Page 1494

West Virginia Income Maintenance Manual Chapter 18

West Virginia Income Maintenance Manual Page 76 Chapter 18 WV WORKS Activities/Requirements

referral. This amount is $5,000 and is shown as the balance following Dental Services. Vision Services are limited to an exam, one pair of frames, and lenses for the first year, and an exam and lenses every other year following. After a referral expires, the Case Manager may issue the participant another one, provided the participant meets eligibility criteria as explained below and has not received the maximum allowable benefit. On a second or subsequent referral for dental services, regardless of the date of the first referral, the Case Manager must obtain the amount of the remaining balance by contacting OMCFH and. enter it on the DFA-R-1. Vision referrals may be made annually for qualified individuals. OMCFH has signed agreements with service sites which detail the allowable services, reimbursements, scope of services, etc. In addition, OMCFH will provide a list of all providers to the appropriate county. The participant may choose his own provider from this list and must make his own appointments. There is a maximum lifetime limit on the payment for these services. This limit is monitored by OFMCH. Closure of the vision and/or dental services case by OFMCH occurs when services are completed, or the maximum allowable benefit is reached. An appropriate notice is sent to the local office to file in the case record. To be eligible to receive vision and/or dental services, the participant must be in either of the two following groups, described below. 18.7.15.A Participating To qualify based on participation in an activity, the participant must meet both of the following requirements: • The participant must be a Work-Eligible Individual in an active WV WORKS case, Poverty Level (PL) period, or EAP participant, when the referral is made. Receipt of Diversionary Cash Assistance (DCA) does not qualify the individual for these services. Once the referral is made, it is valid for one year whether or not the WV WORKS case remains open or is sanctioned; and • The individual is participating in an activity listed in Sections 18.10 through Section 18.18. The participation rate required to qualify for these services is the rate shown on the individual’s SSP. 18.7.15.B Sole Barrier to Participation