BESB: New Low Vision Policy Effective November 1, 2010

New Low Vision Policy Effective November 1, 2010

 

Dear BESB Staff and Community Partners,

Immediately below is the new low vision services policy for the BESB Adult Services Division, that will become effective with eye examinations that occur on or after November 1, 2010. This revised policy contains three significant changes, as approved by the agency board at their September meeting, subsequent to a public hearing on this subject. First, it establishes a cap of $200.00 for the dollar amount that BESB will pay for low vision devices (glasses and magnifiers) prescribed and/or dispensed by eye doctors. Second, it clarifies the role that third party insurance plays as the first payee of low vision examinations, and where applicable for low vision devices, before BESB funds are used. Lastly, it clarifies that CCTV’s are not considered as low vision aids and therefore are not subject to the $200.00 cost cap. Please note that this policy revision only applies to the provision of low vision services through the agency Adult Services Division for independent living services. It does not apply to clients served through Vocational Rehabilitation or Children’s Services. Paragraphs that contain new wording have an asterisk ( * ) immediately preceding the first word of the paragraph.

Adult Services/Independent Living Policy Effective November 1, 2010

LOW VISION SERVICES AND EYE CARE

Low vision services include an evaluation by a qualified low vision specialist of the degree of visual disability present that can be helped by aids and devices that maximize the use of one’s remaining visual capabilities.

Low vision eye care refers to the services offered by low vision specialists in the habilitation or rehabilitation of people with vision impairments. Such services typically include:

Obtaining ocular and medical history

Obtaining functional history of vision use

Identifying client goals and expectations

Assessment of visual acuity and visual field

Functional testing for reading rate, glare, contrast, color vision and depth perception

magnification evaluation

optical and electronic device recommendations

non-optical recommendations

dispensing and training

orientation and mobility considerations

psycho-social considerations

medication management considerations

community and state resource recommendations

follow-up care

For individuals who have some degree of functional vision, it is important that maximum benefit from that vision be obtained for performing independent living tasks. The provision of a low vision evaluation should be considered when changes in the functional vision of a client are reported or observed. For individuals who are experiencing ongoing degenerative eye conditions, it is important to recognize that low vision devices provided at one point in time may become ineffective for the client to use over time. It is therefore advisable to consider follow up assessments in these circumstances to ensure that independent living skills will be maintained.

*The Board of Education and Services of the Blind (BESB) can cover the cost of low vision eye care in the form of a complete low vision evaluation, including an initial visit to a BESB approved ophthalmologist or optometrist, one follow-up training visit, and the purchase of up to two-hundred dollars ($200.00) in optical aids prescribed and/or dispensed by the eye doctor, at a frequency of every two years, unless a degenerative eye condition or significant, noticeable reduction in functional vision within the residential or community setting requires an interim visit.

*For clients who have medical insurance through public or private sources, the eye doctor shall first seek payment for the cost of the low vision examination through the third party insurance before seeking payment from the agency. BESB will cover the cost of the client deductable for the examination as well as the cost not paid by third party insurance as noted on the Explanation of Benefits report submitted to the agency by the eye doctor. The total agency reimbursement, in combination with any amount received by the eye doctor from third party insurance, shall not exceed the agency fee schedule.

*In situations where third party medical insurance covers part of the cost of eyeglasses or magnifying devices, the eye doctor shall submit the Explanation of Benefits report for the covered item(s) to the agency. BESB reimbursement, in combination with any amount received by the eye doctor from third party insurance, shall not exceed two-hundred dollars ($200.00) in total for these items.

Low vision assessments may be initiated prior to the development of an Independent Living Plan if the Social Worker determines that the results of such an assessment are necessary for the development of Independent Living Plan goals, objectives or services. However, it is not a requirement that such an assessment be obtained prior to development of an Independent Living Plan if the Social Worker, through observation or client self reporting, can determine that the client will likely benefit from these services.

Clients are to be given a copy of the approved low vision provider list to review. Client choice shall be the basis for selecting the low vision doctor from the approved list, and the Social Worker shall note this personal choice in the case management system upon initiating the request for the low vision examination.

*For clients with third party medical insurance, a written request to perform the eye examination will be sent to the eye doctor by the agency, with instructions to bill the third party insurance provider prior to seeking agency funding. For clients who do not have third party medical insurance, a purchase order will be issued to the eye doctor to cover the cost of the low vision examination. A written notification form is sent by the agency to the client, with contact information for the doctor’s office so that an appointment can be scheduled.

Low vision eye care does not include vision therapy services, standard eye examinations for health care assessment and maintenance, or medical procedures or surgeries that may be beneficial or necessary. BESB Social Workers may facilitate referrals and provide information under a signed release of information from the client, guardian or court appointed conservator to third parties that assists with the client securing services that are outside of the scope of low vision eye care.

*Although electronic magnification machines (commonly referred to as a CCTV) may be recommended by eye doctors, this section of agency policy does not address the provision of these devices to clients, and therefore the cost cap for low vision devices is not applicable for a CCTV. Refer to the "Adaptive Equipment Provided by the Agency" section of this policy manual for CCTV guidelines.





Content Last Modified on 10/7/2010 2:46:04 PM