Appendices

Appendix A: - Definitions

Administration for Community Living (ACL): The Workforce Innovation and Opportunity Act (WIOA) as Amended, transferred Title VII, Chapter 1, Part B and Part C of
the Rehabilitation Act as Amended (i.e., Independent Living programs) to the Administration for Community Living (ACL) and created a new Independent Living Administration within the agency, adding section 701A of the Rehabilitation Act, 29 U.S.C. 796–1. As part of the transfer, the Administrator of ACL drafted a Notice of Proposed Rule Making (NPRM) that was published on November 16, 2015, to implement changes made by WIOA in accordance with Section 12 of the Rehabilitation Act, as amended, 29 U.S.C. 709(e), and section 491(f) of WIOA, 42 U.S.C. 3515e(f).

Administrative Review: A procedure by which the Department may provide an opportunity for an applicant or client to express and seek a remedy for dissatisfaction with a decision regarding the furnishing or denial of services. 111 I.A.C. 11.9(1).

Americans with Disabilities Act (ADA): ADA became law in 1990. The ADA is a civil rights law that prohibits discrimination against individuals with disabilities in all areas of public life, including jobs, schools, transportation, and all public and private places that are open to the general public. The purpose of the law is to make sure that people with disabilities have the same rights and opportunities as everyone else. The ADA gives civil rights protections to individuals with disabilities similar to those provided to individuals on the basis of race, color, sex, national origin, age and religion. It guarantees equal opportunity for individuals with disabilities in public accommodations, employment, transportation, state and local government services, and telecommunications. The ADA is divided into five titles (or sections) that relate to different areas of public life.

