Questions & Answers Food Package for Qualifying
Contents
1. assign a WIC client whole milk the client will need to simultaneously be assigned a Class II or Class III formula in MI WIC 13 Please clarify the policy regarding the partially breastfeeding BP women who request the partially breastfeeding infant IBP full formula package for their infants It was stated that we should keep the mom on WIC to provide breastfeeding support and other services If mom is giving up her food package can she go to Focus Hope CSFP A No the client would still be counted as a WIC participant and can receive other WIC services like nutrition education and breastfeeding support The client may not participate in both the WIC Program and CSFP simultaneously Whole Milk 14 Why the requirement to have a special formula along with whole milk for clients over age two Why would a client receive a package with milk and a Class II or III formula A The Institute of Medicine IOM committee recommended that the package should be restrictive only to the extent dictated by the participant s health condition any foods contained in the food package that ordinarily would apply to that individual s life stage are to be provided if suitable considering the participant s special dietary needs The federal regulations allow up to the maximum allowance of supplemental foods with WIC formula appropriate for the client s condition The health care provider must make a determination and indicate on the Medical Docume2. assigned an NPP non lactating postpartum woman package then the system will allow the infant the higher amount of formula Soy Milk 52 Is soy milk going to be part of the new changes Will it be available to those with a qualifying medical condition A No soy milk is not available or part of the current change but is being considered for Phase 2 State WIC Office Resources 53 Can we please get the English version of the overview video vignette in DVD form A The DVD was sent to local agencies in late July 54 When will the webcast be archived A The webcast was archived Monday morning July 20 using the same URL link as the live webcast The link is noted below and Is also accessible via the michigan gov wic website select New WIC Foods and scroll down to the Local WIC Agencies section learning mihealth org mediasite wicfoodqualifyingconditions 11 55 When will the State WIC office be sending the new Food Cards and the updated MI WIC Policies 7 03 A English Food Cards were sent in late July Local agencies should expect to receive the Spanish and Arabic Food Cards in early September The MI WIC policies were posted to the WIC website the same day as the live webcast in J uly 56 When can we expect client handouts and bulletin board materials to educate clients about the new food package A Client materials are currently available on the Michigan WIC website at www michigan gov wic at the
3. other qualifying conditions 7 CFR Part 246 10 Special Supplemental Nutrition Program for Women Infants and Children WIC Revision in the WIC Food Packages Interim Rule December 6 2007 41 Are you sure you want us to be issuing cheese to a client with a milk protein allergy A The health care provider would differentiate between food intolerance and food allergy and if appropriate complete the Medical Documentation form specifying a qualifying condition and allowance or disallowance of WIC foods based on that qualifying condition MI WIC System 42 What really need to know is how do we do all this Where s the information on what buttons to push in the system Where are the pictures of the actual MI WIC system A There are only very minor changes to the MI WIC screens For example the RD approval buttons and Expiration Date are the same but new policy determines when they are required Post Implementation Note Release Notes for Release 2 0 were emailed on 7 31 and provide an overview of screen changes The document also references the updated CLINIC User s Manual sections 20 0 and 21 0 43 Are we going to have to go into each of the client records and change their 44 45 46 47 48 49 lt food packages right after August 1 or are we waiting to see each client for a recertification before we make the changes A Some food packages changed automatically others
4. New WIC Foods link Materials that agencies may order via E forms are expected to be available in September The State WIC office Is still in the process of collecting bulletin board materials from local agencies and other states Refer also to the WIC Notice 2009 54 Publications on Web Site for Food Package sent July 31 57 When will we receive the compiled Q amp As from the previous webcast A We plan to have the Q amp AS available from the previous webcast in August 58 Will we receive the compiled Q amp As from this webcast A Yes 12
5. Questions amp Answers Food Package for Qualifying Conditions Formula 1 Nutramigen LIPIL is no longer available in powdered form as of August 1 N Ww U1 Powder form alternative will only be available in the Enflora LGG is this a new name for the powdered Nutramigen A Nutramigen LIPIL powder Is already not available to be assigned in MI WIC Nutramigen LIPIL with Enflora LGG is the new product replacing Nutramigen LIPIL in the powder form only Will the shopping list show fluid ounces or number of formula cans A The shopping list will show the number of formula cans Can Neosure be given to an infant that is a full term infant or small for gestational age A No Neosure and Enfacare should only be approved for premature infants How many cans are 806 624 and 640 fluid ounces A The number of cans varies depending on the formula and the form of formula MI WIC has calculated the number of cans of formula in order for infants to receive the full nutritional benefit For example for infants to receive 806 fl oz of reconstituted Nutramigen LIPIL concentrate per month they would be issued 31 cans per month Each can of Nutramigen LIPIL reconstitutes to 26 fl oz and provides 806 fl oz in 31 cans Can a fully formula fed infant IFF 6 11 months old receiving contract formula via a tube feeding also receive the maximum amount of formula for a 4 5 month old if they cannot receive the supplemental foods A The f
