1 Breastfeeding Promotion and Support (BF) BF-6 Provision of Electric Breastpumps

Maine Center for Disease Control and Prevention WIC Nutrition Program

Effective: October 1, 2012 Policy No. BF-6 Revised: October 1, 2023

Provision of Electric Breastpumps Authority 7 CFR §246.11(c)(3) and (7)(iv) and §246.14(b)(1)(iii) 22 MRSA §255 and §1951

Policy 1. Breastfeeding participants are eligible to receive an electric breastpump from the WIC local agency based upon identified need. 2. The State Agency shall purchase electric breastpumps for Local Agencies to loan to eligible WIC participants, as funding is available. 3. A Local Agency may accept State Agency-purchased electric breastpumps, choose to purchase electric breastpumps, or if circumstances require, may arrange for rental of an electric breastpump from a State Agency-approved pump rental station. 4. Local Agencies shall ensure that their liability insurance will cover the loaning of electric breastpumps. 5. The Local Agency Breastfeeding Coordinator shall oversee the issuing of electric breastpumps and educating participants regarding pump assembly, use and cleaning of the electric pump. 6. WIC benefits shall not be withheld if an electric breastpump is not returned.

Procedures 1. The goal of providing electric breastpumps to WIC participants is to support initiation and maintenance of adequate milk supply. 2. The goal of frequent electric breastpump follow-up is to support breastfeeding mothers in meeting their individualized short- and long-term breast/chestfeeding goals. 3. A Fully or Partially Breastfeeding participants may receive a loaner electric breastpump upon request. 3.1. If needed, the infant may receive up to the maximum amount of formula for a Partially Breastfeeding infant when parent has requested an electric breastpump.

2 Breastfeeding Promotion and Support (BF) BF-6 Provision of Electric Breastpumps

Formula issuance shall be tailored to meet assessed need. 4. Approval for a loaner electric breastpump may be given for Some Breastfeeding participants for special circumstances including but not limited to the following: 4.1. re-lactation; 4.2. prescription medications required for breast/chestfeeding participants which is not recommended while nursing; 4.3. temporary separation of nursing parent/baby; 4.4. medical condition(s); and/or 4.5. multiple infants. 5. If needed, the infant may receive up to the maximum amount of formula for a Some Breastfeeding infant when a Some Breastfeeding participant has a reason for use of an electric breastpump. Formula issuance shall be tailored to meet assessed need. 6. Loaner electric breastpumps may only be issued to participants during the prenatal period on a case-by-case basis and with the approval of the State Breastfeeding Coordinator. Documentation of justification for issuance and approval from State Breastfeeding Coordinator must be documented in the participant file on SPIRIT. 7. If the Local Agency has loaner electric breastpumps available, they shall distribute one to the requesting participant in accordance with the aforementioned procedures. 8. If no loaner pumps are available, if pump is requested outside of clinic hours, or if the participant encounters an extenuating circumstance wherein the immediate provision of a pump could impact the health or overall success of a breastfeeding dyad, a rental electric breastpump may be authorized for no longer than one month. 8.1. If extenuating circumstances exist that require a participant to have a rental pump for greater than one month, an additional month may be authorized. Local agency designated breastfeeding experts must submit a request to the state agency Breastfeeding Coordinator prior to approving a rental pump extension and document such an approval in the participant’s file. 8.2. If a local agency fails to gain state agency approval for a pump rental extension or if inadequate documentation exists in a participant’s file to reflect continued efforts to encourage rental pump returns within the agreed upon timeframe, the local agency may be financially responsible for additional rental charges beyond the first month. 9. The Local Agency breastfeeding coordinator or designee shall use the following procedure when loaning or authorizing rental of an electric breastpump to a client: 9.1. Using the appropriate Electric Breastpump Agreement Form (rental or loaner, see Appendix BF-6-A Electric Breastpump Rental Form and Appendix BF-6-B Loaner Pump Agreement Form.), the Local Agency staff who authorized the rental or loan of the electric breastpump shall complete the following: 9.1.1. Read the agreement with the participant and ask them to sign the form. The authorizing staff must also sign the agreement.