• Activities of Daily Living (ADL): A term used to refer to people’s daily self-care activities. ADLs are defined as the things we normally do such as feeding ourselves, bathing, dressing, grooming, work, homemaking, and leisure, etc.
• Appeal: A request by an applicant or client for a remedy from a current decision or situation.
• Applicant: Any individual who has applied for Independent Living Rehabilitation (ILR) services, but whose eligibility for services has not been determined. 34 C.F.R. 77.1.
• Application Documents: The documents that must be included in the applicant’s case file.
• Application for IL Services includes:
  • IL applicant (Application signature required on form and for paper file unless pandemic conditions see procedure)
  • Health Assessment Questionnaire
  • Applicant’s Rights and Responsibilities Statement
  • Voter Registration Information
  • Iowa Client Assistance Program (ICAP) Brochure
  • HIPAA-Compliant, Signed Authority for Release of Information Form with Proper Notices
  • Certificate of Eligibility
• Assistive Technology (AT) as defined by RSA: AT is designed specifically to help people with vision loss, who are blind or who have other disabilities to remove barriers to independent living or employment.
  • Definition of assistive technology (AT) device means any item, piece of equipment, or product system whether acquired commercially, modified, or customized that is used to increase, maintain, or improve functional capabilities of individuals with disabilities.” Assistive technology devices may include such items as canes, slates, insulin gauges, closed circuit televisions, computers, adaptive software, magnifiers, adaptive cooking items, adaptive recreational items, handwriting guides, braille devices, large button telephones, etc. efinition of assistive technology (AT) services may include the evaluation of assistive technology needs of an individual, services related to acquisition of technology, loan programs, maintenance and repair of assistive technology, training or technical assistance for the individual or professionals related to the use of assistive technology, programs to expand the availability of assistive technology, low vision services related to the use of optical aids and devices, and other services related to the selection, acquisition, or use of an assistive technology device.
• Centers for Independent Living (CILs): A consumer-controlled, community-based, cross-disability, nonresidential private nonprofit agency that is designed and operated within a local community by individuals with disabilities and provides an array of independent living services.
• Client: Any individual with a significant disability, as defined by IL regulations, and who meets IDB criteria to receive services. 34 C.F.R. 364.4.
• Closed Circuit Television (CCTV): AT device that enables some people who are with low vision the ability to read printed materials.
• Comparable benefits or comparable Services: Any appropriate service or financial assistance available to an individual from a program or source other than IDB that will, wholly or partly, meet the cost of IL services listed in the ILRP or Waiver plan. Examples of comparable services and benefits are major medical insurance, Veteran’s Administration, Medicare, Medicaid and Worker’s Compensation benefits. Services may also be procured through the use of volunteers to provide reader service, peer counseling and peer training.
• Designated State Entity (DSE): The Iowa Vocational Rehabilitation Services (IVRS) is the designated state entity under the State Plan for Independent Living (SPIL). 34 C.F.R. 364.4.
• Designated State Unit: The Iowa Department for the Blind (IDB) in the State of Iowa.
• Formal Hearing: A procedure where an applicant or client who is dissatisfied with the findings of an administrative review or mediation concerning the furnishing or denial of services may request a timely review of those determinations before an Impartial Hearing Officer. 111 I.A.C. 11.9(1).
• Frequency Modulation (FM): The modulation of a radio or other wave by variation of its frequency, especially to carry an audio signal.
• Gifts and Bequests fund (G&B): Pursuant to Iowa code 216.3(8), there is established a gifts and bequests fund. The fund is established primarily to provide direct financial assistance in the form of grants or loans to blind Iowans which will materially assist in independent living or vocational success or to provide department services or support services for which other funds are not available. Grants or loans may not be given for the purpose of continuing support. Additional application information and requirements as well as the application for a loan or grant can be found on the at https://blind.iowa.gov/gifts-bequests-fund-guidelines. A
• Goods: Items that are produced, traded, bought or sold, then consumed.
• ICAP – Iowa Client Assistance Program, which is a consumer advocate.
• IL Objectives: Specific milestones that a person sets to achieve as part of his or her IL goal. Five types of objectives are available:
  • Communication
  • Daily Living
  • Integration
  • Leisure
  • Travel
  • These objectives reflect the area in which the individual wishes to improve his or her IL skills.
• Impartial Hearing Officer: An individual who:
  • Is not an employee of the public agency;
  • Is not a member of the Independent Living Advisory Committee or State Rehabilitation Advisory Council;
  • Has not been involved in previous decisions regarding the Independent Living Applicant or Client;
  • Has knowledge of the delivery of independent living, Title VII, Chapter 2, Part B and Title VII, Chapter 2;
  • Has training in the performance of the duties of a hearing officer;
  • Has no personal or financial interest that would be in conflict with the individual objectivity.
• Individual who is Deafblind: Any individual:
  • Who has a central visual acuity of 20/200 or less in the better eye with corrective lenses, or a field defect such that the peripheral diameter of visual field subtends an angular distance no greater than 20 degrees, or a progressive visual loss having a prognosis leading to one or both of these conditions:
  • Who has a chronic hearing loss so severe that most speech cannot be understood with optimum amplification, or a progressive hearing loss having a prognosis leading to this condition
  • For whom the combination of losses described in clauses (1) and (2) cause extreme difficulty in attaining independence in daily life activities, achieving psychosocial adjustment, or obtaining a vocation or
  • Who, despite the inability to be measured accurately for hearing and vision loss due to cognitive or behavioral constraints, or both, can be determined through functional and performance assessment to have severe hearing and visual disabilities that cause extreme difficulty in attaining independence in daily life activities, achieving psychosocial adjustment, or obtaining vocational objectives
    Meets such other requirements as prescribed by RSA regulation. 21 U.S.C. Section 1905; Helen Keller National Center (2012) (rev. 2014).
  • For example, a deafblind person receiving services from IDB may grow up as a blind person, who heavily depended on hearing for communication and environmental information and is now experiencing a hearing loss. He may need equipment such as hearing aids, cochlear implants, or assistive listening devices to improve his ability to hear others. He may also want to consider alternate means of communication such as learning sign language.
  • Another deafblind IDB client may grow up as a deaf or hard of hearing person, may use American Sign Language (ASL) for communication, and is now experiencing vision loss.
  • She may already be involved with the deaf community, but now needs to learn about accommodations for his or her vision loss, such as Braille, independent travel training, and tactile sign language, where his or her can receive signs in his or her hands.
  • Yet another deafblind IDB client may have grown up with normal vision and hearing but is losing both senses as he or she gets older. He or she may need to become familiar with assistive devices for both his or her vision loss and devices for his or her hearing loss.
• Helen Keller National Center (HKNC): Authorized by an Act of Congress in 1967, HKNC is the only organization of its kind—providing training and resources exclusively to people age 16 and over who have combined vision and hearing loss.
• Independent Living Advisory Committee (ILAC): This organization was established by the Department and serves the Department’s IL program. The purpose of this organization shall be to consult on matters of policy, program development, implementation and evaluation, particularly in regard to the initial development and periodic revision of the State Plan for Independent Living. The Committee shall have special responsibilities in the areas of outreach and advocacy.
• Informed Choice: All applicants and clients or their designated personal representatives shall be provided with information, referral, and other support services, including information regarding the labor market and the cost, duration, types of services provided, accessibility, integrated setting of the services, qualifications, and consumer satisfaction, as available, to facilitate the opportunity to exercise informed choice throughout the IL process.
• Legal Blindness: A central visual acuity of 20/200 or less in the better eye with corrective lenses, or central acuity of more than 20/200 if there is a field defect such that the peripheral diameter of central visual field subtends an angular distance no greater than 20 degrees. 41 C.F.R. 51–1.3.
• Mediation: An alternative an Applicant or Client may choose if the Applicant or Client is dissatisfied with the findings of an Administrative Review concerning the furnishing or denial or services. 111 I.A.C. 11.9(1).
• Notice of Proposed Rule Making (NPRM): This is a public notice issued by law when one of the independent agencies of the United States government wishes to add, remove, or change a rule or regulation as part of the rulemaking process.
• Older Individuals who are Blind (OIB): The Independent Living (IL) for Older Individuals who are Blind (OIB) is a program that is administered under Title VII, Chapter 2, of the REhab Act by the Rehabilitation Service Administration (RSA).
• Purpose, Assessment, Intervention, Plan (PAIP): A style of writing case notes to succinctly organize thoughts following an IL client skills training visit or for any other types of client contact that requires the contact to be put into a written format (i.e., case note) within an electronic CMS.
• Rehabilitation Service Administration (RSA): RSA federal agency under the United States Department of Education, Office of Special Education and Rehabilitative Services, and is headquartered within the Department of Education in Washington, D.C.
• State Accounting Enterprise (SAE): This State of Iowa agency collects and reports financial information as well as processes financial transactions. Policies set by the SAE can be found on their website and must be followed by all state employees.
• Service: Work performed by one person or a group of people that benefits others.
• Specific, Measurable, Achievable, Results-Focused, and Time-Bound (S.M.A.R.T.)
  Goal: S.M.A.R.T. goal is a mnemonic acronym, giving criteria to guide in the setting of a number of objectives including personal development objectives.
• State Plan for Independent Living (SPIL): The SPIL is the basis for state operation and administration of the program. All provisions of the SPIL are consistent with State law. 34 CFR 76.104(a)(4) and (8)
• Statewide Independent Living Council (SILC): The mission of SILC is to strengthen the voice of Iowans with disabilities on issues affecting their lives, to build a statewide network of Centers for Independent Living, and to collaborate with our partners in advancing the independence, productivity, and full inclusion of Iowans with disabilities. SILC partners with the DSE and DSU to develop and implement the SPIL. The Statewide Independent Living Council (SILC) that meets the requirements of section 705 of the Act and is authorized to perform the functions outlined in section 705(c) of the Act in the State is Iowa Statewide Independent Living Council (Iowa SILC). 34 CFR 364.21(a)
• Travel Department Authority (TDA): Effective July 1, 2012, Iowa Department of Administrative Services State Accounting Enterprise (SAE) requires that all travel outside the state of Iowa by Executive Branch employees for conferences, meetings or related expenditures as a part of the employee’s official duties must be approved on a Travel Department Authorization (TDA). This also applies to non-employees representing the State (Procedure # 210.315). Departments exempted from this provision are listed in Sections 8A.512A(3) and 97B.7A of the Code of Iowa.
• Visual Disability: Any individual who:
  • Is legally blind; or
  • Has vision loss that is progressive of the visual systems with a central visual acuity of 20/50 or worse in the better eye with best correction, or who has near vision that is decreased to the extent that the individual cannot read print that is smaller than Jaeger nine (J9) with best correction; or
  • Has vision loss that is non-progressive of the visual systems with a visual efficiency (visual acuity and visual field) or restricted fields of 20 degrees or less; or
  • Has visual loss that is progressive of the visual systems with a visual efficiency (visual acuity and visual field) of 40 degrees or less; or
  • When, due to age or severity of the disability, the examiner is unable to obtain visual acuities for inclusion with the required eye reports, the staff can consider the individual eligible for services based on the functional limitations caused by the visual condition if the functional limitations are consistent with the best corrected acuities or fields expressed in 1:5 above.
• WORKFORCE INNOVATION AND OPPORTUNITY ACT (W.I.O.A.): WIOA improves connections to employment and training opportunities that lead to economic prosperity for workers and their families. It strengthens existing workforce development and adult education programs in four ways that can benefit adults and youth with barrier to economic success. The law:
  • Increases the focus on serving the most vulnerable workers—low-income adults and youth who have limited skills, lack work experience, and face other barriers to economic success
  • Expands education and training options to help participants access good jobs and advance in their careers
  • Helps disadvantaged and unemployed adults and youth earn while they learn through support services and effective employment-based activities
  • Aligns planning and accountability policies across core programs to support more unified approaches to serving low-income, low-skilled individuals

