Food Package/Prescription HuBERT Training Module 2
Food Package/Prescription
Module 2
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 the food packages for infants, conditionspecific protocol and formula issuance, and creating default food
packages in the participant folder.
Infant DFPs
Fully Breastfeeding Infants
<FBFICert>
Brook Dale is an infant who was born on 7/13/15 and is being certified
today, 7/29/15.
<FBFIHealthInfo>
We’ve already completed her health information and indicated she is fully
breastfeeding.
<FBFIRF>
So far, she has been assigned two risk factors and at this point, we are just
going to note that she was assigned risk factor 115, which can be assigned
to infants and children < 24 months old.
Let’s take a look at the DFP for a fully breastfed infant. Click the Food
Prescription link.
<FBFChildFP>
HuBERT has auto-generated 3 DFPs.
The DFP listed at the top is a DFP for a 1-2 year old child.
We noted the risk factors because whether HuBERT auto-generates the
child food package is based on the currently assigned risk factors.
If the infant has a risk factor assigned that is applicable for children as well
as infants, such as 115, then HuBERT will auto-generate the child’s food
package.
Let’s take a look at the other DFPs. Click on the plus next to the 1/13/16
food package.
<FBF6MoFP>
Fully breastfed infants will start receiving these foods when they are six
months old.
The infant meats are only provided to fully breastfed infants and they also
receive more jarred fruits and vegetables.
The Effective Date of this food package is Brook’s 6-month birthday.
An infant’s 6-month birthday must be on or before the Printed First Date to
Use of the set of benefits in order for the infant to receive this first set of
benefits with supplemental foods on them.
FirstIssuance
This can be confusing if benefits are picked up late and the infant has
turned 6 months old.
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Food Package/Prescription HuBERT Training Module 2
For instance, if Brook’s issuance cycle were the 10th to the 9th, and she
came in to get her January benefits on 1/16/16, no benefits would print for
January.
This is because although she may be 6 months old when the benefits are
issued, she turned 6 months on 1/13/16 and wasn’t 6 months old on the
PFDTU, which is 1/10/16.
<FBF9MoFP>
Now click on the plus next to 4/13/15.
<FBF9MoFP1>
At 9 months, infants start to receive a cash-value benefit for fresh fruits and
vegetables in lieu of a portion of the jarred fruits and vegetables.
The amount fully breastfed infants receive is higher than those who are
only partially or not breastfed.
Mostly-Breastfeeding Infants
<MBFCert>
Olive Branch is a mostly-breastfed infant born on 7/10/15 who is being
certified today, 7/29/15.
<MBFHealthInfo>
<no script>
<MBFRF>
Note that Olive only has risk factor 702, which is only appropriate for infants
less than 6 months old.
Click on the Food Prescription link.
<MBFSelect>
This time, another screen opens first called Select Formula.
This screen will also open when the breastfeeding amount is changed to
mostly-, some- or non-breastfeeding in the Health Information screen or
when clicking the Use Default button for infants receiving formula.
Contract formula is the default and the only kinds of formula we can
provide to Olive.
We’ll take a look at Special formulas later.
Since Olive is mostly-breastfeeding, all of the formula quantities default to
the minimum allowed, which is 1.
IssueSuppFormula
Women who are breastfeeding may request formula for supplementation.
Part of our job is to promote breastfeeding and minimize formula use
whenever possible.
When a breastfeeding mom asks for formula, we should always take the
time to assess why mom feels she needs formula and to address any
underlying issues that may be making mom feel this way.
If after our discussion with mom we determine that it is appropriate to issue
formula, we always want to issue the lowest amount that should meet
mom’s needs.
<MBFSelectAdv>
We’ve discussed with mom why she feels she needs formula and have
determined it is appropriate to provide it.
We are going to stick with Similac Advance so we just have to click OK.
<MBFWait>
<text animation>
<AgeCats>
This time, HuBERT has auto-generated 5 DFPs; one for each age category.
