standards and a couple of months ago only one school still had asks for a waiver on the whole grain pasta requirement. So thats pretty incredible in a state that has a fairly high rate of problems as it relates to obesity. However, the pew study found that 74 of north dakota schools still need at least one piece of School Equipment kitchen equipment, in order to meet the standards. And senator collins and i have introduced a bill to help schools purchase new equipment and provide them with the Technical Assistance on food preparation and meeting the standards so i want to put a plug in for the School Food Modernization act which i think will give the tools that the many of our people who serve our children everyday, and by that i mean literally and figuratively that the equipment and the tools that they need. Especially this is especially important in rural schools where the School Districts are already strapped, where you have a Large Population but or a small population but a huge need for upgrading. Ive said it many times. My mom was a lunch lady so im especially partial to the school lunch program. I know what that meant. I know what she did everyday to try and put nutritious and good food on the table. And i also knew that there were kids that i went to school with where that may have been the only meal they got all day. So she took that responsibility seriously and so weve been talking a lot mr. Lord, about Program Integrity and making sure people who shouldnt be participating in the program arent. Obviously the surfer dude hit the news last year in a big way. But miss neuberger noted that one in four applications were denied despite actual household circumstance and were wondering, how as we close to loophole and make sure that we dont have fraud in this program, how can we make sure more kids get into this program who actually need these nutritious meals, who actually need that backpack going home on the weekend . Well i think you need to raise awareness and perhaps do additional outreach a