Appendix G: IL Case Documentation Examples

Example 1:

As part of the IL caseload process, an 80-year-old applicant female, her son, and the ILR teacher met on March 3, 2018. She is her own guardian, widowed, a former Veteran and lives by herself in her own ranch style condo, but wanted her son present since she is losing some hearing so isn’t always sure she is catching everything that is being discussed.

Department and IL services were discussed in depth. She was particularly interested in library services for the blind. She was asked why she reached out to the Department. She reported she was experiencing problems with getting lost when she would go outside for a walk; also she reported she was unable to identify some of her appliance buttons when cooking and couldn’t read food labels anymore. She denied she was missing stair steps and falling, but did say she was afraid to do much socializing outside of her own home since she was losing more and more of her vision. As needed, the Veterans Administration covers medical services, medications, and aids, devices and equipment she needs as a result of her vision loss. Her medical records indicate that she has macular degeneration and glaucoma.

Today, we discussed program services in depth, use of structure discovery model (the whys and how it will help facilitate problem-solving and ultimately, independence), answered questions as asked, completed the application, completed health assessment, national voter’s registration where she declined to register to vote since she was already registered.

Voter registration form was completed, signed and dated by the applicant with the proper response selected on the form. Iowa Client Assistance Program (ICAP) was discussed and a brochure in large print left.

Based on the medical records supplied from her doctor at the Veteran’s Administration, the records indicate she is legally blind. This information will be documented in the Blind Journal as mandated under State law. She was informed that she was eligible for service and she expressed she wanted to move forward to complete an IL skills assessment. We completed an IL skills assessment. The results of the assessment confirmed that communications skills training, home-management skills training and travel skills were all skills training this individual would benefit from. All skills training areas and expectations were explained in depth with the client noting the benefits each would bring and how it would effect change in her life.

After talking through the assessment, the client expressed fear in going outside to use the white cane on her own. She received adjustment to blindness counseling where she was assuring she would receive instruction and training with regard to the cane itself, cane techniques, and actual practice using the long white cane while using learning shades so she would first be practicing with her ILR teacher in an area likely in her home to start. She felt comfortable practicing using her cane inside her home and around her front yard to start. She was also very interested in also learning how to identify the buttons on her stove and microwave, and learning to read and write Grade 1 braille to label food and other items around her home.

Next, we discussed the process to develop an IL Plan as well as covered the benefits and differences between the ILRP and IL Waiver plans. The client, and her son felt, given the Client’s goal, that an IL Waiver would probably best meet her needs. The applicant has stated her IL goal is to access her community and remain in her home.” She would like to be able to go shopping and feel confident that she will not run into anyone or anything. She would also like to be able to learn how to use the cane on stairs as she has no depth perception and worries about using the stairs.

To reach this goal, she set a travel, home-management, and communication objective. She feels she could meet her objectives within a year and promised to practice her skills in between teacher visits. For each objective set, the ILR teacher and applicant further set specific, measurable, achievable, realistic and time-bound (SMART) goals where the applicant would demonstrate that she can successfully demonstrate completion of each training objective within a certain period of trials over a certain period of time; then after successfully meeting, the objective would be closed successfully. The applicant would like to be able to go shopping and feel confident that she will not run into anyone or anything.

The ILR teacher will plan to prepare an IL Equipment Transfer case note for a long white cane but had one cane available to start the conversation about the long white cane.

An appointment is scheduled to meet with the client over the next four weeks (state date and time). The client understands and agreed to all objectives written under her IL plan.

She requested to start learning how to use the long white cane first. A signature from the client for her plan was secured. ILR teacher shall case note for the IL Equipment Transfer for the purchase of a long white cane and will await plan approval by the program administrator.

Purpose, Assessment, Intervention, Plan (PAIP)

Problem/Purpose – Describe the problem. What is the purpose of this session?

On this date, met with the applicant to complete the application process and discuss determine eligibility.

Assessment – What are your observations about the Client?

The Client is motivated to learn alternative techniques so she may become more independent within her community and feel safer when in unfamiliar settings.

Intervention – What did you do during the session?

We completed the application process including verifying info and data located in the application, completion of the health assessment, and completion of the national voter’s registration form. All docs that require signatures were signed by individual.

Eligibility determination completed. Individual is eligible for services based on medical documentation from the Veteran’s Administration. The eye condition is macular degeneration and glaucoma. Her heath is otherwise remarkable.

We discussed conducting an IL skills assessment. Individuals were amenable and cooperative. The assessment results indicated that travel skills training, home-management skills training in the area of identifying food labels and appliance buttons, and communication skills training to include Grade 1 Braille were disabilities skills training needs. The individual agreed.

Next, we discussed the benefits and options of each IL plan (ILRP and IL Waiver). She selected the IL Waiver plan. Her goal is “access her community and remain in her home.” Objectives were written per what was identified under the IL skills assessment. The IL plan will be effective starting (add date) and will be scheduled for one year out from the start date. The objectives include:

• Travel – Explore the use of the long-white cane 3 out of 4 trials
• Travel - Explore home block 2 out of 3 trials
• Travel - Techniques to identify curb cuts 2 out of 3 trials
• Travel – Techniques for cross control/uncontrolled crossings 5 out of 6 trials
• Travel – Travel from home to library and back (add number of trials)
• Home Management – identify and use appliance buttons – 3 out of 4 trials
• Communication – Access print material (add trials)
• Communication – Braille instruction/Braille lite instruction (add trials and breakdowns)

Plan – What will each of you do next?

Our next meeting date will be x and we will plan for a first travel lesson. A long white cane shall be ordered and will be hand delivered to the client when we meet again in four weeks.

