Food Package/Prescription HuBERT Training Module 4
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Food Package/Prescription
Module 4
Slide Title
Slide Text
Introduction
This HuBERT on-demand training module is provided by the MN
Department of Health WIC Program.
Overview
In this module, we will review Food Package III and what that means in
terms of food prescriptions and required medical documentation, how to
provide increased amounts of formula in lieu of supplemental foods to
infants, and other food options available to children and women when
they required Food Package III.
Food Package III
FPIII
Food package III allows infants, children and women who have a
documented qualifying medical condition to be issued WIC formula, and
certain adjustments to the standard food package, because
conventional food, or the standard food package, is precluded,
restricted, or inadequate to address their specific nutritional needs.
Infants FP III
For infants, Food Package III, allows issuance of special/medical formula,
which from here on out we’ll just call special formula, and for infants 6
months or older, an increased amount of special or contract formula in
lieu of supplemental foods if the health care provider indicates the infant
has a medical condition and cannot take solid foods .
Children FP III
It allows children to receive contract infant formula or special formula
and allowable WIC foods. If receiving formula, they can also potentially
receive jarred infant fruits and vegetables in lieu of the cash-value
benefit, infant cereal instead of regular cereal, and whole or 2% milk.
Women FP III
Food Package III allows women to receive special formula and allowable
WIC foods. If receiving formula, they could potentially also receive whole
or 2% milk.
Request Form 1
The Request for Medical Formula form, Exhibit 7-D in the MN Operations
Manual, is required documentation for a participant receiving Food
Package III.
The form is completed by their health care provider and specifies the
qualifying condition and the appropriate formula and allowable foods.
It should be completed prior to issuance of any benefits for Food
Package III and should also be scanned into the participant folder.
Request Form 2
CPAs must assess the appropriateness of the formula/food requested,
considering the health condition and/or diagnosis, and make food
package changes as appropriate.
The approval is good for 6 months, or for a duration specified by the
health care provider if less than 6 months, or anytime the food package
changes.
All agencies should have a consistent process for managing medical
requests and a designated CPA who is responsible for managing them.
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Food Package/Prescription HuBERT Training Module 4
However, we should all be familiar with the documentation and the
requirements.
<MedDocForm1>
That said, this is a sample of the medical documentation form: Request for
Medical Formula.
<MedDocForm2>
<pan down>
<MedDocForm3>
<no script>
Special Formulas & FP III
<SpecialCGS>
Bobby Pin is a 3-month old infant who was both premature and
diagnosed with PKU.
His health care provider has completed the Request for Medical Formula
form just prior to our appointment today.
Let’s take a look at his Health Information. Click on the link.
<RequiresFPIII>
The Requires Food Package III checkbox must be selected for us to be
able to issue Special Formula. Go ahead and click on the checkbox.
<VerifyDate>
The Date Food Package III Verified field will auto-populate with the
current date.
<IssueBen>
When issuing benefits for a special formula, HuBERT will perform a
validation to ensure that this date is the current date before suggesting
benefits.
<SFSaveHI>
Click the OK button to save our changes.
<SFSelect>
This time, when the Select Formula window opens, the Special radio
button is auto-selected.
Bobby’s health care provider has approved PHENYL-FREE 1 formula. Click
on the Special scroll bar and we’ll scroll down to this formula.
<FormulaScroll>
<no script>
<SFClick>
Click on PHENYL-FREE 1.
<SelectOK>
Click OK.
<SpecRxItem>
We saw this before when working with a 19 Kcal contract formula.
The Special Prescription Item dialogue is the documentation HuBERT
requires in order to provide formulas that require medical documentation.
Let’s take a quick look at Bobby’s Request for Medical Formula form.
<ExampleForm1>
We knew the approval was for Phenyl-Free 1 and it has been approved
for 6 months due to the qualifying condition of PKU.
<ExampleForm2>
Dr. Who is the health care provider and it was approved on 8/25/15.
<SpecStart>
So, we have what we need to complete this.
The Start Date auto-populates with the current date and could be
changed to a future date but not a past date.
Since our approval date is 8/25/15, we’ll move on. Press the Tab key or
click into the End Date field.
