Adult is an individual who is 19 years of age or over or an individual who is an emancipated minor.
Affidavit of Support is a statement of a sponsor’s income, resources, and willingness to support an alien. The statement is filed with the BCIS (Bureau of Citizenship and Immigration Services) by a U.S. resident who sponsors an alien seeking admission to the U.S. as a permanent resident.
Age Restrictions refers to the restrictions placed on the frequency of the provision of eye care services by age. If the a/r is 25 years old or older, then refractions and eye glasses are restricted to one every two years. However, if the a/r is under age 25, then refractions and eyeglasses are restricted to one per year.
Agency refers to the Division of Services for the Blind.
Alien is an individual who enters the United States without knowledge of the U.S. Bureau of Citizenship and Immigration Services.
Alimony is a court-ordered payment by a spouse or former spouse received by the a/r, or financially responsible person.
Aphakia is the absence of the eye’s crystalline lens, e.g., after cataract extraction.
Appeal is a request from an applicant/recipient for a hearing to review an action of DSB when the a/r is dissatisfied with the decision in his/her case.
Applicant/Recipient (A/R) is an individual who signs under penalty of perjury a written application for assistance through the Medical Eye Care Program or on whose behalf a written application is made by an authorized representative.
Authorization is the automated form issued when the applicant is found to be eligible for MEC services. The initial authorization is issued by the local issuing agent (if computer access is available) and then the recipient takes the form to the provider that he/she has chosen during the application process. Follow-up authorizations must be issued by the NECC in the DSB District Office. The authorization is valid for a six- (6) month period from the date of issue.
Authorized Representative is any individual who is legally bound or designated in writing to act on behalf of the applicant/recipient.
Award Letter is a statement to an individual from a government or private agency indicating benefits for which he/she is eligible.
Blepharitis is the inflammation of the eyelids, usually with redness, swelling and itching. It has many causes, e.g., infection or allergy.
Blindness is legally defined as the best-corrected visual acuity of 20/200 or less or reduction in the visual field to 20 degrees or less in the better-seeing eye.
Case Number is a number assigned to a case by a county department of social services.
Case Record is a file containing the application and all documents verifying initial and continuing eligibility.
Cataract is a pathologic condition characterized by opacity or cloudiness of the crystalline lens, which may prevent a clear image from forming on the retina. Surgical removal of lens may be necessary if visual loss becomes significant, with lost optical power replaced with an intraocular lens, contact lens or aphakic spectacles. May be congenital or caused by trauma, disease, or age.
Certificate for Fitting/Dispensing Eyeglasses is the form generated to show that the recipient is eligible for the provision of eyeglasses if it is a service being sponsored by the Medical Eye Care Program subject to available funding. The certificate is then taken by the recipient to the provider that he/she has chosen during the application process. It is valid for a six- (6) month period from the date of issue.
Certificate of Deposit is a written acknowledgment between a depositor and a financial institution including a promise to pay the depositor plus interest. There is usually a penalty if the funds are withdrawn early.
Certification Period is the six-month eligibility period for the MEC Program.
CHAMPUS is Civilian Health and Medical Program of the uniformed Services.
Change in Situation is a change in an a/r’s circumstances that may affect eligibility for assistance.
Change in Income is an acquired source of income, a change in rate or pay that will continue (not fluctuating income), or a termination of income.
Child is an individual 0 through 18 years of age and not an emancipated minor.
Child Support is money paid or in-kind goods given by a parent for the child’s support and care.
Choice of Provider allows the recipient of MEC services to choose the provider for MEC services whom he/she desires as long as the provider is one who contracts with the MEC Program.
Citizen is one of the following: (1) any person born in one of the 50 states, the District of Columbia, Puerto Rico, Guam, Virgin Island, Northern Mariana Islands, American Samoa, Swain’s Island or (2) any person born outside the U.S. to a U.S. citizen, or (3) a person born outside the U.S. who has been approved by the United States Citizenship and Immigration Services (USCIS) as a naturalized citizen, or (4) a person born outside of the U.S. who was under the age of 18 on February 27, 2001, and meet the following criteria: (a) Had at least one (1) U.S. Parent (by birth or naturalization), and (b) while under the age of 18 s/he resided permanently in the U.S. in the legal and physical custody of the U.S. citizen parent, and (c) was a lawful permanent resident before age 18. Citizenship does not begin any earlier than February 27, 2001. Please note that 4. a. - c. also applies to an adopted child who meets the requirements applicable to adopted children under immigration law. (5) A National of the United States.
Collateral Contact is a person who can substantiate or verify information.
Conference is held at the request of an a/r when he/she is dissatisfied with DSB’s action in his/her case. He/she may request a conference with the Chief, Independent Living and Medical Eye Care Services by completing DSB-7219. The conference will be held within reasonable proximity to the a/r and within 15 working days from the receipt of the original request.
Confidentiality refers to the safeguarding of the a/r’s information.
Conjunctivitis, “Pink Eye” is the inflammation of the conjunctiva (mucus membrane that covers white of eye and inner eyelid surfaces). It is characterized by discharge, grittiness, redness and swelling. It is usually viral in origin and may be contagious.
Consumer is an individual applying for or receiving services from DSB.
Contact Lens is a small plastic disc containing optical correction and it is worn on the cornea or sclera to correct refractive errors or to protect the cornea.
Contribution is a donation of cash or in-kind made by an individual to or on behalf of an a/r.
