Changes to the Georgia WIC Food Packages 2009
 

On October 1, 2009, the Special Supplemental Nutrition Program for Women, Infants and Children (WIC)  significantly changed the food packages that participants receive. The changes to the WIC food packages are designed to improve the nutrition and health of pregnant women, breastfeeding and non breastfeeding postpartum women, infants and children up to age five. The new food packages promote and support the establishment of successful, long-term breastfeeding, provide WIC participants with a wide variety of foods including fruits, vegetables, and whole grains, and provide greater flexibility in tailoring food packages to accommodate the cultural food preferences of WIC participants.


Why are these changes occurring?
On December 6, 2007, the interim rule revising the WIC food package was published in the Federal Register. The revisions largely reflect recommendations made by the Institute of Medicine (IOM) of the National Academies in its report, “WIC Food Packages: Time for a Change”. The last revisions to the WIC food packages occurred in 1980. IOM’s final report contained recommendations to have the food packages align with the 2005 Dietary Guidelines for Americans and infant feeding practice guidelines of the American Academy of Pediatrics.


Highlights of the NEW Food Package

· Addition of baby foods - fruits and vegetables for all infants and meat for exclusively breastfed infants

· Modified infant formula amounts to reflect varying needs at different ages

· Addition of a fruit and vegetable voucher (Fresh / Frozen / Canned)

· New Whole Grain Options for Women and Children (Bread / Brown Rice / Whole Grain Tortillas)

· Whole Grain Cereals- At least half of the cereals on the Approved Food List MUST be Whole Grains

· Required issuance of low fat milk for children over 2 years of age and women

· Soy Milk and Tofu allowed

· Reduced quantities of milk, eggs, and juice and cheese for women and children

Reinforces Nutrition Education Messages
The new food packages are consistent with the nutrition education messages provided to participants:

· Eat more fruits and vegetables

· Decrease saturated fat

· Increase whole grains and fiber

· Drink less sweetened beverages and juice

· Babies are meant to be breastfed

 

Provides greater consistency with infant feeding practice guidelines
Modifies infant formula amounts based on age and feeding method. Infant foods are added and juice eliminated in the packages for older infants in order to promote healthy dietary patterns.


Provides culturally diverse foods
The new food packages provide more participant choice and a wider variety of foods than the previous food packages. Foods such as tortillas, brown rice, soy-based beverage, canned salmon, and a wide choice of fruits and vegetables will provide State agencies increased flexibility in prescribing culturally appropriate food packages.


Promotes Breastfeeding
The food packages for the breastfeeding infant-mother dyad provide stronger incentives for continued breastfeeding, including providing limited formula to partially breastfed infants during the first month of life. Additional quantities and types of food are provided to breastfeeding mothers.


How does this impact my practice?
Approximately 51% of Georgia infants and children qualify for the WIC program, which means a significant number of your patients are receiving WIC benefits. These changes will not only affect the choices of foods that your patients can receive but it will also require you to individualize the package based off your patient’s unique medical needs. Significant changes have been made for the process for writing WIC prescriptions for special formulas & medical foods.


Medical Documentation
 

Medical documentation ensures that you have approved the issuance of special formulas & medical foods that are appropriate for your patient’s specific medical needs. The goal of the new medical documentation requirements is to improve communication and coordination of care between WIC, the family, and the medical home. This will also ensure that there is appropriate justification for the use of special formulas & medical foods.

Medical documentation is required in the following situations:

· Any infants receiving non-contract/exempt or specialty infant formula or WIC eligible medical food

· Allowable supplemental foods to be provided in addition to the formula, for those participants receiving exempt or specialty infant formula or WIC eligible medical food

· Children receiving milk substitutions of soy beverage, tofu, or extra cheese


Note: Medical documentation is not required for the following GA WIC contract formulas: 

Similac Advance EarlyShield & Isomil Advance with Iron

 

The new requirements for GA WIC approved special formulas and medical foods include:

· Name of authorized WIC formula or WIC-eligible medical food. Must be prescribed in ounces (reconstituted fluid) per day

· Qualifying condition(s) for issuance of WIC formula prescribed and/or supplemental food authorized and ICD-9/ICD-10 code

· Length of time (1-6 months) the prescribed WIC formula and/or supplemental food is required by the participant

· Original signature, date and contact information of the requesting health care provider. No signature stamps will be accepted

· Must specify foods allowed for all clients on special formulas (age 6 months & older)

· Can ONLY be signed by a physician, physician assistant, or nurse practitioner

· Physician must authorize the issuance of any tofu or soy milk to children

· Examples of Non-Specific Diagnoses that will not be accepted for special formulas and medical foods include: colic, milk allergy, milk/formula intolerance, feeding problems, poor appetite, inadequate intake, and digestive disturbances

New Medical Documentation Forms have been created to make it easier to document the specific information required by the United States Department of Agriculture regulations. Using the GA WIC Medical Documentation Forms (Form #1 and Form #2) and completing them appropriately will save your practice valuable time and effort.

* Use Form #1 to prescribe special formulas and/or medical foods and to approve the WIC foods allowed based on a patient’s medical condition(s). Instructions and resources for form completion are included.

* Use Form #2 to provide referral data and to authorize special food substitutions for children

These fillable forms can be saved, printed, signed and then faxed to the local WIC clinic or provided to the WIC participant.
 

