GEORGIA WIC PROGRAM PROCEDURES MANUAL NS Medical Diagnoses

Policy No. NS- 210.19 Effective date: October 1, 2016

No. of Pages: 2

Page 1 of 2

Policy Medical documentation for exempt formulas and nutritionals must include a specific, qualifying medical condition. The documented diagnosis or medical condition must be consistent with the manufacturers’ labeled and intended use of the formula or nutritional prescribed, or based on the nutrient composition and nutritional features indicated in the management of the specified condition. The medical diagnoses must also be consistent with the participant’s anthropometric data (e.g., length/height, weight, BMI) and WIC nutritional assessment for authorization of issuance. Purpose To ensure that the formula or nutritional prescribed is appropriate and necessary for the medical management of the participant’s health condition. Procedures

I. Verify that the diagnosis provided is a qualifying medical condition.

A. Qualifying medical conditions include, but are not limited to, premature birth, low birth weight, failure to thrive, inborn errors of metabolism and metabolic disorders, gastrointestinal disorders, malabsorption syndromes, immune system disorders, severe food allergies that require an elemental formula, and life threatening disorders, diseases and medical conditions that impair ingestion, digestion, absorption or the utilization of nutrients that could adversely affect the participant’s nutrition status.

B. A “suspected” diagnosis is allowable if it still meets the other diagnostic criteria (e.g., “suspected milk protein allergy”).

II. Contact the medical provider to clarify any non-specific, general medical diagnoses or clinical signs and symptoms documented as the sole diagnosis. These are not sufficient as Georgia WIC medical documentation. Reference the attachment, Diagnoses Requiring Clarification or Additional Documentation for a list of unacceptable diagnoses.

III. If the issuance of the indicated formula or nutritional is not authorized based on the guidance above, inform the provider of the reason GA WIC cannot provide the requested formula or nutritional. The final decision should be based on the information on the Medical Documentation Form and any additional clarification provided by the physician.

GEORGIA WIC PROGRAM PROCEDURES MANUAL NS Medical Diagnoses

Policy No. NS- 210.19 Effective date: October 1, 2016

No. of Pages: 2

Page 2 of 2

Authority 7 CFR §§ 246.10(d) and (e)

Definitions/Supporting Information Competent Professional Authority (CPA) – An individual on the local agency staff who is authorized to determine nutritional risk and prescribe supplemental foods. The following individuals may be authorized and trained to serve as a CPA: physicians, nutritionists (bachelor’s or master’s degree in Nutritional Sciences, Community Nutrition, Clinical Nutrition, Dietetics, Public Health Nutrition), registered dietitians, licensed dietitians, registered nurses, and physician assistants (certified by the National Committee on certification of Physicians Assistants or certified by the State medical certifying authority), or State or local medically trained health officials.