REVISED SPECTACLE VOUCHER VALUES FROM 1 APRIL 1997

VOUCHER VALUES FOR REPAIR AND REPLACEMENT FROM 1 APRIL 1997

Note:

Where the small frame supplement or special facial characteristics supplement applies, the amount payable for repair of:

· the front of the frame is £39.80

· the side of the frame is £21.50

· the whole of the frame is £44.80

Where more than one repair is made to an optical appliance, the total paid must not exceed the aggregate of the amounts for replacing 2 lenses in the above schedule, and repairs to the part of the frame must not exceed £10.20.

If only one of a pair of contact lenses is replaced the voucher value is £39.80. These provisions for contact lenses only apply to clinically necessary contact lenses prescribed by the Hospital Eye Service or NHS Trust.

DIRECTION

The Secretary of State, in exercise of the powers conferred on him by paragraph 2(1) of schedule 11 to the National Health Service (Scotland) Act 1978 and regulation 2(1) of the National Health Service (Optical Charges and Payments) (Scotland) Regulations 1989 and of all other powers enabling him in that behalf, hereby gives to Health Boards and NHS trusts constituted under the said Act of 1978 the following Direction:

This Direction shall come into force on 1 April 1997 and shall have effect in respect of glasses or contact lenses supplied where the testing of sight leading to the supply of the glasses or lenses, or the first such testing, takes place on or after 1 April 1997.

In this Direction -

"the Act" means the National Health Service (Scotland) Act 1978;

"charge for glasses" and "charge for contact lenses" means a charge authorised by section 70(1) of the Act in respect of the supply of glasses or, as the case may be, contact lenses under the Act.

Subject to paragraphs 4 and 5 below, the charge for glasses shall be the aggregate of the following:

a. an amount which represents the cost to the Health Board, NHS trust, or other person on its behalf, of the purchase of the glasses or their components; and

b. an amount which represents the cost to the Health Board, NHS trust, or other person on its behalf, of the dispensing of the lenses.

Where the aggregate of:-

a. the element of the amount mentioned in paragraph 3(a) above which represents the cost of the lenses; and

b. the amount mentioned in paragraph 3(b) above, exceeds, in the case of glasses each lens of which is a single vision lens, £48.80 and, in any other case, £79.40, the charge for glasses shall be the aggregate of that £48.80 or, as the case may be, £79.40 and, except in a case to which paragraph 5 below applies, the element of the amount mentioned in paragraph 3(a) above which represents the cost of the frames.

Where any patient requires, on clinical grounds, a frame the cost of which is more than that of the cheapest frame in the range supplied by the Health Board, NHS trust, or other person on its behalf, the element of the amount mentioned in paragraph 3(a) above which represents the cost of the frames shall not exceed the cost of the cheapest frame.

The charge authorised by section 70(1) of the Act in respect of the supply of contact lenses under the Act shall be £39.80 for each contact lens so supplied.

Except insofar as it applies to glasses and contact lenses supplied where the testing of sight leading to the supply of the glasses or contact lenses, or the first such testing, has taken place prior to 1 April 1997, the Direction made under paragraph 2(1) of Schedule 11 to the Act and regulation 2(1) of the National Health Service (Optical Charges and Payments) (Scotland) Regulations 1989 which came into operation on 1 April 1995 is revoked with effect from 1 April 1997.

The Scottish Office

Department of Health Assistant Secretary

St Andrew’s House

May 1997

SEPARATION OF PRESCRIBING AND SUPPLY

1.    In order to simplify the arrangements for refunds it has been agreed that from 1 April 1997 prescribing and supply will be separate transactions and the method of calculating the patient's contribution will be revised. Any sight tests conducted on or after 1 April 1997 will therefore be a separate transaction from glasses/contact lenses supplied as a result of that test.

2.    Patients' entitlement to an NHS sight test will be based on their circumstances on the date of the test - patients should continue to use GOS(S)(ST) (form GOS(S)ST(V) for AG3 holders) to apply for an NHS sight test. Their entitlement to a voucher will be based on their circumstances on the date the glasses/contact lenses are ordered - they should complete GOS(S)(V) to apply for a voucher when they order their glasses/contact lenses.

3.    To ensure that patients are not worse off as a result of the separation of transactions, a change has been made in the method of calculating the contribution which AG3 holders have to make. Currently the patient's contribution entered in the glasses and contact lenses section of the AG3 is a sum equal to three times the excess of the patient's income over his requirements. This contribution is deducted from the lower of the cost of the private sight test or the NHS sight test fee and any residue is offset against the value of the spectacle voucher. These arrangements will change as follows.