Copayment is the $5 payment that a recipient of MEC Services must pay on an initial visit for an eye examination (and if the agency is sponsoring eyeglasses subject to available funding then there would be a $5 payment for eyeglasses if prescribed).
Countable Income is the income of an a/r after deductions and exemptions.
Counting Fingers is a measurement to test the individual’s ability to count numbers of fingers presented, usually at a distance of 1 to 2 feet. This is usually administered when vision loss is profound (acuity less than 20/400).
County DSS refers to the county department of social services, the local agency that determines Medicaid eligibility and eligibility for other assistance programs and provides many services in the county.
Deductibles result when the countable income of the family members exceeds the established income or maintenance level for the number of persons in the family unit. This is sometimes referred to as a “spend down.”
Deductible Balance is the amount of the deductible remaining to be met on the date Medicaid is authorized and which the applicant/recipient is responsible to pay.
Denial is a determination that the applicant is not eligible for benefits.
Dependent is an individual who is financially dependent upon another for his/her well being as defined by the MEC Program definition of the family unit.
Diabetic Retinopathy is a pathologic condition that involves a spectrum of retinal changes accompanying long-standing diabetes mellitus. The early stage is background retinopathy (non-proliferative). It may advance to proliferative retinopathy, which includes the growth of abnormal new blood vessels (neovascularization) and accompanying fibrous tissue.
Diagnosis Related Groupings (DRG) pertains to Medicare and Medicaid reimbursements to general hospitals based on DRG’s, a set fee based on the hospital’s classification and the patient’s diagnosis. The fee paid may be greater than the actual charge for the specific procedure provided. The hospital accepts the DRG fee as payment in full. The patient may not be billed if the fee paid to the hospital is less than the actual charge. Conversely, the patient may not receive a credit for any excess if the DRG fee paid to the hospital is greater than the actual charge. The patient would be responsible only for the Medicare part A or Medicaid deductible.
Disability is defined by the Social Security Administration (SSA), as a physical or mental impairment of such a severity that it prevents an individual from engaging in substantial gainful activity (or for a child under 18, an impairment of comparable severity) for at least a year or is expected to result in death.
Disabled Adult Child is an individual who is blind or permanently and totally disabled who is unable to become self-supporting after the age of 18.
Distance vision is a measurement of visual acuity with the target at 20 feet (approximately 6 meters), the optical equivalent of an “infinite distance.”
Dividends are shares of profits received by a stockholder or by a policyholder in a mutual fund interest.
Documentation is the recorded verifications filed in the case record and is used to substantiate eligibility for services.
Earned Income is money received as a result of employment.
Effective Date is the first day of the authorization period for the MEC Program.
Emancipated Minor is a child who is no longer legally dependent upon their parents/guardians, due to marriage, etc.
Enucleation is a surgical procedure for the removal of the eyeball, leaving eye muscles and remaining orbital contents intact.
Epikeratophakia (EKF) is a surgical procedure where a preserved lathe-cut corneal disc is inlayed to the corneal surface, used for correcting refractive errors. A review of the request for payment for this procedure must be made by the State Consulting Ophthalmologist and is only considered in very unusual circumstances.
Exude is defined as to ooze out or to undergo diffusion. Retinal exudates is defined as protein or fatty fluid that leaks from blood vessels into retinal tissue.
Family is defined as the basic unit consisting of one or more adults and children, if any, related by blood, marriage, or adoption, and residing in the same household. Included in the family unit are its children age 18 through 22 that are listed on the family’s income tax return as dependents. Where related adults (other than spouses) or unrelated adults reside together, each is considered a separate family.
Fluorescein Angiography (FA) is a test used to evaluate retinal, choroidal and iris blood vessels, as well as any eye problems that might affect them. Fluroescein Dye is injected into a vein in the arm, and then rapid, sequential photographs are taken of the eye as the dye circulates. The phases are as follows: (1) during the arterial phase the retinal arteries fill with dye; follows a choroidal flush’ (2) a choroidal flush is the first evidence of fluorescein dye reaching the eye; occurs 5 to 15 seconds after the injection; (3) the venous phase occurs when the retinal veins fill with dye before the fluorescence fades. The Last phase; follows the arterial phase.
Forgery is signing someone else’s name without proper authorization.
Fraud is a criminal act in which an a/r or authorized representative makes a false statement and/or withholds information willfully, knowingly, and with deceitful intent and, as a result, obtains or attempts to obtain assistance for which he/she is not eligible.
Glaucoma is a group of diseases characterized by increased intraocular pressure resulting in damage to the optic nerve and retinal nerve fibers. It is documented by typical visual field defects and increased size of the optic cup. It is a common cause of preventable vision loss that may be treated by prescription drugs or surgery.
Gross Income is the total income before deductions.
Guardian is a person appointed by a court to legally be in charge of the affairs of a minor, or of someone incapable of taking care of their own needs. There are three (3) types of guardians:
1. The Guardian of the Person takes care of an individual’s personal needs, but has no authority to access resources of the individual.
2. The Guardian of the Estate takes care of the resources belonging to the individual.
3. A General Guardian is a both a guardian of the person and a guardian of the estate. The guardian can access the individual’s assets.
Hand Motion (HM) is a measurement used to test an individual’s ability to see the movement of a waving hand at a specified distance, usually 1 foot or less. This term is used when vision loss it too profound for counting fingers.
Hearing is a review requested by an a/r to establish whether an adverse action taken by DSB was correct. See appeal.
Homeless is an individual who lacks a permanent or fixed residence.
