N.Y. Comp. Codes R. & Regs. tit. 18 § 368.13

Current through Register Vol. 46, No. 45, November 2, 2024

Section 368.13 - Determination of continuing eligibility

(a) A recipient of AABD shall complete and sign a certification of need (Form DSS-1229) and shall submit such form by mail or in person at least once a year. The determination of continuing eligibility shall include reconsideration of all variable factors of need and eligibility. Particular attention shall be given to any changes in coverage or amounts of benefits, such as disability insurance payments, retirement and disability annuities, veterans' compensation and pensions and workmen's compensation, and to any change in the contributions or ability to contribute of legally responsible relatives.

(b) Change of residence or absence from the district of administration. When a recipient leaves the district of administration the agency shall determine if such absence is temporary or permanent and shall determine its continuing responsibility for the recipient.

(c) Reclassification of blindness.

(1) Where medical treatment or surgery may have resulted in the partial restoration of vision of a blind recipient, a reexamination may be indicated. The report of such examination of Form DSS-542 shall be submitted to the Commission for the Visually Handicapped for reclassification.

(2) Where an eye condition of a recipient who has not been classified as blind, increases in severity, or a recommendation of a review team or other evidence raises a presumption of blindness, an eye examination shall be completed to determine whether or not the recipient is legally blind.

(d) Permanent and total disability. Periodic redetermination and recertification of permanently and totally disabled status shall be made in accordance with department regulations and procedural instructions.

(1) For Group I cases, the status of permanently and totally disabled shall not be considered a factor subject to change. Therefore, the determination of continuing eligibility shall be made by the agency without new medical evidence and without referral again to the review team unless new medical or social evidence indicates improvement or recovery.

(2) For Group II cases, the status of permanently and totally disabled shall be considered a variable factor of eligibility and shall be subject to redetermination for continuing eligibility certification by the review team each 12 months unless prior to the recall date there is evidence of change in the person's condition.

N.Y. Comp. Codes R. & Regs. Tit. 18 § 368.13