4.    From 1 April 1997 there will be two rates of contributions for AG3/HC3 holders:

A. the contribution to the sight test which will be equal to the excess of the patient's income over his requirements, and

B. the spectacle voucher contribution which will be twice the excess of the patient's income over his requirements.

5.    The different rates of contribution will be shown separately on a new HC3 certificate which will replace the AG3 certificate, but AG3s will continue to be valid for some months.

6.    Where an AG3 is presented for a sight test carried out on or after 1 April 1997, the contribution towards a private sight test will be the amount shown in the section of the certificate headed "Travel to hospital for NHS treatment". The patient will pay whichever is less: the amount shown on the AG3 plus any difference between the NHS fee and the private cost, or the total private cost. The patient should continue to use GOS(S)ST(V) and enter at Part B, statement A, the amount shown under "travel to hospital" on their AG3 (statement B should be struck through as this will no longer be needed).

7.    When an AG3 is presented for the supply of glasses/contact lenses after 1 April 1997, the following will apply (unless paragraph 8 would provide more help for the patient) The patient should use GOS(S)(V), tick the AG3 box, at part 3, and enter twice the amount shown under "Travel to hospital for NHS treatment" on their AG3 certificate. The practitioner will reduce the appropriate voucher value by this amount, ignoring anything paid for the sight test. When completing part 4 of GOS(S)(V), the practitioner will use lines A - D and F as now. At line E, the practitioner will enter twice the amount shown under "travel to hospital" on the patient's AG3 (the practitioner may strike through "deduct amount taken into account for sight test" and "balance" as they will no longer be needed).

8.    Any GOS(S)(V) issued on or after 1 September 1996 may be accepted as a voucher towards the purchase of glasses or contact lenses regardless of any changes in the patient's circumstances between the date of issue and the date of ordering. This means that, for a limited period, so as not to disadvantage any GOS(S)(V) holders, entitlement may be based on circumstances at the time the GOS(S)(V) is issued. If an AG3 holder presents such a voucher, its value may be reduced by the AG3 contribution appropriate at the time of its issue (adjusted for any sight test cost) or paragraph 7 may be applied, whichever gives the patient the most help.

9.    Anyone who has a sight test before 1 April 1997 but does not hold a GOS(S)(V) and whose glasses/contact lenses are ordered on or after 1 April 1997 will have to complete a GOS(S)(V) at the time they order their glasses in accordance with paragraph 7. Their entitlement to a voucher will be based on their circumstances at the time of ordering.

1.    Any eligible patient who, on or after 1 April 1997, pays for a private sight test, glasses or contact lenses may claim a refund. Sight test refunds will be available to patients eligible under any of the criteria for NHS sight tests - not just those who subsequently obtain a charges certificate AG2/AG3. Likewise, refunds for spectacles/contact lenses prescribed through the Hospital Eye Service will no longer be restricted to AG2/AG3 holders. The present arrangements whereby a patient's AG2/AG3 certificate must start within 14 days of the sight test no longer apply. In order to support any refund claim, patients will require a receipt which shows: the date of the sight test, the amount paid for the sight test, glasses or contact lenses separately from any other transaction, and the date of payment.

Making refund claim

2.    Patients in the categories below should use HC5 (see paragraph 2 of Appendix 3) to apply for the refund if at the date of the sight test or paying for their glasses/contact lenses:

(a) they or their partner held

- an AG2/HC2

- an AG3/HC3.

The HC5 should be sent to the Health Benefits Division (HBD) of the Prescription Pricing Authority;

(b) they were on a low income. This group will also have to complete a claim form AG1/HC1 - HC5/HC1 sent to the HBD;

(c) they or their partner were receiving

- Income Support

- Income-based Jobseeker's Allowance

- Family Credit

- Disability Working Allowance.

The HC5 should be sent to the Social Security office or Job Centre for checking entitlement and then to the HBD for recording - see paragraph 6;

(d) they were a war pensioner being treated for the pensionable disability. The HC5 should be sent to the War Pensions Agency at DSS Norcross.

3.    Other patients are asked to write to their Health Board if they are in any other group entitled to a free NHS sight test or an optical voucher and have paid by mistake.

4.    The refund claim must be received by the office listed on the AG5/HC5 within 3 calendar months of the date of the sight test or the date of payment for the glasses/contact lenses. This time limit may, exceptionally, be extended if there was a good reason for lateness. Once the arrangements are under way, ignorance will not normally be an acceptable reason for lateness. Practitioners are therefore being asked to mention the availability of refunds whenever a refund claim seems a possibility.