6. can be changed when the client comes in for their next benefit pick up or recertification Is it still required for us to fill out the alternate formula screening forms to determine if a special formula is truly needed If so do we scan it into MI WIC A No the alternate formula screening forms are not required but the CPA RD should evaluate the appropriate use of the WIC formula Refer to Exhibit 7 03F Evaluating Appropriate Use of WIC Formulas Will client food packages change over in the middle of issuance or at the end of BVT date A Client s food package will change over after the current BVT date Can you clarify what the CPA does when a standard package has been customized to remove beans or milk allowance was altered to provide more cheese in preparation for package change A This package will appear in MI WIC as a custom package and will not automatically convert to the maximum food package When clients with customized packages are due for their next benefit issuance the CPA will need to assign a new package consistent with the new requirements Will need to go into those records with customized packages and change them to standard packages before implementation on August 1 A No Customized food packages may be changed at the client s next appointment benefit issuance Food packages will not be changed that already have benefits issued past August 1 until the next time benefits are generated issued A S
7. ederal regulations do not allow us to issue more than the maximum amount of formula for a 6 11 month old when they receive a contract formula The regulations only allow 6 11 month olds to receive the same maximum monthly allowance as a 4 5 month old in lieu of supplemental foods when they have a qualifying condition and receive a Class I1 or Class 1 formula 6 We need clarification on Pediasure and qualifying conditions A The health care providers qualifying condition should indicate the need for Pediasure N If a 2 year old child is diagnosed with failure to thrive and brings in a Medical Documentation form completed by the MD can the client receive Pediasure as well as the other foods in the food package A A 2 year old may receive Pediasure and other supplemental foods up to the maximum monthly allowance The health care provider will indicate what additional foods may be provided and the amounts 8 Can physicians order ready to feed RTF formula for better tolerance A No this is not included in the conditions for issuing RTF in our policy Ww Who qualifies for RTF formula A Ready to feed formula may be authorized when the following conditions exist 1 Poor refrigeration 2 Problems with the water source documented unsanitary or restricted water supply 3 Parent caregiver exhibits difficulty in correctly diluting powder concentrate formula 4 Formula is only available in the ready to feed form 10 Will t
8. equired A Currently we do not have non contract standard formulas To assign a contract formula Class medical documentation is not required If it is determined that that the authorized person AP has concerns regarding a prescribed formula WIC staff should refer the AP back to the physician 25 Do we need a Medical Documentation form completed for lactose free milk if 26 we don t increase the cheese A No you do not need a Medical Documentation form completed for lactose free milk You indicated that the Medical Documentation form must be renewed every 6 months with the exception that a request for cheese would only need to be renewed every certification period Isn t the recertification period usually 6 months or did that apply more to pregnant women who are certified for up to 6 weeks postpartum A Yes the comment applied to pregnant and breastfeeding women Certification periods for clients generally last 6 months except for pregnant women who are certified for the duration of pregnancy and up to 6 weeks postpartum and breastfeeding women are certified up to one year postpartum Health Care Providers 27 What would be the maximum amounts of foods that could be ordered from 28 29 the doctor with Class II and Class III formulas A With a Class II or IIl formula the doctor can order any supplemental foods allowed for the client up to the maximum monthly allowance Do we withhold benef
9. has concerns regarding the prescribed formula the RD should refer the mother back to the physician 22 When does the Medical Documentation form have to be used What date does this go into effect A The effective date for the Medical Documentation forms are August 1 Medical Justification forms or prescriptions are valid until the formula expiration date 23 On the copy of the Medical Documentation form it lists the option for ready to feed formula but does not make a notation that this is only under the conditions you mentioned Will the final form have this notation If not doctors may select this type of formula and then the request may be denied forcing the client to resubmit a new form A The current versions of the Medical Documentation forms do not specify the policy criteria for ready to feed RTF formulas The State will consider including this detail on future revisions of the forms If the Medical Documentation form indicates RTF but the WIC staff cannot approve the order as written because the WIC policy conditions are not met the WIC CPA or RD may substitute an alternate form of the same formula without requiring the health care provider to re submit a new form Note Nutramigen and Nutramigen LIPIL with Enflora LGG are not considered the same product due to slightly different nutrient formulations 24 If a client requests a change from a Class III to a non contract formula is a Medical Documentation form r