Example 2

An appointment was scheduled with this individual, but upon arrival he had been in a deep learning in his recliner, so his thinking seemed to be a bit fuzzy. He disclosed that he had two bouts of Arterial Fibrillation in November and December. He said he had been very weak and short of breath, and when he was checked over that is what they found, so they put him in the hospital for two weeks. He had come back home, and in December, he ended up going in for another two weeks with the same thing. He reported he was taking Coumadin and had been doing well ever since. I worked with this client on his Braille. He was pretty fuzzy, and was not sure where his sheets were, but he was able to find them. We spent 45 minutes of our time going over letters A – E, F, and G. The Client struggled retaining this information. We went over the same letters several times, but when I would come back to them later, he had forgotten them. We spent a lot of time on these letters, and finally I went on to the H, I, and J, which we had covered before. It was my hope we would get back to the point where we had left off. I also wrote up a key for the letters and encouraged this client to do some practice reading with his brother or a friend, as there was a printed guide to go along with his Braille sheets. I asked this client if he had talked with (JB) at the VR about the CCTV she mentioned she had for him, or the Comfort Duet Personal Amplification System. He said he had been down to the Veteran’s Administration (VA) three times, and had stopped into her office, and had also called twice. The way we had left it last time, he was going to call her and let her know when he was going to be at the VA for a doctor’s appointment, so that he could see her around that time, but it sounded like he had not notified her. I did call her, and she was not in, so I left a message for her, and got a call back from her later saying it would be best if he would call and set up an appointment with her. She also said she would certainly be good with working with him on helping him get some hearing products. I also told the client I had learned of the availability of a personal amplification system through Radio Shack. I told him about the two levels of products and said that the tonal quality was not as nice as the Comfort Duet, but it was one-third of the cost, and would be available locally. The client said that there was a Radio Shack close by, and he may see about checking it out there. The client said that in dealing with his blindness, he had highs and lows. Earlier today, he reported he had been pretty good, and he had even walked to the courthouse, which was about three blocks away. I will contact this client when in the area again in about five weeks.

PAIP

Problem/Purpose – Describe the problem. What is the purpose of this session?

The purpose of today’s visit was to provide disability-related skills training and counseling and guidance.

Assessment – What are your observations about the client?

The client discussed having some medical issues during November and December and also experienced some hospitalization. With the passage of time, he was unable to locate his lesson sheets; thus, did not get to practice prior to this training session. During a subsequent follow-up conversation, the client reported improvement in his health situation.

Intervention – What did you do during the session?

A lesson was provided in Braille covering A through J. We started H, I, and J, which we had covered before. It was hoped we would get back to the point where we had left off from the previous lesson. A key for the letters was provided, and he was encouraged to do some practice reading with his brother or a friend, as there was a printed guide to go along with the Braille sheets. Additionally, this writer provided counseling and guidance related to personal amplification devices.

Plan – What will each of you do next?

Our next training lesson will be X, Y, and Z, where we will also work on A, B, and C. The next visit will be in five weeks (state date and time).

Apendix H: Case Note Diction Options

Option 1. iPhone Dictation

IPhone dictation may be used to create case notes when done in the following manner. The Applicant’s or Client’s full name is not used. No confidential or potentially identifying information is dictated. The note is composed in the body of an email via email to oneself and is not sent outside the @blind.state.ia.us domain.

Option 2. Windows 7 Dictation

Since no information leaves the computer, there are no restrictions on what to dictate using this method.

What is confidential information?

The IDB Security Work Rule and Confidentiality Policy define(s) confidential information as follows: Personal information defined by Iowa Code Section 715C; personal information includes an individual’s first name, initial, and last name, in combination with one or more of these:

• Social Security Number
• Driver’s License Number
• Unique Identification Number, e.g., Iowa Student State ID or Medicaid ID Number
• Financial Account Number, Credit Card Number, or Debit Card Number, when in combination with any required security code, access code, or password Unique electronic identifier or routing code, when in combination with any required security code, access code, or password
• Unique biometric data, such as a fingerprint, retina or iris image, or other unique physical representation or digital representation of biometric data
• Any information or record deemed confidential under Iowa Code Section 22.7
• All protected health information for agencies governed by HIPAA
• All protected credit card information defined by the PCI-DSS.
• Any other information that if lost, disclosed, corrupted, or accessed by unauthorized means would violate state or federal law\
• All information defined as confidential by contract or agreement with agency trading partners, customers, vendors, or other entities

What is personally identifying information?

Personally identifying information is information that might connect a case note to an individual. This includes phone number, address, birth date, and email address.

Appendix I: Status 08 Independent Client Living Notice or Letter of Ineligibility for Closing an Application Due to Applicant Not Wanting Services but Would Otherwise Be Eligible

[Date]
Client Name
Street Address
City, State, Zip Code

Dear [Name]:

This letter confirms our most recent meeting on [Date]. You made application to the Independent Living program. After meeting with you, you decided that you were not interested in pursuing Independent Living program services with the Iowa Department for the Blind.

Please find enclosed a copy of your Closure Amendment for your records and a response form which invites you to share your comments with us, if you wish. We request you consider taking time to provide your feedback then return it in the self-addressed, stamped envelope.

If you are a current Library patron, please be assured that closing this Independent Living application this does not affect your Library services. I also encourage you to call the Department for the Blind if in the future you wish to reapply for program services.
If you have any questions about this letter, you can reach me by calling (insert teacher’s cell number). I will be happy to hear from you. If you prefer, you can also get ahold of Kim Walford, program administrator, at 515–250–1184 or 1–800–362–2587.

If you do not agree with this closure, you may contact me to talk, or you call the Independent Living program administrator or you may contact the Iowa Client Assistance Program (ICAP) for help with mediation or an appeal. ICAP is located at:

Iowa Client Assistance Program
Lucas State Office Building
Des Moines, Iowa 50319
Phone: 515–281–8088 or 1–800–652–4298

Thank you for your time and consideration in this matter.

Sincerely,

[Insert teacher’s digital signature][ILR Teacher’s Name]
[Insert teacher’s signature block information]

Enclosures:
ICAP Brochure
Closure Letter
Closure Amendment

[Insert initials of teacher/initial of typist]

Rev. 10/20
Rev. 05/19

Appendix J: Status 08 Independent Living Client Notice or Letter of Ineligibility for Closing an Application Due to Independent Living Client Being Unreachable

[Date]

Client Name
Street Address
City, State, Zip Code

Dear [Name]:

This letter confirms our most recent meeting on [Date]. You made application to the Independent Living program. After meeting with you it was found you were not eligible for Independent Living program services at the Iowa Department for the Blind for (state the reason here).