5.    The amount of the refund will be:

· the full cost of the private sight test if the patient would have been entitled to an NHS sight test (with any balance, as now, being recovered from the practitioner); or

· the difference between the AG3/HC3 contribution and the lower of the actual private sight test cost or the NHS sight test fee; and/or

· the value of the voucher plus any supplements, or the actual cost of the glasses if this is less, appropriate to the prescription less any AG3/HC3 contribution where appropriate.

6.    The patient's receipt for glasses/contact lenses should be returned because the purchase will be a private arrangement and might include a warranty or insurance. To ensure that a receipt can only be used once to claim a refund, the HBD will maintain a computer record of all optical refund claimants which they will search for details of previous claims when a new claim is received. As an additional precaution, Health Boards should stamp receipts for glasses/contact lenses "voucher refund made" before return.

7.    The new arrangements will extend to patients who pay for the replacement/repair of glasses but would have been eligible for a voucher. Other than children, who automatically get a voucher, patients are only entitled to a voucher for replacement/repair if

- they are eligible under the voucher scheme, and

- the loss or damage has occurred through illness.

8.    Claims on behalf of patients other than children will, therefore, be processed as at paragraphs 2 to 4 and then sent to the Health Board to apply the "illness" criteria before making any payment. Patients will use the HC5 to apply for a refund, and provide a note to explain why they think the breakage/loss was due to illness. Financial entitlement (and time limit) will be checked and, where appropriate, the papers then sent to the Health Board to apply the illness criterion. Young people 16 - 18 are not automatically eligible as "children", and will need to be members of a family holding an AG2/HC2, or in the group mentioned in paragraph 2(b) to meet the financial criteria. Otherwise, they may make their own HC1 claim to get an HC2/HC3 before the illness criterion is relevant.

9.    The new arrangements also apply to the Hospital Eye Service. Eligibility for refunds in respect of glasses or contact lenses prescribed by HES has been extended to include all patients who meet the criteria for eligibility for a HES spectacle voucher.

10.    All sight test charges and voucher values refunded under these arrangements should be included in the ISD(S)22 return for the period in which the refund was made. The instructions for completing the ISD(S)22 return covering the period April to September 1997 will make it clear where the information is to be included.

11.    The cost of all sight test or voucher refunds should be charged to Health Boards indicative allocation. Health Boards should include the costs at line 8 of Form 3.6 with a note of the actual refund costs being shown in the Supplementary Information at the foot of Form 3.6.

1.    Regulations governing changes to the NHS Low Income Scheme (LIS):

(a) introduce a short claim form (HC1(RC)) for people who live permanently in residential care or nursing homes and who receive some help with the cost from a Local Authority (but do not receive Income Support). This form will be available from the homes;

(b) make clear how people who are entitled to less than 10p Income Support or Income-Based Jobseeker's Allowance (and are therefore not paid the benefit) may make their LIS claim. They should write to the Health Benefits Division saying that they wish to claim help with health costs and enclose their Income Support or Income-based JSA award notice. They will be sent a certificate for full help for 6 months without the need to make an HC1 claim;

(c) provide for everyone aged 60 or over to have a higher pensioner premium included in their requirements. This may result in some people becoming entitled to full help, for example free NHS dental treatment or sight test;

(d) provide for anyone in a residential care home or nursing home who is entitled to LIS help with health costs to be sent a 12 months certificate.

2.    A new refund claim form HC5 is currently being prepared to include refunds for sight tests and all glasses/contact lenses. It would be helpful if practitioners would hold a small supply of this form. If an HC5 is not available, patients should use an AG5 and show details of the cost under "glasses and contact lenses prescribed by the hospital eye service" in Part 3 and details of their optician in Part 4. Both AG5 and HC5 show where the form should be sent.

3.    A revised HC12 "NHS charges and optical vouchers" is being prepared and will be issued in due course. Any remaining stocks of the HC12 effective from 1 December 1996 should be destroyed when stocks of April 97 version are received.

4.    Leaflets HC11 and HC13 are being updated and will be issued in response to normal orders. Remaining stocks of earlier versions should be destroyed when the April 97 version is received.

5.    Large print version of HC11 A5 size will be available for order from April 97. A supply of these leaflets is being sent to organisations for the visually handicapped.

6.   Audio tape of HC11 is to be produced. A limited stock will be held by DH, London stores. Availability of this audio tape is being notified direct to organisations for the visually handicapped.

7.    Large print version of HC1 claim form is to be printed. It will be held by the Health Benefits Division and only sent to individuals in response to telephone requests: 0191-203 5555.