10. he new qualifying conditions Severe food allergies are not addressed in any other area A This risk is not auto assigned by MI WIC and that will not change since the CPA must assess whether a food allergy actually has an impact on the nutritional status of a client Will lactose free reduced whole milk still be available for children over age 2 A Yes but only with medical documentation for whole milk Children 24 months and older with a qualifying condition may receive lactose free reduced whole milk if they are also receiving a Class or III formula 39 What are the qualifying conditions to justify the use of Nutramigen Pregestimil or Alimentum Does the infant need to have intolerance to soy and milk protein A An infant must have one of the qualifying medical conditions as determined by the health care provider The health care provider would prescribe a formula for the infant s qualifying medical condition based on the indications for use of the formula The infant is not required to have an intolerance to soy or milk protein e g one indication specified by the manufacturer for Pregestimil LIPIL is fat malabsorption Cheese 40 Can you please give an example of a qualifying condition appropriate for assigning anything above 4 Ib of cheese A The Federal Register indicates Amounts of cheese that exceed the maximum substitution amounts may be authorized with medical documentation in cases of lactose intolerance or
11. he State WIC office be providing a conversion chart from ounces to the number of cans of formula for all approved WIC formulas A A chart for Class contract formulas has been provided with the Policy Overview webcast Charts containing the number of cans for Class II and III powder infant formulas are being prepared Coordination of Services 11 Can you please provide the coordination expected between WIC and Medicaid and CSHCS Is WIC the first provider or is Medicaid or CSHCS the first provider A We have significantly reduced the number of special formulas Michigan WIC will authorize If a client is enrolled in CSHCS or Medicaid and also in WIC and the formula is one that CSHCS or Medicaid may authorize under certain conditions WIC should work collaboratively with CSHCS and Medicaid to assure that the nutritional needs of mutual clients are met 12 Can a client receiving special formula such as cyclenex and arginine from the metabolic clinic receive other WIC foods if a medical documentation form is completed by the MD A WIC should work collaboratively with the metabolic clinic to assure that the nutritional needs of mutual clients are met If a client is receiving a metabolic formula from the metabolic clinic the WIC clinic should coordinate services with them in order to supply any additional WIC formula and or supplemental foods prescribed by the health care provider as indicated on a Medical Documentation form In order to
12. ilk A Yes women and children 24 months and older must be Issued a Class II or II formula to receive whole milk If medically warranted they may also receive up to the maximum allowance of supplemental foods for their age and category Class III formulas seem to be an expensive way to go for increasing calories for an underweight child over 2 years In the past we have recommended Carnation Instant Breakfast added to whole milk to increase calories Should we be suggesting Boost Kid etc instead A Underweight is not a qualifying condition A client can only receive a Class II or III formula if they have a qualifying condition such as failure to thrive If a child is underweight and over 2 years of age and does not have a qualifying condition they may benefit from nutrition education Medical Documentation Form 20 Is the State WIC Office going to be providing these forms for us to order as in the past or are we going to have to copy the forms as needed or requested A The Medical Documentation forms will be available through the E form process The forms may also be accessed through the WIC website at www michigan gov wic then go to the link New WIC Foods 21 lt If the MD approved a Class III formula with proper documentation and then the RD approved it but the mother says she wants a different package must we get the MD to fill out new forms with a new diet prescription A Ifthe RD determines that the mother
13. its if a medical provider does not submit a written confirmation within two weeks of the telephone order A Correct the Class II or III formula whole milk and or cheese substitution as prescribed would be withheld If written confirmation was not received within two weeks of a telephone order then the order is no longer valid and the food package should be modified accordingly What is the experience of other states regarding the requirement of physicians to provide detailed food prescriptions How have physicians responded A Other states are just now beginning to implement the new food packages As we learn more about this we can share this information with you 30 Are MDs and DOs the only medical professionals licensed to complete the Medical Documentation forms What about RDs from specialized practices certified nurse practitioners and physician assistants A A health care provider is one that Is licensed to write prescriptions under State law In Michigan nurse practitioners nurse midwives and physician assistants may have prescriptive authority as a delegated act of a supervising physician MDs and DOs Registered dietitians are not licensed to write prescriptions under state aw 31 Can a staff person from the doctor s office complete the forms and have the doctor sign them A A medical determination must be made by a health care provider licensed to write prescriptions under state law The Medical Documen