Hyperopia, Farsightedness, Hypermetropia are terms for the focusing defect in which an eye is underpowered. Thus the light rays coming from a distant object strike the retina before coming to sharp focus; true focus is said to be “behind the retina.” This refractive error is corrected with additional optical power, which may be supplied by a plus lens (spectacle or contact) or by excessive use of the eye’s own focusing ability (accommodation).
Illegal Aliens are individuals who have not been lawfully admitted for permanent residence to the United States. These aliens may be known or unknown to the Bureau of Citizenship & Immigration Services of the Department of Homeland Security (formerly the Immigration and Naturalization Service or INS) but are not in a satisfactory status with the Bureau of Citizenship & Immigration Services.
Income is cash or in-kind resources received for labor, services, government or private benefits, or any money available to the a/r and his/her family unit for their maintenance.
Incur means to become liable for, regardless of whether the expense is paid or expected to be paid by insurance, including Medicare, or some other resource.
Incurred medical expense means a charge for a medical service provided to an individual regardless whether it is paid or unpaid. The expense may be applied to the Medicaid deductible if it will not be reimbursed.
*In-kind income is non-monetary assistance such as food, shelter, or something the individual can use or convert to obtain food or shelter (which includes utilities, heating fuel and property taxes). See Support from Family and Friends.
Insurance is coverage by contract whereby one party undertakes to indemnify or guarantee another against loss by a specified contingency or peril.
Iridotomy is a surgical procedure; a puncture-like opening is made through the iris without the removal of any of the iris tissue. This allows the aqueous to drain freely from the posterior chamber to the anterior chamber.
Itemized deduction is an amount for payroll expenses (includes federal income taxes, state income taxes, Social Security also known as FICA, and Medicare taxes) that must be paid or incurred by the applicant/recipient or a current budget unit member (defined as persons whose income and resources are considered in the determination of eligibility for an individual or family group).
Investigation is a thorough examination and verification of all eligibility factors.
Keratoconus is a degenerative corneal disease affecting vision. It is characterized by generalized thinning and cone-shaped protrusion of the central cornea, usually in both eyes. It is a hereditary disease that becomes apparent during the second decade of life.
Keratomileusis, is a refractive surgical procedure that reshapes a portion of the cornea to change its optical power. A disc or cornea is shaved off, quickly frozen, lathe-ground to flatten its front surface, and then returned to its original position. It is used for correcting very high refractive errors, especially myopia. A request for approval for payment by the MEC Program must be reviewed by the State Consulting Ophthalmologist and will be considered only in very unusual circumstances.
Keratophakia is a refractive surgical procedure where a preserved lathe-cut donor corneal disc is inserted into the cornea. It is used for correcting high degrees of farsightedness (hyperopia). The request for approval for this procedure to be paid by the MEC Program must be reviewed by the State Consulting Ophthalmologist and will be considered only in very unusual circumstances.
LASEK (LASer Epithelial Keratomilusis) is a refractive surgical procedure which reshapes the cornea to change its optical power. This procedure merges features of LASIK and PRK. Instead a microkertome (a surgical instrument used for dissecting (shaving) a precise thickness of tissue from the corneal surface) and diluted alcohol is used to loosen epithelium, which is folded back. A computer-controlled excimer laser reshapes the exposed corneal surface, then the epithelium is returned to normal position. This procedure corrects myopias, hyperopias, and astigmatism, especially in thin corneas.
Laser Therapy is defined in the Current Physicians Terminology Manual (CPT) as a repetitive service often performed in multiple sessions or groups of sessions provided within a defined treatment period. The NECC makes decisions on some requests for laser therapy but there are other requests that must be reviewed by the State Consulting Ophthalmologist. See page 21 for a list of those that may be approved by the NECC.
LASIK (Laser in Situ Kertomileusis) is a method of refractive surgery that reshapes the cornea to change its optical power. A flap of the cornea is cut with an automated microkeratome (a surgical instrument used for dissecting (shaving) a precise thickness of tissue from the corneal surface) and folded back, then a computer-programmed excimer laser reshapes (sculpts) the exposed surface of the corneal tissue. The flap is replaced without suturing. It corrects myopia, hyperopia, and astigmaticism. The MEC Program does not sponsor LASIK surgery (or does not pay for this procedure).
Lawful Permanent Resident (LPR) is an alien who is legally admitted to the U.S. by the Bureau of Citizenship and Immigration Services to live and work on a permanent basis. The majority of qualified aliens are LPR’s, and are often referred to as a “resident alien.”
Legal Representative is a person acting for and legally authorized to execute a contract for an individual. If the individual has been adjudicated incompetent, the legal representative must be either a guardian of the estate, a general guardian, or hold the stated individual’s power of attorney.
Legal Temporary Residents are aliens who have applied for legalization and been granted lawful temporary resident status (LTR) and eventually granted lawful permanent residence.
Light Perception (LP) is a measurement, the lowest level of visual acuity, which denotes an individual’s ability to distinguish light from dark. This term is used when vision loss is profound. Local Issuing Agent is either the county DSS staff or the local DSB staff.
Low-Vision Aids (LVA) are optical devices that have high-powered lenses and telescopes with high magnification, to help individuals who have poor vision.
Macular Degeneration (ARMD, AMD), Age-Related or Senile Macular Degeneration is a group of conditions that include deterioration of the macula, resulting in a loss of sharp central vision. There are two general types: “dry”, which is usually evident as a disturbance of macular pigmentation and deposits of yellowish material under the pigment epithelial layer in the central retinal zone; and “wet” (sometimes called Kuhnt-Junius disease), in which abnormal new blood vessels grow under the retina and leak fluid and blood (neovascularization) further disturbing macular function. It is the most common cause of decreased vision after age 50.