______________________________________________________________________________________

The Georgia WIC Program has developed a webpage for healthcare providers to access GA WIC forms and resources ( Medical Documentation forms 1 & 2, WIC Formula Guide, WIC Approved Food List, and Medical Community Video)

Please visit the following link to view this information

http://wic.ga.gov/hcprovider.asp

______________________________________________________________________________________



Frequently Asked Questions (FAQs) – New Georgia WIC Medical Documentation
 

1.  Can providers use their own prescription pads for formula/medical food prescriptions?

The GA WIC Program will allow you to use the doctor's prescription pad for WIC special formulas and approved WIC foods, but it must have ALL of the following information:

1.  Patient's first & last name

2.  Patient's Date of Birth

3.  Parent/Caregiver's first & last name

4.  Qualifying diagnosed medical condition and applicable ICD-9 or ICD-10 code

5.  Name of formula/medical food requested

6.  Prescribed amount of special formula per day (oz/day)

7.  Form of special formula (powder, concentrate, or ready-to-feed)

8.  Planned length of use for special formula (1-6 months)

9.  WIC Foods- Patient may receive supplemental foods appropriate to their WIC participant category in addition to the approved special formula. If you have no restrictions to WIC Supplemental Foods- It must say "No Supplemental Food Restrictions." If there are restrictions, you must list which food that should not be issued to participant. Infants 6-11 mo. (infant cereal, baby food fruits & vegetables), Children >12 mo. & women (milk, beans/peas, vegetables, fruits, juice, cheese, peanut butter, whole grains, canned fish, cereal, & eggs)

10. Must have provider's name, title, provider's original signature/credentials, and date

11. Medical Office Name, street address, city, zip code, phone number, and fax number

Due to the amount of detailed information that has to be included for documentation, it is highly recommended that providers use the Medical Documentation Form 1.

2. How often do WIC participants need to provide new medical documentation paperwork?

Medical Documentation must be renewed at least every 6 months. New copies must also be provided at every certification, recertification, or mid-certification appointment if the date the authorized health care provider signed the most recent medical documentation form is more than 30 days old at the time of the certification appointment.


3. Can WIC accept a verbal order for medical documentation?

Yes, WIC must document all details of the verbal order in the participant’s WIC record and sign & date the documentation. Only one month of vouchers may be issued to the participant. The WIC clinic must receive written medical documentation within 2 weeks of the verbal order. No additional voucher may be issued until written medical documentation is received (e.g., cannot accept a 2nd verbal order).


4. Which infants ages 6-11 months are eligible to receive more formula if they cannot tolerate solid foods?

Only infants who have a qualifying medical condition and who are receiving an “exempt infant formula” or a “medical food” are eligible to receive additional formula in place of solid foods, if medically indicated. Infants ages 6-11 months who are receiving a standard “infant formula” cannot receive additional formula even if they are unable to consume solid foods (e.g., are being tube-fed a standard infant formula).


5. What are examples of qualifying conditions for issuing tofu, soy milk, or extra cheese on Form #2?

Tofu or Soy Milk = Lactose intolerance, vegan / vegetarian diet, milk protein allergy, religious / cultural reasons (e.g., Russian Orthodox). Extra Cheese = Lactose intolerance, underweight per BMI, inadequate weight gain during pregnancy, increased calorie needs due to a medical condition or illness.


6. What are examples of non-specific medical diagnoses that cannot be accepted on Form #1?

Colic, milk allergy, multiple food allergies, spitting up, milk intolerance, formula intolerance, feeding problems, feeding difficulties, picky eater, poor appetite, inadequate intake, constipation, cramps, digestive disturbances, fussiness, gas. The following diagnoses must have another underlying medical condition present and documented: “underweight,” “inadequate / poor weight gain,” “inadequate / poor growth,” and “feeding disorder.” The Georgia WIC Program cannot accept any of these diagnoses alone – a more specific, primary medical condition must be present and listed among the diagnoses (e.g., Cerebral Palsy, Failure To Thrive, Oral-Motor Feeding Disorder, Prematurity, Dysphagia, etc.).


7. What if the number of ounces of formula prescribed per day on Form #1 is more or less than WIC can issue to a participant?

If the health care provider prescribes more than the maximum monthly allowance of special formula or medical food for any participant, WIC can only issue the maximum monthly amount allowed by WIC policy. The participant should be educated about the maximum monthly allowance of formula based upon the participant category, age, feeding method, etc.

If the health care provider prescribes less than the maximum monthly allowance of special formula or medical food on Form #1 for an infant, WIC must still issue the maximum monthly allowance based on age and feeding method. This is to ensure that the full nutritional benefit is provided and to account for infant age changes and corresponding formula maximum allowance changes that may occur during the 1-6 month time period during which the medical documentation is valid.

If the health care provider prescribes less than the maximum monthly allowance of special formula or medical food on Form #1 for a child or woman, WIC must only issue the amount prescribed by the health care provider in addition to any authorized supplemental foods.


8. Can WIC accept a range of ounces for the formula prescribed per day on Form #1?

Yes. Ranges of formula can be accepted. However, the amount of special formula or medical food issued to the participant can never exceed the maximum monthly allowance based on WIC policy.

 

9. Can the health care provider write “up to,” “ad lib,” “PRN,” or “WIC maximum” for the amount of formula prescribed per day on Form #1?

No. An actual quantity of formula must be listed.

10. What is the cutoff for accepting medical documentation based on the date it was signed by the provider?

Medical documentation must have been signed by the health care provider no more than 30 days prior to when it is received by the WIC clinic.
 

Georgia WIC Program Qualifying Medical Diagnoses Guide for Special Formulas & Medical Foods