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CHAPTER 5. SUPPLEMENTAL FOODS ATTACHMENT 5-3, PAGE 2
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In order to provide the FNB, some exempt powder formulas require issuance of different numbers of containers over the age and issuance period. When reviewing the AL Formula Max Quantity Report, the following formulas have quantities that vary per month: • Neocate Infant with DHA & ARA (14.1 oz. powder) • Nutramigen Enflora LGG (12.6 oz. Powder) • Pregestimil (16 oz. Powder) • PurAmino (14.1 oz. Powder) • Similac PM 60/40 (14.1 oz. Powder)
Ready to feed formula (Chapter 5, Supplemental Foods) Ready to feed formula is authorized when the CPA determines and documents that one of the following conditions is met: • unsanitary or restricted water supply • poor refrigeration • the person caring for the infant may have difficulty in correctly diluting concentrated liquid or reconstituting powdered formula • the individual is homeless • in the professional judgment of the CPA, the ready to feed form better accommodates a participant’s condition or compliance Exceptions to this policy on ready-to-feed formulas would be those exempt infant formulas or WIC eligible nutritionals which are made only in ready-to-feed form. All documentation regarding ready-to-feed formula should be made in the Nutrition Assessment section of the participant’s Care Plan Summary.
Maximum Monthly Allowances (MMA) of Supplemental Foods for Infants in Food Packages I, II and III.
Age Fully Formula Fed Partially Breastfed Fully Breastfed 0 through 3 months 870 oz. powder formula 435 oz. powder formula 0 oz. formula 823 oz. concentrate formula 388 oz. concentrate formula 832 oz. ready to feed formula 384 oz. ready to feed formula 4 through 5 months 960 oz. powder formula 522 oz. powder formula 0 oz. formula 896 oz. concentrate formula 460 oz. concentrate formula 913 oz. ready to feed formula 474 oz. ready to feed formula 6 through 11 months 696 oz. powder formula 384 oz. powder formula 0 oz. formula 8 oz. infant cereal 8 oz. infant cereal 16 oz. infant cereal 128 oz. infant fruits and vegetables 128 oz. infant fruits and vegetables 128 oz. infant fruits and vegetables 40 oz. infant meats