1. Changes to Medical Documentation Form and Requirements 1

2. 2  Updated Medical Documentation form available 10/1/2014

3. Why update the form?  Updated to match new food package requirements  Group of LA WIC Nutritionists worked to simplify the form and make it easier to read 3

4. Take a look at what has changed in each section 4

5. Title and Instructions 5 Added “request”, to emphasize this is not an RX Simplified instructions

6. Section A: Patient Information 6  Option to request an assessment and consult by the RD

7. Section B: Medical Formula information 7 New Tube feeding check box If checked, assign Risk 362 – Developmental, Sensory or Motor Delays Interfering with Eating and document tube feeding

8. Section B: Medical Formula information 8 Formula request Shorter durations “Until 12 months of age” for infants Includes message about re-evaluation and communication with health care provider

9. New Option: Provider asks WIC RD to determine supplemental foods 9 If checked, the Nutritionist can complete a full assessment and select the supplemental foods, the amount and the length of issuance appropriate to the participant’s medical condition.

10. What if the provider has checked this option and the WIC RD is not available?  If the WIC Nutritionist is not available to assign the supplemental foods, issue the medical formula requested and consider the following actions:  Issue one month of vouchers for the default food package that fits the age and category of the participant until the WIC Nutritionist or health care provider can be consulted for the assignment of supplemental foods.  Contact your assigned state Nutrition Consultant to assist with the food package assignment. 10

11. Issuing extra formula instead of foods 11 The “None” box must be checked by the HCP in order to provide additional formula instead of foods.

12. Issuing extra formula instead of foods  A qualifying condition must be identified.  The condition must indicate a situation where eating solids is not safe, they are not developmentally ready for solids (e.g. due to prematurity), or that eating solids puts them at risk for choking/gagging/etc.  It is not intended to boost issuance because the family needs more formula or would rather have more formula and no baby food. 12

13. Providing soy beverage to children no longer requires Med Doc, but… 13 TWIST doesn’t know that yet! Until eWIC, we have to enter something in TWIST.

14. Take a look at the TWIST Job Aid 14 Complete the Medical Documentation pop-up, then issue normally.

15. New requirement: RD review of med doc 15 Policy 765 – The completed form must be reviewed by the WIC Dietitian/Nutritionist (or other health care professional in the clinic )

16. How does the review fit into clinic flow? Med doc receivedVouchers issued RD reviews form with participant chart and approves/denies requested formula RD updates care plan, risk assignment, and appts. if needed RD follows up as needed 16

17.  The RD review should not interfere with voucher issuance, so the RD can review after vouchers are issued if needed.  Consider issuing one month of vouchers if this is a new formula or new request, if the RD is not available to do the review before voucher issuance.  A health care professional in the clinic can do the review if the WIC RD is not onsite on a regular basis (e.g. contract RD). 17

18.  The reason for the review is to make sure the RD is able to coordinate the care of participants who are medically fragile and need frequent monitoring and oversight.  This is an opportunity to determine if the requested formula is appropriate based on the qualifying medical condition listed and information in the chart.  The RD may contact the health care provider for more information or clarification. 18

19. Why would a formula request be “denied”?  Sometimes the health care provider may not understand what WIC can provide.  Sometimes they don’t have some of the information we have in the participant’s chart.  Sometimes the health care provider will submit a med doc form more at the participant’s request than because there is a qualifying medical condition (e.g. PediaSure for a picky eater). 19 This is a great time for communication with the health care provider!

20. What happens if the formula request is “denied”?  The RD will do further assessment and counseling with the parent/caregiver about options  See the Job Aid: Pediatric Nutritionals and Diet Assessment  The RD will document the reason in the chart  The RD will communicate with the health care provider  See the sample denial letter 20

21. 21  Based on what is learned the RD may need to:  Add additional risk assignments (e.g. tube feeding);  Update the care plan in progress notes in TWIST;  Schedule a high risk follow up appointment for the participant; or,  Work with the family to develop a plan to transition off the medical formula or nutritional or return back to breastfeeding, standard infant formula, and/or WIC approved supplemental foods.

22.  Now that the RD has all this great information, they can make sure that the families that need extra care coordination can benefit from their expertise and get the care they need. 22 RD follows up as needed

23. Check out the new back of the med doc!  Includes policy info  States what WIC can’t give  Clarifies qualifying medical conditions 23

24. How will I get the new med doc forms?  The new med doc form will be posted to the website by 10/1/2014.  A pad of the new forms will be sent to your agency, but feel free to use up any remaining forms that you have.  You can print copies of the form if needed or order additional copies from the state mailroom. 24

25. Ideas for sharing the new form with providers  Consider modifying the sample letter to share with your local health care providers  Send a pad of the new forms to providers with a cover letter  Note on your FAX cover sheet that this is a new form  FAX both the front and back of the form  Add the Word version of the back of the form to your FAX cover. 25

26. What are your thoughts? 26

27. Concerns? Questions?  If you have any concerns or questions about implementing these changes in your agency, please contact your state nutrition consultant. They are available to help problem solve! 27