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COMAR 10.09.24.05

541

State of Maryland Medical Assistance Manual Revised July 2012

The ophthalmologist or licensed optometrist shall submit a report of the examination to the LDSS or LHD.

The report shall be reviewed by an ophthalmologist, contracted by the Department or its designee, who determines on behalf of the local department of social services or other designated entity determining Medical Assistance (MA) eligibility:

o Whether the person meets the definition of blindness and o The need and frequency of re- examination for periodic redetermination of blindness.

When processing applications involving determination of blindness, it is important for the CM to keep in mind the period under consideration. If the applicant is requesting assistance for the retroactive period under consideration and indicates the existence of the impairment during that period, the required medical and social information must be collected for the retroactive period. The medical form specifying blindness must be completed and used to report information to the SRT and the State’s reviewing ophthalmologist. This form may be supplemented by any additional medical statements or reports submitted by the examining practitioner. Payment may be made to the customer’s ophthalmologist or optometrist, through issuance of a vendor payment, for completion of the medical form at the time of the customer’s MA application and at a scheduled review. Re- examinations for periodic redeterminations’ of blindness will be conducted according to the Procedure for Determination of Blindness. The LDSS or other entity determining MA eligibility shall accept the Social Security Administration’s determination of blindness for a person receiving a Social Security benefit based on blindness. (c) Disability Determination To be eligible for Medical Assistance as disabled in an Aged, Blind or Disabled (ABD) coverage group an applicant shall meet the definition of “disabled.” “Disabled’ is defined as the inability to engage in any substantial gainful activity due to any medically determinable physical or mental impairment which is expected to result in death, or which has lasted or is expected to last for a continuous period of not less than 12 months. Applicants must also meet all other technical and financial requirements. That includes the requirement that the applicants apply for and take all other necessary steps to obtain and accept all income benefits to which he or she may be entitled. Therefore, all applicants must be referred to the Social Security Administration (SSA) to apply for income benefits. Acceptable proof that an applicant has made an SSA application(s) will be discussed later in this Section.