Migrant Farm Worker is a person who moves with the migrant stream in order to follow seasonal farm work employment and does not return to his/her permanent home each night.
Military Allotments are benefits received by dependents of military personnel.
Minor refers to an individual who has not attained majority either by age or emancipation. North Carolina law states that when a person becomes 21 years old, he/she is automatically emancipated and becomes an adult. However, for the MEC Program, a child 18 through 22 who is listed as a dependent on the family’s income tax return, would still be included in the family unit.
Multifocal Lens is an eyeglass lens that incorporates more than one optical power, which permits focusing at different distances.
Myopia, Nearsightedness is a refractive error, a focusing defect in which the eye is overpowered. Light rays coming from a distant object are brought to focus in front before reaching the retina. Myopic individuals are able to see close-up objects clearly but distance vision is blurry. This condition requires a minus lens correction or refractive surgery to “weaken” the eye optically and permit clear distance vision.
Near Vision is a measurement of visual acuity measured with the target at 16 inches (approximately 40 centimeters) corresponding to normal reading distance.
Net Income is the income allowed after deductions.
Net Profit is the income (minus expenses) received from self-employment, farming, rental income, or small business.
Non-immigrant Aliens (temporary residents) are aliens who are not permanently residing in the U.S. These aliens are lawfully admitted but only for a specified period of time, such as foreign students, and are in satisfactory status with the Bureau of Citizen and Immigration Services.
Nuclear Sclerosis is a type of cataract characterized by increasing hardness or density at the center of the eye’s crystalline lens. It usually results in a refractive change toward increasing myopia and it occurs with aging.
Nursing Eye Care Consultant (NECC) is the individual in the DSB District Offices who has the supervisory responsibilities for the Medical Eye Care Program. She/he must give prior approval for eye surgery or obtain the approval of the State Supervising Ophthalmologist for certain requests. Also, approval must be given for the purchase of eyeglasses if the service is being provided by the agency and special requests for more frequent examinations. In addition, the NECC does low vision evaluations in consumers’ homes, and conducts video magnification evaluations in the District Office, (Delete screens for glaucoma,) screens pre-school children and performs vision screenings at health fairs.
Nystagmus, Jerk Nystagmus is the involuntary, rhythmic side-to-side or up and down (oscillating) eye movements that are faster in one direction than the other.
OCT (optical coherence tomography) is a test that uses a computerized instrument that creates a magnified cross-section of the transparent parts of the eye. The test is particularly useful for evaluating the retina: thickness, regularity, macular holes, and vitreous strand adherence.
Ocularist is a person who makes and fits ocular prostheses (cosmetic “false eyes”).
Ophthalmologist is a medical specialist, a physician (MD) who specializes in diagnosis and treatment of refractive, medical and surgical problems related to eye diseases and disorders.
Optician, Dispensing Optician is a vision care specialist. This professional makes and adjusts optical aids, e.g., eyeglass lenses, from refraction prescriptions supplied by an ophthalmologist or optometrist.
Optic Nerve is the second cranial nerve and the largest sensory nerve of the eye. It carries impulses for sight from the retina to the brain.
Optic Neuropathy is the non-inflammatory abnormality or degeneration of the optic nerve.
Optometrist is a vision care specialist, a Doctor of optometry (OD) who specializes in vision problems, treating vision conditions with spectacles, contact lens, low vision aids and vision therapy, and prescribing medications for certain eye diseases.
Orthotics is the discipline dealing with the diagnosis and treatment of defective eye coordination, binocular vision, and functional amblyopia by non-medical and non-surgical methods, e.g., glasses, prisms, exercises. All requests for these services must be reviewed by the State Consulting Ophthalmologist.
Peripheral vision or “side vision” is elicited by stimuli falling on areas of the retina distant from the macula.
Perjury is the voluntary violation of an oath or vow by swearing to what is untrue or by omission to do what was promised under oath. A signed application is a signed oath.
Photodynamic therapy (PDT) is a two-step surgical procedure for treating neovascularization (abnormal new blood vessels) associated with Age-Related Macular Degeneration (AMD). First, a dye (verteporfin) that concentrates in the neovascular blood vessels is injected into a vein in the arm. A few minutes later, the blood vessels are treated with a laser to close them off. Treatment often needs to be repeated.
Photocoagulation is the application of a laser beam to burn or destroy selected intraocular structures, e.g., abnormal blood vessels or tumors, or to create new fluid passages.
Pinhole (ph) is an opaque disc test instrument that has one or more holes ranging in diameter from 0.5 milimeters to 2 milimeters in diameter. The patient looking through the hole with one eye (the other eye is covered) will improve their vision if the reduced vision is caused by an optical defect or refractive error.
Power of Attorney (POA) is an individual(s) authorized by a competent adult to manage his/her affairs. The scope of the POA’s authority may be broad or narrow as specified in the official document. Both general and durable POA’s serve as attorneys in fact to act in legal matters. The POA ends when the adult dies or when the competent adult revokes authority. North Carolina law recognizes three types of Powers of Attorney:
1. General Power of Attorney-Authority ends when adult becomes incompetent.
2. Durable Power of Attorney-Authority continues after the adult becomes incompetent or may be drafted in advance to begin only when the adult becomes incompetent.