14. ntation form if the client may receive milk in addition to a Class I1 or Class 11 formula 15 Why would overweight be a qualifying condition for whole milk A Overweight is not a qualifying condition 16 Will we be able to give Class III and Class II formulas to children 24 months and over without also giving whole milk A Yes Class II and Class III formulas may be issued without also providing whole milk The health care provider must indicate on the Medical Documentation form DCH 1326 if whole milk is allowed 17 Is it possible to issue whole milk without a physician s order to clients who 18 19 are underweight or at high risk of becoming underweight Can a 2 4 year old underweight child be issued whole milk A No Women and children 24 months or older who have a qualifying condition and require a Class I1 or Class III formula may also be issued whole milk if indicated on a Medical Documentation form DCH 1326 or 1327 completed by a health care provider A client cannot be issued a WIC formula solely for the purpose of managing weight without an underlying qualifying condition A 2 4 year old child must have a qualifying condition such as failure to thrive and require a Class or Class formula in order to also receive Whole milk in place of reduced fat or skim milk Do women and children 24 months and older need to be on a Class II or IH formula to receive whole milk Can they be issued whole m
15. ome food packages will automatically be changed but the clients benefits will not change to the new package until the next benefit issuance Post Implementation Addendum Refer to the 8 3 09 Coordinator Notice regarding New Food Package Transition Issues and implications related to milk benefits for clients receiving an old food package Is there a report can run to identify clients with customized packages 10 A There is not currently a MI WIC report staff can run at the local agency to identify clients with customized packages See Q amp A below also 50 Can a local agency request an ad hoc report of clients with tailored custom food packages since there is not a way to get a report in MI WIC A A report listing clients whose food packages will NOT be automatically converted was mailed to agencies in late J uly early August refer to WIC E Notice 2009 51 Client Food Packages Not Automatically Converted to a New Food Package sent July 31 The report is sorted by BVT dates with the earliest dates first This allows WIC staff to reference the data relative to the client s anticipated appointment date so that CPA support may be planned accordingly 51 When assigning a maximum formula package to a partially breastfeeding infant IBP does the mom s food package NPP package for a BP have to be assigned first Does it matter whose package is assigned first A Yes the partially breastfeeding women BP will first be
16. tation forms must be signed by a health care professional licensed by the State to write prescriptions in accordance with State law 32 Can an agency complete a Medical Documentation form using the Rx with 33 a diagnosis from the signed hospital discharge or prescription forms and attach scan the signed Rx A No The health care provider must complete and sign the Medical Documentation form They must also include the qualifying condition s WIC formula including amount needed per day supplemental foods appropriate for the qualifying condition and the length of time the prescribed WIC formula and or supplemental food is required by the client When an RD is making a dietary recommendation to a physician can the RD complete the form and send it to the physician for approval and signature A No An RD Is not qualified to diagnose a qualifying condition which is the basis of the Medical Documentation form Any WIC formula and supplemental foods indicated would be contingent upon the qualifying condition 34 We were told the DCH 1326 and DCH 1327 forms were going to be sent to physicians directly by WIC Is this correct or do we need to obtain the forms and forward them to physicians at the local agency level A Family practitioner pediatrician and the primary care association 35 members have been sent a memo referring them to the WIC website to access the Medical Documentation forms As needed local agencies ma
17. y refer physicians to the website www michigan gov wic select New WIC Foods and scroll down to Medical providers What you need to know about new WIC foods to access the forms or local agencies may send the forms to physicians by email or US Mail am considering putting together a presentation for physicians to explain all of the changes think they will be very confused by all of this Does anyone have a PowerPoint presentation that would be appropriate for this audience A Thank you for getting the word out to your physicians You may contact the State WIC office to obtain an electronic version of the Power Point slide presentation which may be modified to meet your needs In addition the web site contains a memo to health care providers which you may use as needed Lactose Free Milk Formula Lactose ntolerance 36 Why is lacto free formula no longer available 37 38 A Mead Johnson discontinued their Lactofree LIPIL product and it has thus been removed from our list of authorized formulas Other Mead Johnson products that contain a reduced level of lactose or are lactose free include Gentlease and Nutramigen respectively Note that true congenital lactase deficiency is extremely rare On the medical portion of the MI WIC system Medical Condition is highlighted and does address lactose intolerance Question 9 on page 1 asks about allergies and is not highlighted Will this be changed due to t
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