Appendix A. PROCEDURE FOR DETERMINING VISUAL ACUITY

The County Medical Consultant reviews the reports of all eye examinations and certifies finally to the degree of vision. The County Assistance Office sends to the County Medical Consultant all copies of the Form PA 40’s of prior examination and other available pertinent information.

A County Assistance Office without a Medical Consultant contacts its Regional Office which will arrange for another County Medical Consultant to review reports of eye examinations and certify finally to the degree of vision.

I. Authorizing examinations.

A. Initial examination.

If an applicant for SBP appears to meet all other eligibility requirements, the County Office authorizes an opthalmologic examination for determining his degree of vision except in the following circumstances: both eyes are missing (the caseworker records his observation of this condition in the case record); or the Office for the Visually Handicapped has referred the person to the County Assistance Office and has submitted an OB 401 (see II).

The applicant has a choice of examiner who is either a physician skilled in the diseases of the eye or by an optometrist.

If for any reason it is not possible to arrange for an examination, the County Office contacts the County Medical Consultant for advice. The County Office gives the name of the applicant’s physician and any available medical data regarding the applicant’s physical or mental condition.

Use of forms.

The County Assistance Office gives the applicant the following forms in an envelope addressed to the examiner:

a. Three copies of Form PA 40, Ophthalmologic Report. The examiner keeps one copy and returns two copies to the County Assistance Office.

b. One copy of Form PA 48, Authorization for Services and Supplies.

c. One envelope addressed to the County Board of Assistance to be used by the examiner for the return of the forms.

When the forms are returned to the County Assistance Office, the Form PA 40 is checked for completeness and conclusiveness, that the examiner has signed at least one copy and that his statement of visual acuity appears to agree with the recorded visual acuity. If the Form PA 40 is incomplete, inconsistent, or otherwise unsatisfactory, the form is returned to the examiner for amplification or clarification.

If the County Assistance Office is satisfied the Form PA 40 is completed properly, the Form PA 259 is checked to see that the charges are in accordance with the fee authorized by the Form PA 48. A notation ‘‘report received’’ is then written in the upper right hand corner of the Form PA 48. The completed Form PA 48, Form PA 259, and Form PA 259-S are sent to the Office of the Comptroller, Harrisburg. Both copies of the Form PA 40 together with copies of any prior opthalmological reports and other information in the case record related to visual eligibility are forwarded to the County Medical Consultant for review and certification. If a trustee is being requested for the same client, the Form PA 50 is forwarded to the Office of Medical Programs, Bureau of Medical Assistance.

When the information is returned from the County Medical Consultant, the County Office forwards the second copy of the Form PA 40 to the Bureau for the Visually Handicapped District Office.

If the examiner has recommended treatment or surgery and the client is not receiving treatment, the County Assistance Office makes known to him the available resources for treatment.

B. Reexamination.

The County Assistance Office authorizes a reexamination under the following conditions:

a. Applicant or recipient.

Whenever the County Medical Consultant requests a reexamination.

b. Recipient.

If the County Office believes that his vision may be better than at the time of his last examination.

However, the County Assistance Office does not authorize an immediate reexamination if the recipient has had treatment or surgery that may be the cause of improved vision, or has had a recent refraction. In such case, the County Assistance Office requests a written report from the Office for the Visually Handicapped District Office, if appropriate, or from the recipient’s opthalmologist or clinic. If the County Assistance Office receives the report within one month from the date of request, it sends the report to the County Medical Consultant for review; this information without another examination may be adequate for a determination of visual eligibility. If the County Office learns that the report will not be forthcoming, or if the County Office has not received the report within one month, the County Office authorizes a reexamination by another examiner. When sending the Form PA 40 to the County Medical Consultant, the County Assistance Office informs the County Medical Consultant of its inability to get the report without examination.

When there is a sound basis for considering that the recipient’s vision has improved to the point of visual ineligibility, the County Assistance Office not only takes appropriate action as stated above, but also suspends State Blind Pension until it receives final certification of the degree of vision from the County Medical Consultant.

c. Reapplicant.

1. Former applicant or recipient who was found ineligible because of visual acuity, if he reapplies six months or more after the examination that was the basis of the decision of ineligibility. If less than six months have elapsed, the County Assistance Office may not authorize a reexamination without prior approval of the County Medical Consultant. To request approval, the County Assistance Office sends to the County Medical Consultant for review, any information indicating that the client’s vision may be different from that shown on the last report.

2. Former recipient ineligible for reasons other than visual acuity if: (a) five or more years have elapsed since last examination; or (b) he has had eye treatment or surgery since his last examination; or (c) there is some indication that his vision may be better than his last examination.

Copies of all prior Form PA 40’s and OB 401’s or their equivalent, in the case record are always submitted with a report of current examination, with a request for authorization of a reexamination, or with an inquiry as to the need for reexamination.

The Form PA 40’s and the Form PA 48 are processed as described in ‘‘A’’ above.

II. Ophthalmological reports from the Office for the Visually Handicapped.

State Blind Pension applicant.

If the Office for the Visually Handicapped District Office finds that a person to whom it is giving vocational rehabilitative service appears to be visually eligible for State Blind Pension, it will refer the person to the County Assistance Office for information on the State Blind Pension Program. The Office for the Visually Handicapped District Office will send the County Assistance Office an original, or a certified true copy, of the OB 401. A covering memorandum will state that the person has been referred because ‘‘his visual acuity with best correction is 3/60 or 10/200 or less.’’ If the person applies for SBP and the County Assistance Office finds him eligible in all other respects, and the OB 401 is current, the County Medical Consultant may use this report as the basis for determining visual eligibility.

Notes of Decisions

Forms

Although the applicant is normally responsible for obtaining medical verification required for SBP benefit eligibility, it is improper to withhold benefits because of a delay caused when a case worker sends the verification forms to the applicant’s doctor and in so doing causes the applicant to rely on the case worker for advisement as to return of the forms and the information contained therein. Groller v. Department of Public Welfare, 422 A.2d 1212 (Pa. Cmwlth. 1980).

Cross References

This appendix is cited in 55 Pa. Code § 451.3 (relating to requirements).