3. Health Care Power of Attorney- Authority is limited to decisions regarding the adult’s health and medical care.
Presbyopia is a refractive error, diminished power of accommodation arising from the elasticity of the crystalline lens and/or loss of the ciliary muscle function, that occurs with aging and usually becomes significant after the age of 45. The condition may also be caused by such diseases as hypothyroidism and glaucoma.
PRK (photorefractive keratectomy) is a surgical procedure that uses a computer-controlled excimer laser to reshape the corneal curvature (changing its optical power) after the surface layer of the cornea (epithelium) is removed by gentle scraping. This procedure corrects myopia and and hyperopia. The MEC Program does not sponsor this procedure.
Prism is an optical device that is a wedge-shaped, transparent medium that bends rays toward its base and does not docus.
Prism diopter is a unit of measure that indicates prism strength and defection of a light ray by 1 centimeter at a distance of 1 meter.
Private Disability or Unemployment Benefits includes benefits paid by private insurance plans for incapacitated/unemployed persons.
Proceeds are the income earned on the principal of the trust or other investments.
Proliferative (Diabetic) Retinopathy (PDR) is a severe retinal blood vessel disease that may accompany advanced diabetes or other retinal blood vessel diseases (e.g., retinal vein occlusion, sickle cell disease). Findings include formation of abnormal new blood vessels (neovascularization) and/or fibrous tissue growing on retinal surface, later extending into the vitreous. Leads to vitreous hemorrhage, retinal traction and detachment, and visual loss.
Protective Payee is a substitute payee appointed when the beneficiary recipient mismanages SSI or SSA benefits or fails to comply with program regulations. Also referred to as a Representative Payee.
Provider describes a licensed health care professional or facility enrolled with Medicaid or the Medical Eye Care Program to provide health care services to recipients. The term also refers to medical supply firms and vendors of durable medical equipment.
Pseudophakia is the state of having an intraocular lens implant taking the place of the eye’s natural lens.
Public Institution is an institution that is the responsibility of a governmental unit or over which a governmental unit exercises administrative control (e.g. state mental hospital, prison, etc.).
Qualified Alien is an individual who lives in the U.S. but has not been lawfully admitted for permanent residence in the United States. The individual may be known or unknown to the Bureau of Citizenship & Immigration Services of the Department of Homeland Security (formerly the Immigration and Naturalization Service or INS) but are not in a satisfactory status with the Bureau of Citizenship & Immigration Services.
Radial Keratotomy (RK) is a surgical procedure where a series of spoke-like (radial) cuts (usually 4-8) are made in the corneal periphery to allow the central cornea to flatten, reducing its optical power and thereby correcting nearsightedness. The MEC Program does not sponsor this procedure.
Reapplication is a subsequent application when eligibility for the MEC Program has expired, or the application was denied, or withdrawn.
Recipient refers to a person authorized for Medical Eye Care Program coverage.
Refraction, as it relates to optics, is the bending of light rays as they travel from a clear medium of one density to another of different density. In relation to the test in the professional’s office, refraction is the determination of an eye’s refractive error and the best corrective lenses to be prescribed. A series of lenses in graded powers are presented to determine which provide sharpest, clearest vision. A prescription for eyeglasses or contact lenses is the result of the testing when an error is found.
Regular Employment is employment, either full-time or part-time, on a permanent or temporary basis.
Representative is any individual who alleges that he is acting in behalf of an applicant/recipient. This is not the same as a substitute payee.
Reserve is cash or its equivalent (liquid assets) and/or real property (non-liquid assets), which are currently available (or in 20 days) to an a/r.
Resident is a person who is in North Carolina voluntarily with intent to remain and is not an illegal alien or he/she is a migrant worker temporarily in North Carolina for purposes of employment and is not an illegal alien. The migrant worker must present a "Green Card” (which is not green) for verification. This “Green Card” or Permanent Resident Card is the I-551 or the I-94 with a temporary I-551 stamp.
Resource is the cash, stocks, bonds, property or other assets owned by the a/r.
Retinal Degeneration is the deterioration or change of tissue in the retina to a lower or less functionally active form.
Retinitis Pigmentosa (RP) is a progressive retinal degeneration in both eyes. Night blindness, usually in childhood, is followed by loss of peripheral vision (initially as ring-shaped defect), progressing over many years to tunnel vision and finally blindness. It is a hereditary condition.
Safety Lens are eyeglass lenses that have been treated with heat, chemicals, or lamination to resist breakage and splintering from a direct blow.
sc (without correction) signifies the individual was not wearing corrective lenses or contact lenses while their vision was tested.
Seasonal Employment is employment that is engaged in for a portion of the year and at a predictable time each year. The employment may cover a few weeks or several months.
Self-Employment is income earned from a business enterprise or trade controlled by one’s self; e.g., produce sales, farm rental, farming, craft sales, baby-sitting in one’s own home.
Self-Supporting is maintaining one’s self without financial assistance from others.
Slit Lamp or Biomicroscope is a table-top microscope used for examining the eye. The instrument allows the cornea, lens, otherwise clear fluids and membranes to seen in layer-by-layer detail. This is one of the most important of the ophthalmic instruments that has a low magnifying power (6x to 40x) with a light source that projects a rectangular beam that can be changed in size and focus.
Snellen Chart is a test chart for assessing visual acuity. It contains rows of letters, numbers, or symbols in standardized graded sizes with a designated distance at which each row should be legible to a normal eye. An individual is usually tested at 6 m (20 ft.).
Spouse is an individual who is married to another person.