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Food Package/Prescription HuBERT Training Module 2
Infants have 5 age categories: 0 to 1, 1 – 3, 4 – 5, 6 – 8, and 9 – 11.
Up to 6 months old, infants only receive formula…
<2AgeCats>
…which is why Brook, our fully breastfeeding infant, only had 2 infant DFPs.
<MBF0to1Mo>
Back to Olive, notice that a one-year child DFP wasn’t automatically
created.
Remember, Olive only had risk factor 702, which isn’t applicable to
children. Therefore, the system doesn’t auto-generate a child DFP.
Let’s take a look at each of Olive’s food packages. Click the plus next to
the dates, starting at the bottom.
<MBFOpen1>
<no script>
<MBFOpen2>
<no script>
<MBFOpen3>
<no script>
<MBF2Cans>
During our discussion with mom, we determined that two cans would be
appropriate based on her concerns and needs.
Currently, we have the minimum allowed for each age category, which is
one can.
Let’s try to increase her 7/29/2015 food package for the 0 to 1 month age
category and see what happens. Go ahead and edit it.
<MBF2Cans1>
<no script>
<MBF2Cans2>
<no script>
<MBF2Cans3>
<no script>
<NoIncrease>
Why won’t it increase?
HuBERT will not allow us to increase the amount beyond the maximum
allowed.
Although we are going to issue Olive two cans of formula, she is mostlybreastfeeding and in accordance with Federal Regulations, we can only
provide one can of the Similac Advance powder formula for the first
month.
ContractGuide
The MN WIC Contract Formula Amounts Guide provides the minimum and
maximum number of cans of contract formula we are allowed to issue
based on formula type and the participant’s age and breastfeeding
amount.
MedicalGuide
Minimums and maximums based on age and breastfeeding amount for
special formula is provided in the MN WIC Formula Amounts Guide for
Medical Formula.
GuidesOnWeb
These references are available on the MDH WIC website.
<CancelEdit>
Click Cancel.
<CancelEdit1>
Click it one more time.
<Edit1-3Mo>
So, let’s edit the 1-3 months food package, which has a range of 1-4 cans
allowed.
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Food Package/Prescription HuBERT Training Module 2
Go ahead and increase the 8/10/2015 food package to 2 cans.
<Edit1-3Mo1>
<no script>
<Edit1-3Mo2>
<no script>
<Edit1-3Mo3>
<no script>
<Edit1-3Mo4>
<no script>
<Edit1-3Mo5>
<no script>
<View1-3Mo>
<pause for text animation> Let’s take a look at our revised food package.
Click the plus next to 8/10/2015.
<pause for circle> So the question now is: is this change forwarded to our
other DFPs?
Click the plus next to 11/10/2015 and then 1/10/2016 to see.
<View6-8Mo>
<no script>
<NoAdjustment>
That answers that. HuBERT does not automatically adjust our future food
packages based on a change in quantity in a preceding food package.
This provides us with the flexibility to adjust Olive’s food packages based
on her actual supplementation needs.
We should open a dialogue every time we issue benefits to ensure we are
issuing the least and most appropriate amount of formula to our
breastfeeding infants and adjust the food package accordingly.
Some-Breastfeeding Infants
<SBFCert>
Ginger Ale is a some-breastfed infant born on 7/15/15 who is being
certified today, 7/30/15.
<SBFHealthInfo>
<no script>
<SBPOpenFP>
Click on the Food Prescription link.
<SBFMinimums>
Unlike mostly-breastfeeding where the minimum quantity is always 1, the
minimums for some-breastfeeding varies depending on formula and age.
Again, let’s just stick with Similac Advance. Click the OK button.
<SBFWait>
<no script>
<SBFExpand>
Go ahead and expand each food package by starting from the bottom
and clicking on the plus next to the dates.
<SBF1-3Mo>
<no script>
<SBF4-5Mo>
<no script>
<SBF6-8Mo>
<no script>
<SBFDone>
We can see that the minimum number of cans for each age category is
included in the DFP.