Please find enclosed a copy of your Closure Amendment for your records and a response form which invites you to share your comments with us, if you wish. We request you consider taking time to provide your feedback then return it in the self-addressed, stamped envelope.

If you have any questions about this letter, you can reach me by calling (insert teacher’s cell number). I will be happy to hear from you. If you prefer, you can also get ahold of Kim Walford, Independent Living program administrator, at 515–250–1184 or 1–800–362–2587.

If you do not agree with this eligibility determination and closure, you may contact me to talk, or you may call the Independent Living program administrator or you may contact the Iowa Client Assistance Program (ICAP) for help with mediation or an appeal. ICAP is located at:

Iowa Client Assistance Program
Lucas State Office Building
Des Moines, Iowa 50319
Phone: 515–281–8088 or 1–800–652–4298

Thank you for your time and consideration in this matter.

Sincerely,

[Insert teacher’s digital signature][ILR Teacher’s Name]
[Insert teacher’s signature block information]

Enclosures:
ICAP Brochure
Closure Letter
Closure Amendment

[Insert initials of teacher/initial of typist]

Rev. 10/20
Rev. 05/19

Appendix K: Status 26 Rehabilitated, Independent Living Notice or Closing Il Plan Successful

[Date]

Name
Address
City/State/Zip

Dear:

Congratulations on meeting your independent living goals! As we discussed, this means I will be inactivating your case. Please be assured that this does not affect your Library services should you receive that service.

Enclosed with this letter is your copy of the Closure Amendment for your records. There is also a “Client Feedback Form”, in which you are welcome to share your comments on services you received. You may return this form in the self-addressed, stamped envelope, also enclosed.

If you do not agree with this closure, you may contact the Iowa Client Assistance Program (ICAP) for help with mediation or an appeal. An ICAP brochure has been enclosed. ICAP is located at:

Iowa Client Assistance Program
Lucas State Office Building
Des Moines, Iowa 50319
Phone: 515–281–8088 or 1–800–652–4298

Should you have any questions about this closure regarding your Independent Living services or case, please feel free to contact us. The Department’s phone number is 800–362–2587 if it is long distance for you to call us. My direct phone number is [insert teacher’s number].

I’ve enjoyed getting to know you and work with you. Thank you for your time and consideration in this matter.

Sincerely,
[Insert teacher’s digital signature][ILR Teacher’s Name]
[Insert teacher’s signature block information]

Enclosures:
ICAP Brochure
Client Closure Amendment
Client IL Feedback Form

[Insert initials of teacher/initial of typist]

Rev. 10/20
Rev. 05/19

Appendix L: Status 28 Closed, Other Reasons, After Il Plan Initiated Independent Living Notice or Letter Closing an Il Case Plan as Discontinuing Services With Training Plan Incomplete

[Date]

Name
Address
City/State/Zip

Dear [name]:

In follow-up with our conversation on (state date), we have agreed to discontinue Independent Living services for (state reason). Enclosed with this letter, you will find your Closure Amendment Form for your records as well as a Client Feedback Form. The Client Feedback Form invites you to share your comments about our services, if you wish. There is also a self-addressed, stamped envelope enclosed to return the form.

If you are a Library patron, please be assured that this does not affect your Library services. I also encourage you to call us if, in the future, you want to reapply for Independent Living program services.

If you do not agree with this closure, you are willing to contact [ insert teacher’s info]. If you prefer, you are welcome to call our Independent Living program administrator, Kim Walford, at 515–250–1184 or 1–800–362–2587. You also have the right to contact the Iowa Client Assistance Program (ICAP) for help with mediation or an appeal. There is a brochure enclosed about ICAP. ICAP is located at:

Iowa Client Assistance Program
Lucas State Office Building
Des Moines, Iowa 50319
Phone: 515–281–8088 or 1–800–652–4298

Thank you for your time and consideration in this matter.

Sincerely,

[Insert teacher’s digital signature][ILR Teacher’s Name]
[Insert teacher’s signature block information]

Enclosures:
ICAP Brochure
Closure Amendment
Client Feedback Form

[Insert initials of teacher/initial of typist]

Rev. 10/20
Rev. 05/19

Appendix M: Plan Status 30, Closed Other Reasons, Before Ipe is Initiated

[Date]

Name
Address
City, IA Zip

Dear [name],

The Independent Living Services program of the Iowa Department for the Blind has determined that you will not be receiving Independent Living services from this agency as we did not receive a response from you. Please be assured that this does not affect any Library services you may receive.

If you have any questions regarding this decision, please contact me or the Independent Living program administrator, Kim Walford, at 515–250–1184 or 1–800–362–2587. You have the right of appeal and you may also want to contact the Client Iowa Client Assistance Program at 1–800–652–4298.

Thank you for your attention to this matter, and I wish you the very best moving forward.

Sincerely,
[Insert teacher’s digital signature]
Teacher’s Name
Independent Living Teacher
Iowa Department for the Blind
524 4th Street
Des Moines, IA 50309

[Insert initials of teacher/initial of typist]

Rev. 10/20
Rev. 05/19

Appendix N: Sample Applicant/client Transfer Letter

[Date]

Name
Address
City/state/zip

Dear [name]:

This letter confirms our recent conversation, when I explained that I will no longer be serving (Name of County) for the Iowa Department for the Blind; as we discussed, this change is due to a regional service area change for all rehabilitation teachers.

(Write the reason for the change in regional service area). You may email, text or call your teacher at any time and they will respond to questions whether they are working in yours or another area.

(Insert name of new teacher) will serve as your new teacher and will be calling you to introduce herself/himself and provide more information about when she/he expects to be working in your area. (Name of new teacher) may be reached at (insert phone number) and (insert email address).

I have enjoyed working with you and wish you the best.

Sincerely,

[Insert teacher’s digital signature][ILR Teacher’s Name]
[Insert teacher’s signature block information]

[Insert initials of teacher/initial of typist]

Rev. 10/20
Rev. 05/19

Appendix R: The Blind Journal

The Blind Journal is a record of all persons in the State of Iowa who are blind or severely visually impaired. By law, the Department is charged with maintaining this record, and new entries are posted when a person is certified as being legally blind. ILR teacher’s tasks during the initial contact are to determine whether the person is legally blind or has severe vision loss. All individuals who are determined to be legally blind must be registered immediately in the Blind Journal, even if they decline services from the Department.