3 Breastfeeding Promotion and Support (BF) BF-6 Provision of Electric Breastpumps

9.1.2. Provide education on assembly, cleaning and maintenance of the breast pump, verifying that this education was provided at the time of issuance by initialing beside “Assembly, Use & Cleaning Reviewed” on the agreement form. 9.1.3. Provide human milk storage guidelines. 9.1.4. Document completion of the aforementioned tasks by uploading signed Electric Breastpump Agreement Form into SPIRIT and in writing in the participant’s file. Adherence to this policy will be assessed during Management Evaluation Reviews within 90% accuracy.

4 Breastfeeding Promotion and Support (BF) BF-6 Provision of Electric Breastpumps

9.1.5. When authorizing a loaner breastpump for a participant that is a minor (under the age of eighteen years old) staff shall inquire if another person over the age of eighteen years old is available to assume responsibility and sign the agreement in addition to the participant. Staff shall print the additional person’s name, provide a phone number and obtain the signature. 9.1.6. If there is not a person available who can assume responsibility for the loaner breastpump, staff shall issue the loaner pump. 9.2. Send the signed Electric Breastpump Rental Agreement Form to the vendor for proper documentation if using an outside vendor. This documentation shall be created even in cases where an outside vendor calls and receives verbal approval to rent the electric breastpump.

9.3. Give the name and phone number of the authorizing Local Agency staff to the outside vendor to call if the participant needs help. 9.4. Inform the participant that they shall receive follow-up phone calls regarding the continued use of the breastpump. 9.5. Document approval of breastpump loan or rental in participant’s electronic record: 9.5.1. Create an alert 9.5.2. Copy alert into a general note 9.5.3. Scan signed breastpump agreement form into scanned documents section of record 9.5.4. Document in local agency breastpump log 9.6. Document all follow-up contacts (or attempted follow-up contacts) in the participant’s electronic record including continued need for the use of breastpump and frequency of usage. 9.6.1. Call participants who have been provided with a loaner or rental electric pump at least monthly (every 4 weeks) to provide breastfeeding support and to see if there is continued need for the pump. More frequent weight checks and/ or follow up contacts for a dyad with complications shall be completed by or after consultation with the Local Designated Breastfeeding Expert. 9.6.2. If the pump is in use for > three (3) months, loaned or rented pumps shall be reviewed monthly to determine if need still exists. 9.6.3. Electric breastpump usage, including frequency of pumping and ounces yielded, should be discussed during nutrition education appointments and documented in the participant’s file in SPIRIT. 10. Initial follow up phone contact should be made within 2 business days.

5 Breastfeeding Promotion and Support (BF) BF-6 Provision of Electric Breastpumps

11. Local Agency staff shall ask the following questions to evaluate continued need for the breastpump and document responses in the participant’s electronic record: 11.1. How many times a day are you using the breastpump? If need is only one time a day, would a manual pump meet the need? 11.2. How many days a week are you using the breastpump? 11.3. How much milk are you expressing at each use? 11.4. How much infant formula are you supplementing with each day? 12. When evaluating continued need for the breastpump, staff shall consider if the return of a breastpump will mean the difference between a successful breastfeeding experience and stopping. 13. Collection kits may be provided to breast/chestfeeding participants for use with an electric pump. Due to the potential for cross-contamination these kits are not to be returned to the Local Agency for reuse 14. The Local Agency staff shall ensure that a participant: 14.1. Can demonstrate assembly and dismantling of the pump.

14.2. Can identify proper storage methods of breast milk following pumping.

14.3. Is provided appropriate educational materials, in print form and/or on the internet.

14.4. Knows to discontinue use of the pump at the first sign of discomfort and call the Local Agency for assistance. 15. Education on the use of loaner pumps shall be documented in the participant’s file and on Appendix BF-6-B Loaner Pump Agreement Form. 16. Document return of breastpump loan or rental in participant’s electronic record: 16.1. Create an alert which includes documentation of date breastpump returned 16.1.1. Leave alert in record for three (3) months after return for SA staff invoice processing purposes. 16.2. Copy alert into a general note 16.3. Scan breastpump agreement form with staff signature verifying return of breastpump or hospital return receipt into participant’s electronic record. 16.4. Document in local agency breastpump log 17. The Local Agency staff shall maintain an up-to-date spreadsheet of loaned pumps and pump rentals. This includes participant name, ID number, vendor name for rentals, reason pump requested, date approved, end date and the stop payment date if applicable for each pump.