<SpecEnd>
Our approval is for 6 months and our reason is Medical Documentation.
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Food Package/Prescription HuBERT Training Module 4
Type 2/25/16 into the End Date field and click on Medical Documentation.
<VerbalCheckbox>
The Physician’s Name is required but before we go there, let’s talk about
the Verbal checkbox.
Verbal Checkbox
The Verbal Checkbox can be selected to indicate the initial approval for
the special formula was provided via a phone call.
This is allowable if delaying approval could potentially increase the
participant’s nutrition risk.
However, only one month of benefits can be issued; any further issuance
can only occur once the Request for Medical Formula form has been
completed.
If the initial approval is by phone, we are required to document both the
qualifying condition and the physician’s name in a note.
We are also required to create an alert to inform the next person who
helps the participant that appropriate medical documentation must be
obtained before more benefits can be issued since HuBERT will not limit
further issuance under these circumstances.
<PhysName>
OK. Back to the Physician’s Name field. Every Local Agency should have
a standard format for completing this field.
Our format is going to be the doctor’s last name, which is “Who”,
followed by a comma, space, and “ Dr.”
Type: Who, Dr. Then click the OK button to save the information.
<6-8MoMsg>
Since we are in the CGS and HuBERT is creating future food packages for
the 6-8 month and 9-11 month age categories, it needs to know if we:
Want the system to automatically remove the solid food items from the
food prescription so the formula quantity may be increased to the 4-5
month old limit.
So what exactly is this asking?
Remember, an infant 6-12 months of age with Food Package III, whose
health care provider has indicated a medical condition so that he
cannot take solid foods...
...is eligible to receive a greater quantity of formula in place of the infant
foods that WIC begins to provide at 6 months.
Formula Guide
If we look at the Formula Amounts Guide that we mentioned previously, it
shows us that for Phenyl-Free 1, the 4-5 month maximum quantity for nonbreastfeeding infants is 8 cans.
The 6-11 month maximum decreases to 6 when supplemental foods are
added to the food package.
If the health care provider has indicated that supplemental foods should
not be added, we can increase the amount of formula back to the 4-5
month quantity of 8 cans.
<FormOmitFoods>
And according to Bobby’s Medical Formula Request form we should only
provide formula.
<6-8MoMsgYes>
Go ahead and click Yes.
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Food Package/Prescription HuBERT Training Module 4
<9-11MoMsg>
So, why are we seeing this same message again?
Well, the first message was for the 6-8 month age category while this one
is for the 9-11 month age category.
Since our approval is only for 6 months and Bobby is currently only 3
months old, we can’t really know what the next approval will indicate.
So for now, we’ll click the No button. A new food package can always
be created if the next approval indicates supplemental foods should
again be omitted.
<SFFP1>
Let’s take a look at the food prescriptions. Click on the plus next to
08/25/2015.
<SFFPDates>
Now click the plus next to 7 - PHENYL-FREE 1.
<OnlyDates>
Remember from before that only the approval dates are displayed on this
screen.
Go ahead and click on the plus next to each of the other prescriptions
starting near the bottom with 09/13/2015.
<Open6-8MoFP>
<no script>
<Open9-11MoFP>
<no script>
<DifferenceBn>
Notice that the 6-8 month food package has 8 cans of formula while the
9-11 month food package has only 6 cans and the supplemental foods.
Let’s take a look at one more thing. Go ahead and edit the PHENYL-FREE
1 in the 02/13/2016 food package.
<SFEdit>
<no script>
<FormulaHighlt>
<no script>
<FormulaEdit>
<no script>
<Edit>
<Pause for text animation> Notice that the only field we can edit for a
special prescription is the quantity.
Any other change to the food prescription will require us to create a new
one.
Contract Formulas & FP III
<ContractFPIII>
Infants, 6 months or older in age who require food package III, can
receive an increased quantity of contract formula in lieu of supplemental
foods when medical documentation is provided from the health care
provider indicating the infant has a medical condition that prevents him
from consuming complementary foods.
Jerri Rigged is a 6-month old infant whose health care provider has
submitted a Request for Medical Formula form.
She is receiving Similac Advance, which is a contract formula, and the
form indicates that she is currently unable to take solid food and should
be provided only formula for the next 3 months.
