December 1973 Eligibility Requirements

1055.015.00 ELIGIBILITY BASED ON VISUAL ELIGIBILITY

The procedures to be used in establishing the visual eligibility are:

  1. Select an ophthalmologist or optometrist or a physician skilled in diseases of the eye who accepts the Medicaid rate.  Usually the examiner nearest to the claimant is selected since the claimant is expected to provide his own transportation, if able to travel.  If the claimant is unable to travel and an examination in the home is required, arrangements may be made with an examiner who is willing to examine the claimant at the claimant’s home.  An additional $5.00 will be paid to cover the cost of the trip.
  2. Make the appointment for the examination, and send a copy of the visual examination form (IM-68) to the examiner.
  3. The Examination Report is submitted by FSD to the State Supervising Ophthalmologist for review and decision.
  4. If the State Supervising Ophthalmologist indicates ‘eligible’ on the returned form, and if the claimant meets all other eligibility criteria, the case can be approved.  If the form indicates the claimant is ineligible based on vision criteria, reject the application or close the case.  If the Supervising Ophthalmologist recommends another examination before visual eligibility can be determined, a second examination must be performed by an examiner designated by FSD.
  5. If the claimant is eligible based on vision criteria, the State Supervising Ophthalmologist indicates the date for the next examination.