Food Package III

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Food Package III Medical Documentation
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What is Food Package III?

• Food package III is reserved for woman,
  infant, and child participants who have a
  documented qualifying condition that requires the
  use of a WIC formula (infant formula, special
  formula, or WIC-eligible medical food) because
  the use of conventional foods is precluded,
  restricted, or inadequate to address their
  special nutritional needs.

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Major Changes in Food Package III

• Now includes infants as well as women and
  children with qualifying conditions
• Whole milk may be issued to women and children gt
  2 years of age with a qualifying condition
  (diagnosed by a physician) under Food Package
  III.
• Full food package may be provided including
  milk
• Increased requirements for medical documentation
  - new form

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Food Package III Women and ChildrenParticipants
with Qualifying Conditions
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Food Package III for Infants

• Infants will qualify for Food Package III if they
  require a special formula.
• To receive Food Package III an infant must have
  medical documentation of a qualifying medical
  condition requiring a special formula.
• Infants 6-12 months old must have a completed
  medical documentation form detailing which foods
  offered through the WIC program are restricted or
  contraindicated.
• If an infant receiving a special formula is
  unable to consume solid foods and this is
  documented by the health care provider, the
  infant may be issued the 4-5 month fully formula
  feeding amount of formula.

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When is Medical Documentation required?

• Contract formulas Good Start 2 Gentle Plus and
  Good Start 2 Soy Plus
• Non-contract formulas Similac Sensitive and
  Enfamil AR LIPIL
• Special infant formulas
• Any infant formula for children
• Medical foods for women and children

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When is Medical Documentation required? (cont)

• Whole milk for anyone 2 years and older (issued
  with formula/medical foods only)
• Cheese
• Greater than 1 pound for children, pregnant
  women, mostly breastfeeding and some
  breastfeeding/delivered women
• Greater than 2 pounds for fully breastfeeding
  women
• Soy based beverage
• For children (1-4 years old)

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New Medical Documentation Form

• New Output in WICnet
• Replaces Physicians Request for Special Formula
  and Intolerance to Contract Formula forms
• Continue to keep forms on file

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Medical Documentation Form - Output in WICnet

• WICnet will auto fill
• Participants name
• Parent/guardian name
• Date of birth
• Local agency name, telephone number and fax
  number

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Medical Documentation Form

• Section 1 is completed by the health care
  provider to issue formula/medical foods.
• Name of the formula/medical food prescribed
• Medical diagnosis
• The amount needed per day
• Time needed
• Authorized supplemental food(s) and their
  prescribed amounts

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Medical Documentation Form

• Section 2 is completed by the health care
  provider to issue milk substitutes.
• Milk substitute requested soy beverage or
  cheese
• Medical diagnosis
• Time needed

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Medical Documentation Form

• Section 3 is completed by the health care
  provider for both situations (formula/medical
  foods and milk substitutes).
• Signature of health care provider, printed name
  and credentials
• Date
• Clinic name and address
• Phone and fax number

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What are some of the qualifying conditions?

• Prematurity
• Low birthweight
• Failure to thrive
• Inborn errors of metabolism
• Gastrointestinal disorders
• Malabsorption syndromes
• Immune system disorders
• Severe food allergies requiring an elemental
  formula
• Diagnosed food allergy or formula intolerance to
  lactose
• Life threatening disorders
• Diseases and medical conditions that impair
  ingestion, digestion, absorption, or the
  utilization of nutrients that could adversely
  affect the participants nutrition status

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Food package III is not authorized for

• Formula intolerance or personal preference
• Spitting up
• Gassy
• Colic
• Solely for the purpose of enhancing nutrient
  intake or managing bodyweight without an
  underlying qualifying condition

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Authorized Quantities for Infants

• Maximum formula in Food Package III is the same
  as Food Package I and II
• Infant 6-11months of age whose medical condition
  prevents them from consuming complementary infant
  foods may receive formula at the same maximum
  monthly allowance as infants ages 4 through 5
  months of the same feeding option.
• Must be receiving a special formula

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Authorized Quantities for Women and Children

• Maximum formula in Food Package III is
• 455 fl. oz. liquid concentrate
• 910 fl. oz. reconstituted powder
• 910 fl. oz. ready-to-feed

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When is Medical Documentation required for soy
milk?

• Soy milk for children (1 to 4 years old)
• Qualifying conditions may include
• A milk allergy
• Severe lactose intolerance
• Vegan diet
• Can substitute the entire amount of fluid milk
  for soy milk

Medical documentation is not required for women
requesting soy milk.
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What are the substitution amounts for soy milk?

1 quart of milk
1 quart of soy milk
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When is Medical Documentation required for
cheese?