What is the first thing we need to do in order to provide the increased
amount of formula without supplemental foods? Go ahead.
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Food Package/Prescription HuBERT Training Module 4
Right! Jerri Must have the Requires Food Package III checkbox selected.
<ContFPIIIHI>
<no script>
<ContFPIIIReq>
Let’s take a look at her food package. Click the appropriate tab.
<SaveChange>
<no script>
<ContFPIIIFPTab>
Since this is a special prescription, we need to create a new food
package. Wait…
<ContFPIIIAdd>
OK. Go ahead.
<ContFPIIIDefault>
<no script>
<ContFPIIIMsg>
Is our answer Yes or No?
<ContFPIIIContract>
What do you think we do next?
<ContFPIIISelect>
<pause for text animation>
Although we want to provide Jerri with Similac Advance (powder)...
...the maximum quantity allowed for this particular Similac Advance is
based only on age and not whether the participant is receiving Food
Package III.
Let’s click below the scroll bar and look at the rest of this list.
<SimilacFPIII>
Notice that Similac Advance is listed again but this time with Child or
Infant FPIII in the name.
If we want to issue a 20 kcal contract formula, which includes either
Similac Advance or Gerber Good Start Soy, to a child or infant who
requires Food Package III, we must select the formula with Child or Infant
FPIII in its name.
Go ahead and select Similac Advance powder for food package III.
<SimilacFPIIIOK>
Click OK.
<ContFPIIIStartDt>
Our start date is today, so press the Tab key or click into the End Date
field.
<ContFPIIIEndDt>
Remember, our approval is for 3 months. Type 11/27/15 into the End Date
field and select our reason, which is Medical Documentation.
<ContFPIIIDr>
Jerri’s health care provider is Dr. McCoy. Type: MCCOY, DR. into the
Physician’s Name field and click OK.
<ContFPIIINewFP>
Notice our quantity is 10 cans instead of 7 and there aren’t any
supplemental foods listed.
Save our food package.
<ContFPIII3Mo>
Since Jerri’s health care provider only approved omitting the
supplemental foods for 3 months, the 11/20/15 food package may still be
appropriate so we’ll leave it for now.
Click the plus next to 8/27/15 to double-check our new food package.
<NewContFP>
<no script>
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Food Package/Prescription HuBERT Training Module 4
19Kcal Formulas & FPIII
<19KcalDemo>
Remember from earlier that 19 kcal formulas can be approved for one
year using either the Condition-Specific Protocol or Medical
Documentation form for Similac Sensitive, Total Comfort and Spit-up
depending on our agency’s policy.
If the health care provider has indicated that the infant has a medical
condition, cannot take solid foods, and should receive increased formula
in lieu of the supplemental foods, the Request for Medical Formula form,
Exhibit 7-D in MOM, must be completed to indicate this;
completion of the CSP form or previous medical documentation for the
19 kcal formula is not adequate for Food Package III.
Today is 8/31/15 and Ollie Baba has come in for a nutrition visit.
He is a 6-month old infant for whom we’ve received a Request for
Medical Formula form indicating that he has a medical condition and
can’t take solid foods and that we should provide only formula for the
next 6 months.
We’ve already marked him as requiring Food Package III so click on the
Food Prescription tab.
<19KcalAdd>
We’ve expanded both his 6-8 month and 9-11 month food packages so
that we can see them.
Notice that Ollie already has a special prescription for Similac Spit Up (a
19Kcal contract formula) that started on 5/27/15 and ends on 2/28/16.
We need to increase the formula and remove the supplemental foods in
Ollie’s food packages. So, what do we do? Go ahead.
<19KcalDefault>
<no script>
<19KcalMsg>
<no script>
<19KcalContract>
<no script>
<19KcalSpitUp>
<no script>
<19KcalSpitUpOK>
<no script>
<19KcalRxMsg>
<pause for text animation>
Since Ollie already has a special prescription for powdered Similac Spit
Up, this message is asking if we want to use the existing prescription.
The existing prescription is only an approval for the 19Kcal formula. We
are not editing that prescription.
Instead, we are creating a new prescription that starts today and has the
medical documentation supporting the removal of the supplemental
foods.