And it may be necessary to increase the quantity provided based on our
discussion with mom before issuing benefits.
19 Kcal Formulas
<CSPNBF>
So far, we’ve discussed the DFPs for breastfed infants.
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Food Package/Prescription HuBERT Training Module 2
Now, we are going to take a closer look at formula issuance.
It should be noted that the information discussed in this section could also
be applied to a breastfed infant receiving supplemental formula.
This is Hazel’s Participant Folder. She is a non-breastfeeding infant born on
5/27/15.
She was certified today via VOC, which is an out-of-state transfer, and we
need to create a food package for her.
Click on the Food Prescription tab.
<FoodRXPF>
Unlike in the CGS, where HuBERT auto-generates our infant food
packages, we will have to create them in the Participant Folder.
Unfortunately, our screen is too big so we are going to have to pan down
to see the buttons on this tab...
<FoodRxPan>
<no script>
<PFAddRx>
Let’s add Hazel’s first food package. Click the Add button.
<PFDefault>
In order to issue benefits, we will need a food prescription with an effective
date that starts today, which is our default.
What do you think our next step is? Go ahead.
<PFSelect>
Since Hazel is a non-breastfeeding infant, the quantities are the maximum
allowed for the formula and her current age category.
This time, we are going to select a different contract formula. Click on
Similac Sensitive (12.0 oz pwd)-Rx or FPIII.
<PFSelectOK>
Click OK.
<SpecialRx>
The Special Prescription Item dialogue begins the documentation process
for special formulas and contract formulas that require medical
documentation.
SpeciaRxContract
There are three kinds of contract formula that provide 19 kcals/oz.: Similac
Sensitive, Similac Spit Up and Similac Total Comfort.
These formulas can be easily identified in HuBERT because they have –Rx
or FPIII at the end of the formula names.
Since these provide less than the 20 kcals/oz required for contract
formulas by WIC Federal regulations, we must have supporting medical
documentation in order to issue them.
SpecialRxContract1
There are two methods for obtaining medical documentation to approve
providing these formulas in MN.
The Condition Specific Protocol (CSP) for Providing Similac Sensitive, Total
Comfort, and Spit-up form, which is Exhibit 7-D(3) in the MN Operations
Manual, also known as MOM, can be used for all infants in our agency if
our agency utilizes CSP.
Otherwise, if our agency doesn’t utilize CSP, then each individual infant’s
health care provider would need to complete the Medical
Documentation Form for Similac Sensitive, Total Comfort, and Spit-up,
which is Exhibit 7-D(2) in MOM.
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Food Package/Prescription HuBERT Training Module 2
Regardless of the approval method, we must always ensure the
appropriate documentation has been scanned into the participant’s
record.
CSP
CSP requires the WIC agency to work in conjunction with their County
Medical Consultant, or Health Officer.
This person acts as the health care provider prescribing these formulas to
any infant in our agency that may be receiving one of the 19-kcal
formulas.
The CSP form is signed by the County Medical Consultant and Health
Department Administrator, or Designee, and is renewed annually.
CSPForm
Copies of these forms should be available and if we determine that one of
these three kinds of formula would better meet the infant’s needs…
SignedForm
…a copy of the signed form…
CompletedForm
…should be completed…
CPASigned
…and signed by the CPA prior to issuing benefits for Similac Sensitive, Spitup or Total Comfort.
<CSPScan>
Once the form is completed and signed, it must be scanned into the
infant’s participant folder.
CSPCPA
Additional documentation could be written in a note if we feel the
explanation for the need to change formula is useful in the quality and
continuity of care for the infant.
19Kcal Med Doc 1
If our agency doesn’t utilize CSP to issue the 19 kcal formulas then the
Medical Documentation Form for Similac Sensitive, Total Comfort, and Spitup…
19Kcal Med Doc 2
…would need to be completed by an individual’s health care provider.
Like the CSP form, this should also be scanned into the participant’s folder.
Regardless of the approval method, once medical documentation is
completed, the 19 kcal formula can be provided until the infant turns one
year old.