1 pound of cheese
3 quarts of milk
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Lactose Intolerance

• Lactose-free/reduced milk should be offered
  before soy milk to participants with lactose
  intolerance.
• These milks do not require medical documentation.
• Women and children who have a food intolerance to
  lactose or milk protein can be managed with a
  milk substitute (cheese or soy milk).
• Cheese may be substituted, up to the maximum
  allowances for fluid milk

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What is the approval length for Medical
Documentation?

• Length of time the formula is medically required
• Not to exceed 6 months for formula/medical foods
• Can be indefinite for soy based beverage/cheese
• Certain situations require a form to be
  completed.
• The heatlh care providers signature, date and
  contact information is required.

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How to Handle Incomplete Forms

• If you receive an incomplete medical
  documentation form, you can issue one month of
  checks only.
• If you receive a prescription pad for a special
  formula, you can issue one month of checks for
  the formula/medical food only.
• Can issue the supplemental foods after receiving
  the completed form
• In WICnet, must complete Medical Documentation
  group box with the information you have, then
  update it at the next visit.

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Can I complete the medical documentation over
the phone with the health care provider?
Answer

• When absolutely necessary, the initial
  medical prescription may be provided by
  telephone. However, a signed, completed medical
  documentation form must be received from the
  health care provider before additional formula is
  issued.
• Maximum issuance is 30 days without signed
  medical documentation form.

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Transition Period

• All participants will need a new form completed
  before they come in for their next appointment
  after October 1.
• Provide a copy of the form, memo, and physician Q
  A to the participant to have their health care
  provider complete.
• All this information can be found on our website
  at http//www.ndhealth.gov/wic/Formula20and20Med
  ical20Documentation.htm.
• If the participant doesnt bring the form back in
  Oct./Nov., issue one month only of the
  formula/medical food (if you have a current
  prescription on file), but no supplemental foods
  until the form is completed.

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Communication with Physicians

• Non-contract formula policy letter July
• New medical documentation letter August
• All this information can be found on our website
  - http//www.ndhealth.gov/wic/Formula20and20Medi
  cal20Documentation.htm.

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Staff Resources

• Medical Documentation Guide
• Formula Issuance Guide
• Infant Formula Ranges Cheat Sheet
• Formula Manual currently being revised

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Formula Manual Revisions

• Most valuable information how much to issue
• Will be providing information on formulas/medical
  foods that will be in WICnet starting October 1
• Deactivated formulas in WICnet notification by
  e-mail
• Call state office with new formulas/medical foods
  to be added to WICnet

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Questions from You!
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Can a participant receive all of the milk,
formula, and other supplemental foods if
prescribed by the physician?
Answer

• Yes, Food Package III now includes all
  supplemental foods including milk as well as
  formula/medical foods. So a child could receive
  113 cans of PediaSure, 4 gallons of milk, and all
  of the other supplemental foods.

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Can I approve a physicians request for low fat
milk for children under 2 years of age?
Answer

• No, a physicians request for 2, 1, or skim
  milk cant be allowed for children under 2 years
  of age.

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Can I approve a physicians request for whole
milk for women and children over 2 years old?
Answer

• Yes, whole milk can be provided only when
  receiving formula under Food Package III with
  medical documentation.

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Can 2, 1, or skim lactose free/reduced milk be
provided to children under 2 years of age?

• No, whole lactose free/reduced milk must be
  provided to children under 2 years of age.
  Lactaid is one brand that carries a whole lactose
  free milk.

Answer
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How will WIC handle requests for children to
receive soy milk solely based on personal
preference?
Answer

• According to USDA, medical documentation for
  soy
• beverages for children ensures that a childs
  health care provider is aware that the child may
  be at nutritional risk when milk is replaced by
  other foods.

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Can I refuse a medical documentation form if the
medical diagnosis doesnt match the information
in the WIC record?
Answer

• Yes, you can, but communication with the health
  care provider is important before refusing the
  form. Example medical diagnosis for additional
  cheese is underweight, but the WIC record doesnt
  show the participant is underweight.

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If I receive a prescription for a special formula
do I need to have the infant try a contract
formula product first before issuing it?
Answer

• No, if there is a medical need, you can issue the
  special formula with medical documentation. This
  includes Similac Sensitive and Enfamil AR LIPIL.
  

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If a child is on formula past one year of age,
can that child receive the baby food fruits and
vegetables and infant cereal if prescribed by the
physician?
Answer

• Yes and no, 32 ounces of infant cereal can be
  substituted for the 36 ounces of regular cereal,
  but the baby food fruits and vegetables cannot be
  substituted.

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Thank You!

• Thanks to the New York State, Colorado, and
  Missouri WIC programs for use of their materials
  to adapt in creating this presentation.