State Data Exchange (SDX) is a computer file listing the amount of an individual’s Supplemental Security Income benefits and which also reflects Social Security amounts for individuals who receive both SSI and Social Security. This file is available as an on-line inquiry through EIS.
Stocks are certificates of ownership of shares of a corporation entitling the holder to dividends and other rights of ownership.
Substantiate refers to verification of information alleged by the applicant/recipient/representative.
Suspected Fraud is the belief that fraud may have been committed.
Trabeculectomy is a surgical procedure that removes part of the trabecular meshwork to increase the outflow of aqueous from the eye. This procedure is a type of filtering procedure used in the treatment of glaucoma.
Trabeculoplasty (laser) is a surgical procedure that applies a laser beam to selectivity burn the trabecular meshwork area, to lower intraocular pressure. This procedure is used to treat open-angle glaucoma.
Third Party Recovery (TPR) refers to the responsibility of an individual, institution, corporation, or public or private agency to pay for all or part of medical costs of an a/r.
TRICARE is the Department of Defense program supporting private sector care for military dependents. The program was formerly named Civilian Health and Medical Program of the Uniformed Services (CHAMPUS).
Trust is a legally binding agreement regarding assets or income held by one party for the benefit of another.
Trustee is an individual(s) or entity (such as bank or insurance company) that manages and administers the trust for the beneficiary.
Tonometry is a test that measures the intraocular pressure in the eye.
Ultrasound is a test to evaluate the transmission of high frequency sound waves into the eye, which are reflected by the ocular tissues and displayed on a screen so that internal structures can be visualized. The test permits intraocular distance measurements and aids in diagnosis of eye and orbital problems.
Uncorrected visual acuity (UCVA) is the vision measurement obtained without using an optical aid.
Unemployment Insurance (UI) is a benefit check received by a budget unit member who has stopped work.
Unearned Income is money received from any source other than earned income.
Uveitis is the inflammation of any structures of the uvea (pigmented vascular layers of the eye such as the iris, ciliary body, choroid which contains most of the intraocular blood vessels).
Verification is the confirmation of facts and information used in determining eligibility.
Video magnification (formerly Closed Circuit Television (CCTV) and move the definition to Video is a magnification system that increases the size of printed material or any object that is placed on the sliding table and under the camera. Then the enlarged image is displayed on the monitor. Portable models are available, color or black and white is an option, and many models allow use of a regular television monitor.
Visual acuity is a measurement of the assessment of the eye’s ability to distinguish object details and shape, using the smallest identifiable object that can be seen at a specified distance (usually 20 feet or 16 inches).
Visual Field is the full extent of the area visible to an eye that is fixating straight ahead. It is measured in degrees from fixation.
Vitrectomy is a surgical procedure that removes the vietreous, blood and/or membranes from the eye, using a needle-like cutting device that has suction and fluid injection capabilities.
Wages/Salary is the compensation paid regularly for services rendered.
Worker’s Compensation is the benefit that results from the loss of employment due to injury on the job.
YAG Laser is a laser that produces a short pulsed, high-energy light beam to cut, perforate, or fragment tissue.
20/20 is normal visual acuity. The upper number is the standard distance (20 feet or 6 meters) between the eye being tested and the eye chart; the lower number represents the eye tested can see the same small standard-sized letters or symbols as a normal eye at 20 feet.
Dictionary of Eye Terminology, Fifth Edition by Barbara Cassin and edited by Melvin L. Rubin, M.D. was utilized as a resource.
North Carolina Division of Medical of Assistance Adult Medicaid Manual http://info.dhhs.state.nc.us/olm/manuals/dma/abd/man/
Medicaid (Title XIX) is the program authorized by the Social Security Act to provide health care services to persons who are categorically and income eligible. Federal, state and county funds finance North Carolina Medicaid. Individuals eligible for Medicaid are generally not eligible for services through the MEC Program.
Medicaid Deductible is the amount of medical expenses for which the individual is responsible before Medicaid will pay for a covered service. Also called spend down.
Medicaid ID Card (MID Card) is the card issued annually to identify individuals eligible for Medicaid coverage. The cards will be printed on gray card sock. The effective date of this change may be as early as 9-8-09. The cards will no longer be blue, pink, buff, or green with each color denoting a certain type of coverage. The card has the recipient’s name if an adult, the MID number, current eligibility, the Medicaid benefit category, and other insurance information. The changes mean the MID card will no longer serve as proof of recipient eligibility, and at each medical visit the provider will have to verify their eligibility.
1. Baby Love is a Medicaid program aimed at reducing infant mortality by improving access to health care and support services for low-income pregnant women and young children. The extended coverage for pregnancy women is called Medicaid for Pregnant Women (MPW) and provides pregnancy-related care. The extended coverage for children allows the child to receive all Medicaid benefits. Maternity care coordination is a key aspect of Baby Love. Pregnant women eligible for MPW benefits are not covered for routine eye care or glasses Special consideration can be given to recipients referred by a medical doctor due to complications of pregnancy.
2. Breast and Cervical Cancer Medicaid is a program of medical assistance for enrolled women and screened for breast and cervical cancer through the Breast and Cervical Cancer Control Program. Women in this program are not covered for routine eye care or glasses.
3. Carolina ACCESS is a Medicaid program created to improve recipient access to primary care. Medicaid contracts with primary care physicians to deliver and coordinate health care. The primary care physician becomes the recipient’s “care coordinator” for the delivery or arrangement of needed services.
4. Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) or Medicaid for children is administered under the name Health Check in North Carolina. Services, products or procedures requested by physicians and licensed clinicians for Medicaid recipients under the age of 21 are provided if the service is medically necessary health care to correct or ameliorate a defect, physical, or mental illness, or a condition identified by a screening examination. Services provided include periodic screening, vision, dental, and hearing services.
5. Regular Medicaid benefits are issued to those persons eligible under regular Medicaid eligibility requirements. There are three different types of options: (1) Full Medicaid covers eye refractions and visual aids. Prior approval is required for visual aids (such as glasses). (2) HMO services are covered in the plan and are billed to the HMO directly. (3) Medicaid recipient enrolled in Carolina ACCESS are not required to obtain their primary care physician’s approval for an eye care provider to perform an eye refraction and supply glasses. These services are subject to all Medicaid guidelines, limitations, and prior approval criteria.
6. Medicaid Family Planning Waiver (FPW) is a program for men age 19-60 and women 19-55 to receive family planning services.
7. Medicaid for Pregnant Women (MPW) is a part of the Baby Love program, which extends Medicaid coverage for pregnancy-related services to low-income pregnant women who have income and resources that exceed the limits for regular Medicaid coverage. There are three different types of benefits: MID Card-MPW, MID Card-HMO, and MID Card-Carolina ACCESS. Pregnant women covered for MPW benefits are not covered for routine eye care or eye glasses with any of the three cards. However, special consideration can be given for conditions that are due to complications of pregnancy. See Baby Love.
8. Medicaid for Working Disabled/Blind workers is being provided in North Carolina under the Health Coverage for Workers with Disabilities Act (HCWD). This coverage provides an incentive for persons with disabilities to go to work or to increase their hours of work while protecting their Medicaid eligibility. This program covers individuals 16-64. Recipients are entitled to full Medicaid coverage under MAB (Medicaid to the Blind) or MAD (Medicaid to the Disabled).
9. MQB: A Medicaid ID card issued to those persons eligible for Medicare-Aid, a type of Medicaid, which qualifies them for payment of some Medicare-covered services. The holders of this card are Medicare Qualified Beneficiaries (MQB). No payment of straight Medicaid claims is allowed and Medicare does not cover eye refractions or non-aphakic visual aids (such as glasses). Therefore, these services are not covered by Medicaid for MQB recipients. Co-payments and deductibles for Medicare-covered services will crossover to Medicaid for payment. Advise MQB recipients that they are potentially eligible for assistance from the Medical Eye Care Program for a basic eye exam/refraction. See MQB.
Spend Down –See Medicaid Deductible.
Medicare is a program of health insurance for aged and disabled individuals who meet the program’s eligibility requirements. It is Title XVIII of the Social Security Act.
Approved amount in Medicare claims is the portion of the medical charge that Medicare approves as reasonable. Medicare pays 80% of the approved amount.
Assignment for Medicare is the medical provider’s agreement to accept Medicare’s approved amount. Medicare pays the provider directly and the provider may charge the patient only the 20% coinsurance. Providers must accept the Medicare assignment if they bill Medicaid for the 20% coinsurance.
Low Income Subsidy is a program that provides additional assistance for Medicare beneficiaries with less than 150% of the FPL (Federal Poverty Level) for the Medicare Part D Program. See also Medicare Qualified Beneficiaries.
Medicare D provides prescription drug coverage for all Medicare beneficiaries. The Low Income Subsidy is part of this program. See www.medicare.gov for more details and plan options.
Medicare Medical Health Savings Account (Medicare Advantage) (MHSA) are annual Medicare deposits into an interest-bearing account to help the plan member cover their health care costs until the deductible is met. The accounts are linked too high deductible health insurance policies, and these plan account funds are a countable resource for Medicaid purposes.
Medicare Qualified Beneficiaries (MQB or Medicare uses QMB) is Medicaid for low-income persons who have Medicare; also called Medicare-Aid. In the Specified Low Income Subsidy Program there are three different types of coverage: (1) M-QB-B, Specified Low Income Medicare Beneficiaries is a limited Medicaid program which pays for a recipient’s Medicare Part B premiums only. Individuals do not receive a Medicaid card. (2) M-QB- Q (Qualified Medicare Beneficiaries) is another limited Medicaid program which only pays a recipient’s Medicare premiums, deductibles, and copayments only. (3) M-QB-E (Qualifying Individual 1 “QI1”) is a limited Medicaid program which pays a recipient’s Medicare B premiums only. Funding for this program is capped. Individuals do not receive a Medicaid card.
Department of Health and Human Services (DHHS) was formerly the Department of Human Resources. It is the single state agency charged with overall administration of human services programs and licensure of health care providers under North Carolina law.
Disability Determination Services is the section of the North Carolina Division of Vocational Rehabilitation (VR) that is responsible for making determination of disability for Retirement, Survivors, Disability Insurance (RSDI), Supplemental Security Income (SSI), and Medicaid.
Division of Facility Services (DFS) is the division-specifically the Licensure and Certification Section-within DHHS that is responsible for enforcing licensure standards for private and public institutions that provide service to Medicaid recipients.
Division of Medical Assistance (DMA) is the division within DHHS responsible for the administration of the North Carolina Medicaid program. DMA interprets federal regulations, establishes policies to ensure that Medicaid-eligible North Carolinians receive appropriate medical care, enrolls providers and conducts quality assurance audits and reviews to ensure the integrity of program operations and provider payments. DMA also establishes reimbursement rates in accordance with the Appropriations Act, enacted by the General Assembly, and State Medicaid Plan.
