PA-Breastfeeding Coalition Minutes of meeting January 12, 2000

Present -
Dawn Blanchard individual-Messiah College Nursing faculty
Karen Foard-PA MILC (Mid-state ILCA Chapter)
Susan Fraser individual---Medela, Western PA
Judy Heald Cooperative Extension and EFNEP
Martha Kautz St Joseph's Hospital and Lancaster County Bf Coalition
Cindy Maki State WIC program
Mary Ann Mihok Dietetic Educators
Chris Mulford PRO-LC (E-PA ILCA Chapter)
Pat Panighetti North Central area WIC
Kathy Romberger Pinnacle Health System
Linda Shaw Central Region AAP Bf Coordinator
Ruth Solomon La Leche League
Jeanne Spencer PA Academy of Family Practice
Andrea Schappert Maternal Family Health (Wilkes-Barre)
Rosa Snyder-Boyd individual---Washington and Green County WIC
Theresa Wirtner Erie County WIC

Add to mailing list (has not been getting newsletter and minutes)
Theresa Wirtner
139 E Main Street
GIRARD PA 16417

Minutes corrected:
Linda Shaw and Karen Foard were both present. Karen Foard moved that the minutes be approved as corrected.

Treasurer's report:
Current total balance is $912.75. One new membership has come in since last meeting. Martha will include an invitation to join in the next newsletter.

The credit union where we have our account no longer gives interest on small checking accounts, and accounts over $1001 earn only 1%. We voted to move the bulk of our money into our savings account, where it will earn 3.04%. Judy Heald moved to accept Treasurer's report.

Correspondence:
Jeanne Spencer sent a letter to the American Heart Association commenting on the guidelines for treatment of acute stroke which they had distributed. Certain medications were listed as contraindicated for nursing mothers. Jeanne wrote to clarify the ways such a situation can be handled. She recommended advising temporary cessation of breastfeeding while mother expresses and discards her milk, rather than either withholding a needed medication or advising the mother that she must stop breastfeeding. We received a reply from an AHA physician at the U of Iowa.

Mary Ann Mihok and Tasha Dershem wrote an article about the PA-BC for the State Dietetic Association newsletter. Two people responded with interest in joining.

Old business:

Non-profit application:
Chris Mulford has asked several members to provide information about past and present projects of the PA-BC. She thanked those who responded (Jeanne, Linda, Connie) and reminded those who have not (Martha, Chris) to send their replies.

Karen Foard asked that these accounts include all the dates possible, since this is what the reviewers focus on.

Martha sent the change of address for our EIN number on 9-29-99. The EIN number is 23-2985555.

Website:
Still down. Martha will follow up with Tasha Dershem and Barb Shocker.

WIC breastfeeding services:

breastpumps:
Cindy Maki reported in detail on the new WIC allocation of money from the food budget to purchase breastpumps. This is a major change from the former system of using only administrative funds for breastfeeding services. All agencies will have such funds; decisions on how to spend the money are made at the local level with approval at the state level. Cindy expects all agencies to have submitted their plans to her by March.

Criteria for distribution and for selecting pump brands and models have been developed at the federal and state levels. The USDA's goal is to provide a pump to every breastfeeding mother who meets the criterion of "reasonable need," such as a mother working full-time, the mother of a premie, or a mother who temporarily must suspend breastfeeding because of medication. (Rosa added that her agency also provides pumps for temporary problems such as low milk supply or poor latch-on.) The pump is not an incentive and not a "perk" to be given to every mother who breastfeeds. Other sources for pumps, such as hospitals that distribute an effective manual pump, and MA coverage for rental pumps, must be used whenever possible.

Martha asked whether the PA-BC could help in any way. Cindy mentioned a possible need for volunteer trainers in Bucks County. Chris will email a request for help to the PRO-LC list.

