207.01 Verification: ANB (AAM)

207.01 Verification: ANB (AAM)

SR 15-18 Dated 04/15 Previous Policy

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Verify blindness at the initial eligibility determination and verify the Disability Determination Unit (DDU) approval still exists at subsequent redeterminations.

For ANB financial determinations, send the following form when forwarding the request to DDU:

• DDU Form 901, Report of Eye Examination , completed by a licensed ophthalmologist or optometrist.

Additional verification may include any of the following:

• medical records, provided they are no older than 2 years;

• any additional material which may bear on the decision; or

• supplemental information requested by DDU, such as additional evaluations, consultations, or second opinions.

Note: A completed BFA Form 770, Reimbursement Agreement and Acknowledgment , (including all required signatures, dates, and notarized) must be received prior to financial assistance being approved.

References : He-W 601.01; He-W 642.04; RSA 167:6,IV; RSA 167:28