6 Breastfeeding Promotion and Support (BF) BF-6 Provision of Electric Breastpumps

18. The Local Agency staff shall fax or email the State Agency an updated spreadsheet of pump rentals on a monthly basis. 18.1. If emailing the State Agency an updated spreadsheet that includes participant names, the spreadsheet must be password protected. 19. The Local Agency Breastfeeding Coordinator shall know the rental practices of the vendors in her area. Arrangements for the rental of electric breastpumps shall be made with vendors recognized by the Maine CDC WIC Nutrition Program office. 20. If the vendor does not provide instruction on the use of the breastpump, trained Local Agency staff shall provide the participant with instruction on its use. Local Agency staff shall also provide the participant with an appropriate referral contact such as La Leche League, a lactation consultant or home visiting programs if problems arise with the use of the pump. 21. Except in rare cases, the maximum supplemental issuance of formula along with a loaner electric breastpump is the maximum allowance for a partially breastfed infant, (see Appendix NS-2-D Formula Reconstitution Monthly Amounts). 22. The period of time the breastpump is loaned or rented shall be individualized and monitored.

22.1. Maine CDC WIC Nutrition Program shall not cover any electric breastpump rental past the child’s first birthday. 22.2. The standard amount of time for allowing the use of a WIC loaner breastpump is up to the child’s first birthday. 22.3. Exceptions may be made to allow the extension of a WIC loaner breastpump beyond the child’s first birthday 22.3.1. Examples of qualifying circumstances include but are not limited to medical conditions, child not tolerating other foods, severe food allergies or extended periods of separation. 22.3.2. Staff must address these situations on a case by case basis and document the need in the participant’s electronic file. 22.3.3. Maintain consistent follow up with participant.

22.3.4. Tailor the food prescription to meet the nutrition needs of the child.

22.3.5. Schedule return of the loaner breastpump prior to when the child turns twenty-four (24) months.

23. When it has been deemed that the Maine CDC WIC Nutrition Program shall no longer pay for rental of an electric breastpump or authorize a loaner breastpump, the local agency breastfeeding coordinator or designee shall:

7 Breastfeeding Promotion and Support (BF) BF-6 Provision of Electric Breastpumps

23.1. Call the participant to let her know the date the pump needs to be returned and reason(s) why; 23.2. Complete the Electric Breastpump Stop Payment Form (see Appendix BF-6-C) or send the participant a letter specifying a date of return for the breastpump, and reason why the breastpump loaner or rental is no longer authorized. 23.3. If the breastpump is a rental pump:

23.3.1. Fax the Electric Breastpump Stop Payment Form to the vendor;

23.3.2. Mail a copy of the Electric Breastpump Stop Payment form to the participant, and

23.3.3. Scan one copy into the participant’s electronic record.

24. Local agencies are to adhere to the following process prior to referring a suspected case of participant fraud to the state agency: 24.1. After a minimum of four (4) attempted contacts or a missed appointment, send agency pump letter or electric breastpump stop payment form; 24.2. If participant does not respond to correspondence in one week, send standard state EBP certified letter (see Appendix BF-6-D);

24.3. All mailed correspondence must be scanned into the participant’s electronic record.

24.4. If the breastpump is not returned to the agency within two (2) weeks from the date the certified letter was mailed, or the certified letter comes back as unclaimed, send an email to the State Agency Breastfeeding Coordinator; include the participant ID number, serial number of pump and the request for referral to the DHHS Fraud Recovery Unit. 25. Local agencies with loaner electric breastpumps shall follow these minimum guidelines for inventory control: 25.1. Maintain updated physical inventory document which includes serial and state asset tag numbers for all pumps.

25.2. All pumps and accessories shall be stored in an area or cabinet that can be locked when staff members are not present; 25.3. The Local Agency Breastfeeding Coordinator shall identify staff members responsible for cleaning and disinfecting breastpumps; 25.4. When a pump is returned, it shall be cleaned based on manufacturer recommendations and tested for any problems;

8 Breastfeeding Promotion and Support (BF) BF-6 Provision of Electric Breastpumps

25.5. When issues with loaner electric breastpumps arise, local agency staff are responsible for: 25.5.1. Trouble shooting pump problems

25.5.2. Discussing damaged pumps with manufacturer directly

25.5.3. Sending damaged pumps directly to manufacturer to be replaced or for repair after approval of an estimate by the State Agency 25.5.4. Make the State Agency aware of damaged or defective pumps