This determination may be made during initial contact, interview, or at eligibility.

The definition of legal blindness means:

• A visual acuity of 20/200 or less in the better eye with best correction; or restricted fields of 20 degrees or less; or
• A person cannot count fingers at 5 feet; or
• A person cannot efficiently read 24-point type at 14 inches.

Certification methods:

1. Medical proof (e.g., a photocopy, original letter, library application, or Social Security transmittal) of a statement by a medical doctor declaring the individual to be legally blind; or
2. A case note indicating that the ILR Teacher has observed that the individual has only Light perception or no vision in both eyes; or
3. A case note stating that the ILR Teacher has performed a finger counting test and that the individual’s best acuity is finger counting at five feet or less, or that the individual is unable to efficiently read 24-point type at 14 inches.

Designations When Documentation Is Not Available:

It is not always possible to obtain the documentation to determine legal blindness or severe vision loss. In those instances, the individual must be assigned one of the following designations:

• Not Blind: The individual does not have a progressive eye condition that would lead to blindness. Maybe only one eye has diminished vision.
• Severe Vision Loss: The individual’s visual acuity is between 20/50–20/199.
• Presumed Blind: The individual has several functional limitations based on vision loss, but there is no documentation to support the legal blindness designation.

Appendix S: Case Statuses

• 02 – Applicant
• 08 – Closed, Not Accepted/Ineligible for IL Services
• 10 – ILRP or Waiver Development
• 12 – ILRP or Waiver Completed
• 18 – Training
• 24 – Services Interrupted
• 26 – Closed Rehabilitated
• 28 – Closed Not Rehabilitated
• 30 – Closed Other Reasons Before the IL Plan Initiated

Rev. 05/19

Appendix T: Procedures & Standards for Length of Time in Statuses

To ensure that IL services are provided in a timely manner, IDB has established standards for the length of time an individual will stay in a particular case status. These guidelines do not constitute absolute time limits on the provision of specific services or on the provision of services to an individual. The duration of each service needed by any individual shall be determined on a case-by-case basis and reflected in that individual’s file.

Status Maximum Times

• 02: 2 months. If a case must remain in Status 02 due to exceptional circumstances, e.g., the Applicant’s health or the Applicant’s being out of state, the issue shall be documented in the case file and the ILR Teacher or Program administrator must approve the exception by writing a note in the case.
• 10: 3 months. While this is the maximum time for an IL case, unless exceptional circumstances arise, the case should be moved to Status 18 with the development of the ILRP or Waiver immediately after the eligibility determination has been made.
• 18: 12 months
• 24: 6 months

These standards are intended as tools for both the ILR Teacher and the Program Administrator in processing cases and in monitoring case processing.

Cases remaining in a status beyond the recommended time in status shall have documentation reflecting the case activity, and IDB requirements pertaining to case documentation shall be applied for all cases.

Appendix U: Case Narration

Record of Services:

State and federal regulations and IDB policy require that certain information be contained in each individual’s record of services. The nature and scope of that information varies in relation to where the individual is in the VR or IL process denoted by the statuses used. This document applies to the IL Division of the IDB.

Case Notes:

Case notes serve several purposes for the ILR teachers, reviewers and consumers, as well as others, such as auditors, impartial hearing officers, and mediators to

1. Review an individual’s progress through the IL process by presenting a picture of measurable and observable events that have happened, that are happening, and that are being planned
2. Review the organization and integrate subjective impressions and ideas
3. Serves as a repository of information on individuals including those when cases are transferred to another program staff in the future
4. Serves as a historical record, justifications, and the actions taken by program staff

For the ILR teachers, the case notes provide information to assess:

• the planning process in the case
• progress or lack of progress in the plan
• compliance with the IL or IL-OIB processes and other IDB policies and procedures

For the reviewers, the case notes provide information to assess compliance with the state and federal regulations and IDB policies and procedures pertaining to the IL processes as well as information to document the appropriateness of expenditures.

Guidelines to apply to case note documentation:

IL case notes must be in the record, the electronic or hard copy file, preferably within 24 hours following the visit; however, no later than ten (10) business days after the contact.

The longer the lapse of time before the case note is created, the likelihood that important details will be forgotten increases. ILR teachers have five (5) business days to enter VR case notes when there has been contact with a VR applicant and/or client of the agency.

The case record is a legal document so do not make comments in a case note unless you are prepared to defend those statements on the public record in a court of law. IL teachers may not copy and paste program administrator/supervisor or other colleague emails or transcribe phone conversations to case records. IL teachers may document for instance a decision to an exception to policy such as (a) the program administrator approved the exception to policy or (b) the program administrator denied the exception to policy.

Case note entries should be made to synthesize information which permits the ILR teacher to understand the applicant better, document important events and developments such as movement through the IL rehabilitation process (the statuses), justify actions taken, synthesize progress or lack of progress toward achievement of the IL rehabilitation goal and objectives, and facilitate required periodic reviews (at least annual reviews of the plan), and related efforts and activities.

Guidelines to apply to case note content:

Case status summaries can be written at the time of movement from one case status to another with reference to the activity necessary to move into the case status.

Counseling and guidance case notes should be documented in the record of services and focus upon the purpose and outcome of the counseling session and the actions to be taken by the ILR teacher and client prior to the next contact.

Observations of the client should be recorded in behavioral statements rather than using medical or psychological labels or subjective components because behavioral statements are observable and measurable.

If possible, reference forms and reports (medical, training, assessment, etc.) by date and author of the particular report being referenced in the record of services, in order to avoid duplicating information that appears elsewhere in the case.