<SpecialRx>
For Hazel, her prescription starts today and is going to end on her first
birthday, which is May 27, 2016.
Since our agency does utilize CSP, the reason, which is required, would be
CSP – Similac Rx.
Go ahead and type 5/27/16 into the End Date field and select CSP –
Similac Rx from the Reason(s) list.
<MDName>
The Physician’s Name is also required.
Since this isn’t the infant’s actual health care provider, we are going to
type “CSP - ” followed by the last name of the approving Medical
Consultant.
Our consultant is Dr. Dan D. Lion. Go ahead and type: CSP – LION and
click the OK button.
<SaveNewRx>
Click OK again to save our new food package.
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Food Package/Prescription HuBERT Training Module 2
<CSP2MoFP>
Notice our special prescription dates are displayed but not the reason or
the physician’s name, which are only stored in the database and not
displayed anywhere in HuBERT.
MoreCSP
A couple of other things we need to note about 19 kcal formulas:
We already mentioned that the approval is good until the infant turns one
year old.
The assumption is that the CSP forms will be implemented annually, which
means we do not have to worry about expiration of the CSP approval.
If the infant needs to try another one of these three formulas, the same
approval form can be used; another form does not have to be
completed.
However, best practice is to document in a note why the formula needed
to be changed.
Also, we can honor existing CSP or individual health care provider
approvals if the infant transfers into our agency.
As always though, we should evaluate the situation to ensure the current
formula is still appropriate.
Our agency can provide us with more detailed information regarding
issuing 19 kcal formulas. Information is also available on the MN WIC
website.
Click the Continue button.
Creating Food Packages
<NBF1to3FP>
In order to issue benefits, we will need to make sure Hazel has a food
package for each age category before issuing.
Although HuBERT will inform us when trying to issue benefits if a food
package is required, it may be best practice to create those food
packages now.
Since Hazel was born on 5/27/15, the 8/4/15 food package we just
created is the food package for the 1-3 month age category.
Next let’s create the 4-5 month age category DFP. Go ahead and get us
started.
<Create4to5>
What should the start date of the next food package be?
Again, Hazel’s birth date is 5/27. So, all we have to do is add 4 months to
May and we get 9/27.
Type 9/27/15 into the Effective Date field and click the Use Default button.
<Select4to5>
Go ahead and select the same formula, which we’ll select for each food
package we create: Similac Sensitive (12.0 oz. pwd).
<Select4to5OK>
Click OK.
<Msg4to5>
This message displays since we’ve already completed the special
prescription information for this formula and asks if we want to use the
current special prescription, which we do; so, click Yes.
<Save4to5>
Click OK to save our 4-5 month food package.
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Food Package/Prescription HuBERT Training Module 2
<Add6to8>
We now have our 1-3 and 4-5 month food packages.
But we still need to create our food packages for the 6-8 and 9-11age
categories. Go ahead and do this.
<6MoEffDate>
<no script>
<Select6to8>
<no script>
<Select6to8OK>
<no script>
<Msg6to8>
<no script>
<Save6to8>
<no script>
<Add9to11>no e
<no script>
<9MoEffDate>
<no script>
<Select9to11>
<no script>
<Select9to11OK>
<no script>
<Msg9to11>
<no script>
<Save9to11>
<no script>
<Done>
<no script>
Infant F/V
There is one more thing we need to mention about infant food packages.
The 2 lbs. of bananas and the cash-value benefit for fresh fruit and
vegetables are included in the default food packages but both are
optional.
Most infants 6-11 months old should be progressing to foods with increased
texture and finger foods.
However, some infants may not yet be ready for these kinds of foods, in
which case we have two options.
We can explain to the infant’s caretaker how to prepare fruits/vegetables
so that they are appropriate or we can tailor the options provided by the
food package
Simple Guide
This shows us the different options and quantities that could potentially be
provided to an infant.
It is available on the MDH WIC website for reference.
Click on the Finish Module button when ready to continue.
End Slide
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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