In general, the only time we would answer “Yes” to this message is if we
needed to create a new food package in order to tailor the food items.
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Food Package/Prescription HuBERT Training Module 4
For example, if we didn’t have a food package that we could edit and a
participant had a special prescription for PediaSure and was receiving
supplemental foods and they wanted to change their peanut butter to
canned beans.
In that instance, we would use the existing special prescription because
nothing about the prescription has changed.
Otherwise, as is our case with Ollie, we are going to answer No and
continue to create a new prescription. So, click No.
<19KcalSpRxItem>
This time, we are going to quickly complete this information...
<19KcalSpRxDone>
…and take note that regardless of whether our agency uses CSP, our
reason for this special prescription is Medical Documentation for
increasing the formula and omitting the supplemental foods.
Go ahead and save our new prescription.
<19KCalSaveNew>
<no script>
<19KCalNew>
We’ve saved a couple of steps and expanded the 8/31/15 food
package.
Notice that our new prescription starts on 8/31/15 and only has 10 cans of
formula...
…and that the change to the formula prescription has been forwarded to
the existing 11/10/2015 prescription.
However, the food package itself, and the quantity of formula, has not
changed.
We have two options; we can either delete this food package and
create a new one or edit the existing food package. Let’s edit it.
<19KcalEdit>
<no script>
<SuppFdsDelete>
In order to edit this, we would first need to remove all of the supplemental
foods.
Go ahead and delete the infant cereal to get us started and we’ll delete
the rest of them.
<SuppDeleteYes>
<no script>
<SuppFdEdit>
Now that the rest of the foods have been deleted, we need to edit the
amount of formula. Go ahead.
<SuppQuantity>
Type our new quantity and click the OK button.
<SuppOK>
<no script>
<SuppDone>
Our food prescriptions are now good-to-go for the next 6 months.
Children & FPIII
<CFPIIIList>
Children who require Food Package III will have more food options in the
Food Category list.
To provide any of these other food options, we must have the
appropriate medical documentation.
Let’s take a look at the food category list; click the drop-down arrow.
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Food Package/Prescription HuBERT Training Module 4
<CFPIIIFormula>
Notice that at the top of this list for children who require FP III is FORMULA.
Go ahead and select it.
<CFPIIISpecial>
We can provide either Contract formula or Special formula.
The Contract formula list will only include those formulas with either “-Rx or
FPIII” or “-Child or Infant FPIII” in the name.
Now, click the Special radio button.
<CFPIIIChildren>
The formulas listed in both of these lists are only those that can be
provided to children.
Click the Cancel button.
<CFPIIIList1>
Click the drop-down again.
<CFPIIIMilk>
This time, select MILK.
<CFPIIIMilkOptions>
Milk now has “2% or Whole milk” options for children two years of age and
older. Again, only allowable if indicated by medical documentation.
Click the drop-down.
<CFPIIICereal>
Notice that INFANT CEREAL is also listed even though we are in a child’s
food package. Select INFANT CEREAL.
<CFPIIIInfantCereal>
Again, allowable with Food Package III if indicated by medical
documentation.
Click the drop-down one last time.
<CFPIIIFV>
The last change we could make to a child requiring Food Package III that
had appropriate medical documentation is to replace the cash-value
benefit with jarred infant fruits and vegetables.
Women & FPIII
<WFPIII>
The FORMULA option also displays for women who require Food Package
III and can be provided with the appropriate medical documentation.
Go ahead and select FORMULA from the drop-down list.
<WFPIIIContract>
Although the Contract radio button is selected, nothing is listed because
women can only receive Special formula.
Click the Special radio button.
<WFPIIISpecial>
<pause for highlight>
Click the Cancel button.
<WFPIIIMilk>
The only other food option that is different for women requiring Food
Package III is MILK. Select the MILK category.
<WFPIIISelectMilk>
<no script>
<WFPIIIMilkList>
Like children, women who require Food Package III and have the
appropriate medical documentation can receive 2% or Whole milk.
End Slide
This concludes our training on the Food Package/Prescription in HuBERT.
We appreciate you taking the time to review this HuBERT on-demand
training module presented by the MN Department of Health WIC Program.
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