Planning efforts and outcomes should be recorded in the case notes, in addition to what has occurred. Examples of case note content driven by where the individual is in the IL process:

• Status 02 application. Case notes should be relevant to activities in determining eligibility such as documentation of disabilities, resultant functional limitations, and the need for independent living services, documentation that the applicant has been informed of the informed choice process, documentation that the applicant has been given the required information regarding his or her privacy rights under HIPAA, and documentation of any assertion that the applicant for IL services is eligible under Title VII, Chapter 1 or Title VII, Chapter 2 and the Administration for Community Living program.
• Status 08 closed, not accepted/ineligible for IL. Case notes should reflect that, if determination is made that the applicant is ineligible, documentation that the ILR teacher and client or the client’s representative, as appropriate, have had an opportunity for full consultation regarding the decision, including the reasons for the determination, the means by which the client may express dissatisfaction, and the specific remedies. If the case is closed before the eligibility determination is made, document that the reasonable attempts made to contact the individual are unsuccessful.
• Status 10 IL developed. Case notes should contain information relevant to determination of the impact of the disability-related limitations as it relates to the IL functional limitations as it relates to the comprehensive IL Skills Assessment and the Client’s abilities, as well as the ILRP or IL plan waiver development.
• Status 12 IL completed. Case notes should include that the ILRP or Waiver plan has been completed and agreed to in partnership between the client or the client’s personal
  representative and the ILR teacher.
• Status 18 this is a training status. The signed and agreed to ILRP or IL Waiver plan form should be in the paper case record and in the electronic CMS. The case notes should contain information relative to progress or lack of progress toward attaining the IL goal and objectives and justification or rationale for the authorizing or the purchase of services, devices or equipment including the transfer of aids/devices/equipment (not just, that an authorization was written). Case notes must be entered by the teacher to the electronic by the teacher within 10 business days of meeting the client and 5 days within meeting the VR client. The plan review can be reviewed at any time with the client and at least annually between the teacher and client. If the client is unavailable to conduct the review in partnership with the teacher and attempts have been made to meet with the client to conduct the review, the teacher will conduct the review and document the results.
• Status 24 is service interruption. Case notes require documentation of the rationale if there has been any interruption in services on the part of the agency or the client or if any service(s) was not initiated according to the timelines identified on the plan.
• Status 26 closed rehabilitated. Case note information should include a determination by the ILR teacher and Client that the outcome is satisfactory and that the client and ILR teacher are in agreement that the Client is performing well in the IL situation. Documentation confirming that the outcome is consistent with the IL goal on the plan should be present.
• Status 28 closed, other reasons, after IL plan initiated. Case note information should reflect Closed for Other Reasons after the plan, and the rationale for closing the case because Waiver is initiated, the client is deceased, the Client terminated the partnership before the Plan was completed, or the client moved out of the state.
• Status 30 closed, case closed before IL plan was initiated. Case note information should reflect Closed for Other Reasons, before IPE initiated.

Appendix V - Health Insurance Portability and Accountability Act (HIPAA) & Confidentiality of Information

Overview of HIPAA:

The Health Insurance Portability and Accountability Act of 1996 (HIPAA), Public Law 104–191, resulted in the establishment of the HIPAA Privacy Rule in December of 2000. The HIPAA Privacy Rule is a federal rule designed to protect individuals’ medical records and other personal health information. This federal law provides further requirements and restrictions in addition to the confidentiality provisions set out in IDB’s Confidentiality Policy.

In the course of business, the Department receives, discloses, and utilizes Protected Health Information (PHI) of employees and consumers for a variety of reasons. Employees should exercise care at all times to discuss confidential, sensitive, or personal health information in a manner or place where the discussion is not able to be easily overheard. Measures should be taken to ensure that health information is not accessible to anyone other than authorized personnel. IDB staff will maintain privacy, confidentiality and integrity with regard to PHI as required by state and federal laws, rules, regulations, and professional ethics codes. Employees found to be in violation of this policy may be subject to disciplinary action up to and including discharge as well as prosecution in a court of law.

With certain exceptions, PHI refers to any individually identifiable health information that is created or received by a covered entity. PHI is defined as any information relating to past, present, or future physical or mental health of an individual; the provision of health care to the individual or the payment for health care services. Individually Identifiable health information is health information that identifies or may reasonably be used to identify the individual. To be PHI, it must include medical information and a personal identifier.

PHI includes but is not limited to:

• Consumer Name
• Address and telephone number
• Employer and occupation
• DOB and SSN
• Medicaid number
• Diagnosis
• Hospital, physician, and therapist evaluations and records
• Eye examination reports
• Authorizations, payments, and statements of charges for services
• Consumer contacts, progress notes, and summaries
• All information contained in the case record is considered PHI

HIPAA requires:

• In limited circumstances, giving the individual an opportunity to agree or object to uses and disclosure of PHI
• The Privacy Notice
• Allowing individuals to access their PHI
• Permitting individuals to request an amendment to their PHI
• Allowing persons to request an accounting of disclosures of their PHI
• Defining a minimum use standard
• Establishing who has access to PHI
• Civil and criminal penalties for violating the HIPAA standards
• Workforce members to be trained on and to acknowledge the HIPAA privacy provisions
• Verifying the identity and authority of persons requesting a consumer’s PHI
• Allowing recipients to request restrictions on the use and disclosure of PHI
• That organizations have a Privacy Officer.

The Notice of Privacy Practices must be provided to consumers and documented in the case record effective April 14, 2003 and then thereafter by:

• Providing a copy in an accessible format upon an individual’s request
• Providing a copy at the time a person applies for IDB services
• Posting the notice in each office in a clear and prominent location
• Making the notice available at each office so an individual can request and obtain a copy
• Issuing a copy within 60 days of a material revision of the notice
• Notifying the client, no less frequently than once every three years of the availability and how to obtain a copy
• Posting the notice on the agency’s Web site
• Emailing a copy upon an individual’s request for an electronic notice

Federal regulations provide that employee use and access to PHI must be limited to the minimum necessary to carry out the intended purpose of use, disclosure or request. In general, the minimum necessary does not apply when requested by the individual who is the subject of the information, when requested by a health care provider for treatment or disclosures required by law. Staff must ensure that PHI is not unnecessarily or inappropriately accessed or disclosed. If staff members have any concerns that what is being requested is beyond the minimum necessary, directly ask the requestor if they believe this is the minimum that is required to accomplish the task. If staff members still have a question involving disclosure of more than the minimum amount and it concerns situations named in this paragraph, contact the IDB Privacy Officer through appropriate Supervisory channels for guidance.

With regard to individually identifiable health information, “use” means the sharing, examination, utilization, employment, or analysis of the information within IDB. Disclosure means the release, transfer, provision of access to, or divulging information outside of IDB.