Martha asked Cindy whether arrangements might be made between a WIC agency and a local supplier such as a hospital or coalition; for instance, the local group might offer to cover the gap if WIC runs out of pumps. Cindy said that such an arrangement would be fine and is best made on the local level. Kathy mentioned Dauphin County, where Pinnacle's nursing mothers group has donated several Lactinas to the local WIC program. However, in a neighboring county without a group that can make such donations, WIC has no pumps to loan.

A potential problem is that Hollister has been marketing vigorously to area hospitals. Thus there may be a need to have both Medela and Hollister products on hand in order to be compatible with what is available locally. Yet the WIC funds for pumps are spent once a year, with little flexibility.

MA and other insurance coverage for rental pumps:
Cindy reported on the difficulty of getting rental fees covered for low-income women. Medical Assistance (MA) is supposed to cover pump rental for the mother of a premie, a NICU baby, or a full-time working mother. HMOs that provide for MA mothers are supposed to provide everything that MA provides; however, their usual practice is to tell the mother she may have a manual pump only.

Cindy has tried to bring this up with MA at the state level, but had no success. She surveyed MA HMOs about their criteria for covering breastfeeding services or equipment, and got a variety of answers which did not match the MA criteria. However, sharing her findings with the Department of Public Welfare did not get her anywhere. She recommends that mothers work through the person who handles insurance matters at their provider's office.

Theresa has experience working with a third party payer to get payment for a rental pump for a full-time working mother with an MA card. She had the mother's doctor contact the state agency that enforces policies regarding HMOs. She will send Chris more information about this to be distributed to PA-BC members. Jeanne said that as a doctor it's helpful to be able to quote the rules.

Jeanne and Linda expressed willingness to take these stories to their state associations and ask for support. The state medical societies are a force we would like to enlist in this struggle.

Getting non-Medicaid HMOs to cover pump rental is not any easier. Martha said that it is never a standard benefit, but always an exception.

Susan reports that Medela has developed a letter that a physician can send to an HMO if the HMO denies a mother coverage for a pump. Theresa's experience is that an office employee of the physician can call the HMO for authorization after a claim is rejected.

Linda commented that HMOs look only to the next quarter and are not interested in potential long-term cost savings.

Karen Foard reports that Geisinger loans electric pumps to some premie mothers---only while the baby is hospitalized.

Billboard Project:
Jeanne reported that Lamar billboard company will donate unused space to a non-profit organization. The non-profit designs the graphics and provides the paper (costs about $100 per billboard) and Lamar prints the poster, chooses which site, and installs the poster. It stays up until they rent the billboard---could be one day, could be six months.

Medela can provide a free graphic. Best Start has a billboard poster in their catalogue, no price listed. Jeanne says her coalition has a goal of putting up 10 billboards in their area. They will give the PA-BC website as a resource.

Taking positions on topics:
Chris raised the question of whether the PA-BC will want to take a position on an issue and if so, how would we do it? How could members speak for their organizations? We represent different types of organizations, and some might find it easier to give official support than others. Some organizations may not be able to support anything except the most general positions.

Some examples of issues would be:
Support for bills before the legislature, Pressing PA hospitals to move toward baby-friendly status, Jeanne's letter to the American Heart Association

We agreed that our voice would be more powerful if we listed the coalition members who supported a particular position statement.

Chris was asked to develop a proposal for a process of getting support from our member organizations. The process might depend on what type of issue we are asking them to support.

Committee reports-brief
Research: needs a chair.
Public Policy: no activity
Membership: No new members in last quarter. Martha will put an invitation for membership into the next newsletter.
Public Relations: The next newsletter is nearly ready.
Provider Education: The immunization poster was not distributed at the
PA-MILC Conference, but will be ready to hand out at the April coalition meeting.

Announcements:
Cindy gave the dates for upcoming WIC Breastfeeding Training. There may be room for extra students in some sessions. Contact her.

Pittsburgh March 29, 30
Erie April 6, 7
Wilkes-Barre May 23, 24
Harrisburg June 27, 28

Meeting schedule:
April 12--State College
July 12--Harrisburg
October 1--State College