Mo. Code Regs. tit. 13 § 40-13.020

Current through Register Vol. 49, No. 23, December 2, 2024

Section 13 CSR 40-13.020 - Vision Re-examination

PURPOSE: This amendment clarifies that visual eligibility for persons to receive Blind Pension (BP) must be met in both eyes. It adds the prohibition that a person with a valid driver's license is not eligible for B P. It also gives the Family Support Division (FSD) the authority to review a participant's visual eligibility based on available technological advances.

PURPOSE: This rule establishes the requirements to determine whether an individual previously eligible for a blind pension is required to submit to a re-examination of the individual's vision less often than every five (5) years, and whether the division can waive future re-examinations.

(1) Scope: This rule specifies how and when an individual eligible for a blind pension is required to submit to a re-examination of the individual's vision less often than every five (5) years, whether the division can waive future re-examinations, and the reporting responsibilities for all blind pension recipients concerning changes in vision or other circumstances.

(2) An individual has "no usable vision" when-

(A) One (1) or both of the following two (2) conditions are met:

1. The individual has no vision or only light perception in their better eye; or

2. The individual's vision, with or without proper adjusted glasses, or assistive technology, is determined to be up to, but not including, five two hundredths (5/200) in their better eye, or whose best visual field is five (5) degrees as tested with five (5) millimeter target or perimeter in their better eye; and

(B) The individual's vision loss is permanent; or is medically unlikely to return or improve, with or without assistive technology.

(3) Applicants for blind pension and recipients of blind pension may apply to the division for a waiver of the requirement that they submit to a re-examination of their vision every five (5) years as authorized in section 209.040, RSMo. To qualify for the waiver, the individual shall have no usable vision in the better eye as certified by an ophthalmologist, a physician skilled in diseases of the eye, or an optometrist designated or approved by the division and that condition can reasonably be expected to persist for five (5) years . The certification required by this section shall be in writing and submitted to the division on a form provided by the division or in a letter on the provider's letterhead. Such certification must be provided within ninety (90) days of the examination conducted to determine if the individual has no usable vision. The health care provider conducting the examination shall personally sign the form. The form or letter shall include the following information:

(A) The name and license number of the ophthalmologist, physician skilled in diseases of the eye, or optometrist who conducted the examination;

(B) The name of the individual examined and the date of the examination;

(C) The ophthalmologist, physician skilled in diseases of the eye, or optometrist who conducted the examination shall state whether-

1. The individual has no usable vision in the better eye; or

2. The individual's vision, with or without proper adjusted glasses, is up to, but not including, five two hundredths (5/200) in their better eye, or his/her best visual field is five (5) degrees or less as tested with a five (5) millimeter target or perimeter in their better eye; and

(D) The ophthalmologist, physician skilled in diseases of the eye, or optometrist who conducted the examination shall state whether the individual's vision loss is-

1. Permanent; or

2. Is medically unlikely to return or improve, with or without glasses or assistive technology.

(4) The ophthalmologist, physician skilled in diseases of the eye, or optometrist who conducted the vision examination may indicate that a re-examination should be performed in less than five (5) years. This shall be sufficient evidence to give the division reasonable belief that an individual's vision will improve.

(5) The Family Support Division shall grant the waiver to applicants for blind pension and blind pension recipients upon receipt of the certification required in section (3).

(A) FSD may terminate the waiver for any blind pension recipient based on review of available technological advances and said blind pension recipient's circumstances.

(6) Blind pension recipients shall notify the division if they have or obtain a valid driver's license or experience any improvement in their vision, with or without assistive technology, within ten (10) days of change in circumstances.

(7) Blind pension recipients who have been granted a waiver of the vision re-examination shall certify that their vision has not improved at the time of their annual eligibility redetermination. The individual shall provide the following information when making the written certification:

(A) The name of the individual making the certification;

(B) The individual's current physical address;

(C) Mailing address, if different from physical address;

(D) The individual's department client number or Social Security number;

(E) A statement that the recipient certifies, subject to penalty of perjury, that his or her vision has not improved, with or without glasses or assistive technology; and

(F) The certification shall be signed by the blind pension recipient or the recipient's authorized representative.

(8) Whenever the blind pension recipient reports that his or her vision has improved or the division has reasonable cause to believe that a blind pension recipient's vision no longer meets the vision requirement to receive blind pension, the division shall require the blind pension recipient to submit to a vision re-examination to determine whether the individual is still qualified for the waiver or for blind pension benefits. The blind pension recipient shall promptly submit to an eye re-examination or visual determination made by an ophthalmologist, a physician skilled in diseases of the eye, or an optometrist, designated or approved by the Family Support Division when requested to do so by the division.

(9) The division shall deny or terminate the blind pension recipient's benefits at any time the division determines that a blind pension recipient -

(A) Is not blind;

(B) Is not eligible for the benefit;

(C) Has failed to timely notify the divi-sion that he or she may no longer meet the visual or other requirements for the blind pension program;

(D) Fails to submit to a re-examination under section (7) or (8); or

(E) Who otherwise fails to comply with his or her responsibilities under this section.

(10) Any blind pension payment made to a recipient who was not qualified for blind pension benefits shall be a debt immediately due to the state and collected as overpayment. The blind pension recipient shall repay the sum of the blind pension payments that the individual was not entitled to receive, and any MO HealthNet benefits received while not eligible.

(11) Certifications submitted by mail or any commonly available electronic means such as fax or e-mail, shall be accepted and treated the same as an in-person filing of a certification. A blind pension recipient who submits a certification by electronic transmission certifies under penalty of perjury that the certification and the information contained therein is true, accurate, and authentic. The blind pension recipient shall retain and provide the original certification to thedivision upon request.

(12) Any blind pension recipient who intentionally or knowingly submits, or causes to be submitted, false information to the division shall not be deemed a person of good moral character and shall not be eligible for a blind pension pursuant to section 209.030, RSMo.

(13) All information provided to the Missouri Department of Social Services, Family Support Division in the certification shall be true, accurate, and complete.

(14) A blind pension recipient who is aggrieved by a decision of the division under this regulation may appeal the division's decision pursuant to section 209.110, RSMo.

13 CSR 40-13.020

Adopted by Missouri Register June 1, 2015/Volume 40, Number 11, effective 7/31/2015

Amended by Missouri Register August 15, 2019/Volume 44, Number 16, effective 9/30/2019