Division of Public Health (DPH) is the division within DHHS responsible for programs to prevent disease and compile health statistics. Go to www.ncpublichealth.com for information about the many programs and services of this division.
Division of Services for the Blind (DSB) is the division within DHHS responsible for providing a complete array of services including Independent Living, Vocational Rehabilitation, Medical Eye Care, Deaf/Blind and Special Assistance for the Blind Programs to persons who are blind or have very limited vision.
Division of Social Services is the division of the North Carolina Department of Health and Human Services responsible for providing financial assistance and services for families with children and aged and disabled individuals.
Office of Administrative Hearings is where the a/r who is not satisfied with the decision from the Conference with the DSB Chief, Independent Living and Medical Services, can take his/her complaint. The a/r must file a petition with the Office of Administrative Hearings (OAH) within 60 days if he/she wants the complaint heard by this Office.
BENDEX is Beneficiary Data Exchange System. It is a computer printout listing the amount of an individual’s Social Security Administration benefits.
Retirement, Survivors, Disability Insurance (RSDI) is a program administered under Title II of the Social Security Act through the Social Security Administration. It pays benefits to persons who have contributed enough quarters to the Social Security System, or who are the dependents of one who has contributed to the system, when they are aged or retired, are a surviving spouse or dependent child, or are disabled.
Social Security Administration (SSA) is the agency of the federal government that issues regulations for the RSDI and SSI programs, as well as Medicare and Medicaid, under the Social Security Act.
Substantial Gainful Activity is the amount of earnings a disabled recipient may have before an RSDI or SSI disability payment is suspended by the Social Security Administration.
Supplemental Security Income (SSI) is a Federal assistance program administered by the Social Security Administration for aged, blind, and disabled persons under Title XVI of the Social Security Act to guarantee a certain level of income. SSI recipients have contributed nothing or not enough to the Social Security System to be able to receive benefits on their own earnings record.
Supplemental Security Income Standard of Disability is the definition of physical or mental impairment which prevents an individual from engaging in substantial gainful activity and which has lasted or is expected to last for at least 12 months or is expected to result in death.
Title XVIII (Medicare) is the title of the Social Security Act that contains the principal legislative authority for the Medicare program and therefore a common name for the program.
Title XIX (Medicaid) is the title of the Social Security Act that contains the principal legislative authority for Medicaid and therefore a common name for the program.
State and County Programs
CAP is the acronym for the Community Alternatives Programs. These Medicaid waiver programs provide home and community-based services as an alternative to institutional care. The programs allow those who otherwise would be institutionalized to live in the community. CAP participants must meet all the eligibility requirements for full coverage Medicaid.
CAP/C (CAP for Children) is the CAP program that provides home care for medically high risk children under age 19 who otherwise would require nursing or hospital care.
CAP/Choice is the CAP Program for Disabled Adults, Consumer-Directed Care, which is similar to CAP/DA. This program uses four non-traditional case management services: (1) Care Advisor; (2) Financial Management Services; (3) Personal Assistant Services, and (4) Consumer- Designated Goods and Services.
CAP/DA (CAP for Disabled Adults) is the CAP program that provides home care for disabled adults age 18 and up who would otherwise require nursing facility care. The recipient must meet the intermediate level of care (ICF) or Skilled Nursing Facility (SNF) level of care.
CAP/MR/DD is the CAP program for Persons with Mental Retardation/ Developmental Disabilities, which provides home and community care for persons who otherwise would require Children’s Health Insurance Program (CHIP) is the national title for the Health Choice Program.
Children’s Health Insurance Program (CHIP) is the national title for the Health Choice Program.
Money Follows the Person (MFP) provides services and supports to allow Medicaid eligible individuals, who meet the criteria for enrollment in CAP/Choice, CAP/DA, CAP-MR/DD, or PACE to leave institutions and return home or into the community.
North Carolina Health Choice for Children (NCHC) is a health insurance program for uninsured children under the age of 19 who do not qualify for Medicaid and have a family income under 200% of the FPL (Federal Poverty Level). Funding for this program is capped. See Children’s Health Insurance Program (CHIP).
Program of All-Inclusive Care for the Elderly (PACE) is a managed care service delivery for the frail community-dwelling elderly, most of whom are eligible for Medicare and Medicaid. Most of these individuals are certified eligible for nursing home placement.
State/County Special Assistance for Adults (SC/SA) is a program of financial and medical assistance for aged and disabled individuals with special needs, such as adult care home placement.
Special Assistance to the Aged (SAA) is State/County Special Assistance for Aged Adults. It is an assistance payment to individuals age 65 and over that meets the eligibility requirements of the program.
Effective 9/1/2010, Special Assistance for the Blind (SAB) was merged with the State/ County Special Assistance for Adults (SA) Program administered by the Division of Aging and Adult Services. This change was enacted by the North Carolina General Assembly in Session Law 2010-31 (Senate Bill 897), which was ratified on June 30, 2010. The goal of the merger was to eliminate duplication and improve access to services. Our SAB was a State/County Special Assistance Program for persons who are legally blind of any age. Individuals must meet the eligibility requirements of the program to receive a payment.
Special Assistance for the Disabled (SAD) is State/County Special Assistance for Disabled Adults. It is an assistance payment to individuals from age 18 through age 64 who meet the eligibility requirements of the program.
For questions or clarification on any of the policy contained in these
manuals, please contact the local district office.