An individual’s medical records such as hospital and doctor reports and medical claims are PHI and confidential. Release of these medical records requires a signed authorization from the consumer or consumer’s representative except as listed below. Staff should use an IDB Authorization to Obtain or Release Health Care Information when requesting health information from medical providers or other agencies. IDB staff may use and disclose PHI without the consumer’s authorization, subject to certain restrictions, in the following situations:

• To the consumer
• For treatment, payment or health care operations
• De-identified PHI
• Incidental disclosures
• To family and friends involved in the person’s healthcare
• To a public health authority*
• To report child abuse or neglect*
• To the United States Food and Drug Administration for purposes concerning quality
  • Or
• Effectiveness of such FDA regulated products or activity*
• To a health oversight agency that is authorized by law to conduct audits, investigations, inspections and other activities for oversight of health care systems, certain government programs, etc., (for example, RSA) *
• To respond to court orders or subpoenas and discovery requests. Staff should immediately deliver a copy of such requests to the IDB Privacy Officer*
• To law enforcement officials as required by law or pursuant to a court order, a court-ordered warrant, or a subpoena or summons issued by a judicial officer; a grand jury subpoena; or an administrative request, such as an administrative summons or a civil investigative demand; for purposes of identifying or locating a suspect, fugitive, material witness, or missing person; or regarding a crime victim*
• To avert a serious threat to health or safety e.g., staff contacts the local police department to request assistance to prevent or lessen serious or imminent threats*
• To certain governmental functions (such as national security purposes, veteran’s information)*
• As required by law such as in legal proceedings in which the consumer is represented by an attorney or legal aid*
• To agencies that are government programs providing public benefits*

The above releases marked with an asterisk (*) are subject to tracking requirements. If staff disclose PHI for reasons above listed with asterisks, or if an unauthorized disclosure is inadvertently made, the disclosure should be tracked by completing the Record of Disclosures Form, placing a copy in the case record and submitting a copy to the IDB Privacy Officer.

Consumers may complete the IDB Request for an Accounting of Disclosures. Each consumer should submit this form directly to the IDB Privacy Officer.

A “business associate” is a person or organization, other than a member of a covered entity’s workforce that performs or assists in the performance of a function or activity involving the use or disclosure of individually identifiable health information or provides services to the IDB. With certain conditions, HIPAA allows the IDB to share and disclose to a business associate any PHI necessary to perform the job. A business associate may separately create or receive PHI for the Department. HIPAA requires that IDB obtain satisfactory assurance through written contract that the business associate will appropriately safeguard the information. IDB will use Memoranda of Understanding (MOU) rather than Business Associate Agreements with governmental entities.

Consumers have the right to request specific restrictions on the use or disclosure of PHI by completing the IDB Request for Restriction of Information Form. Staff must send the completed request to the IDB Privacy Officer, who will then determine whether to accept or deny the request.

A consumer or the consumer’s personal representative who believes his or her health records are incomplete or incorrect may request an amendment or correction of the health records by submitting the Request to Amend Health Information Form to the Privacy Officer.

Do not consider information learned during the regular course of business to be an amendment, e.g., when a consumer provides the name of a new treating physician. Additions to the file are not amendments. Regarding minor discrepancies such as typing errors, misspelled names, wrong dates, etc., staff may correct the entry by drawing a single line through the error, adding a note that explains the error, dating it, initialing it, and by making the correction as close as possible to the original entry in the record. All other requests for the amendment of PHI must be in writing and include the reason to support the amendment. The request should include any documentation that explains or verifies the incorrect or incomplete PHI that the consumer is requesting to amend.

Consumers may request to have access to and obtain a copy of their PHI. The request may include the complete case record or specific PHI, such as an eye report. The consumer must complete the IDB Request for Access to Health Information Form. Staff shall process the request as instructed on the form. Place the original IDB Request for Access to Health Information Form in the case file. Send a copy of the form to the Privacy Officer.

If the requested information is maintained electronically and the consumer requests an electronic or faxed copy, accommodate the request if possible and explain the risk to security of the information when transmitted as requested. If the information is not available in the format requested, produce a hard copy document or other format agreed upon by the consumer. Provide the access requested in a timely manner, and arrange for a time and place for the consumer to inspect the PHI or obtain copies, unless access by another method has been requested by the consumer and agreed to by staff.

The requesting individual must be allowed to inspect or obtain a copy of his or her PHI no later than 30 days after staff gets the request (60 days if the information is not maintained or accessible to IDB on-site). This deadline may be extended up to 30 days if the individual gets a written statement of the reasons for the delay and the date staff or the Privacy Officer will fulfill the request.

DO NOT give the claimant the requested PHI. Immediately forward to the IDB Privacy Officer a copy of the information that the consumer is requesting and the Request for Access to Health Information Form. The Privacy Officer shall determine whether to approve or deny the request. If the request is denied, the Privacy Officer shall notify the claimant and staff of the decision.

If the Privacy Officer denies access to PHI, in whole or in part, he or she may instruct staff to provide the consumer other PHI information accessible to the individual after excluding the denied PHI and information regarding where the consumer can direct the request if the PHI requested is not maintained by IDB and staff knows where the requested information is kept. The Privacy Officer may provide a summary or explanation of the requested PHI if the consumer agrees in advance to the summary or explanation in place of the record or the consumer agrees in advance to pay any fees imposed for the summary or explanation.

The PHI of a deceased consumer may only be released to the personal representative or executor of the person’s estate.

The consumer usually exercises his or her own privacy rights. However, some persons may be legally or otherwise incapable of asserting their privacy rights. Moreover, an individual may authorize another person to act on his or her behalf. When a consumer has a designated personal representative, whose identity is clear from a legal document, the representative shall be treated as the consumer.

Under certain circumstances, HIPAA permits disclosures “… to a family member, other relative, or a close personal friend of the individual, or any other person identified by the individual, the protected health information directly relevant to such person’s involvement with the individual’s care or payment related to the individual’s health care.” Before disclosing information to one of these persons, staff must:

• Obtain the consumer’s agreement
• Give the consumer an opportunity to object to disclosure, and the consumer does not object
• Staff infers from the circumstances based on professional judgment that the individual does not object to the disclosure
• If the consumer is not present due to his or her incapacity or emergency circumstances, staff concludes that it is in the best interest of the consumer to disclose the minimum necessary PHI that is directly relevant to the person’s involvement with the consumer’s health care. (This situation may occur when a family member or relative is applying for and handling the affairs of their hospitalized, institutionalized, disabled, blind, or elderly relative.)
• Staff must ensure that PHI is not improperly released. To avoid this, verify the requestor’s identity and ensure that the person has the proper authority to obtain the PHI. If the consumer is unknown to the person or entity releasing the information, require the consumer to verify his or her identity. For telephone calls, staff may have to return the call.

Before returning the call, verify the number through the phone directory.

If any individual believes that IDB or its representatives are not complying with the requirements of HIPAA, he or she may file a complaint with one or both of the following:

DSS Complaint Officer; PO Box 1527; Jefferson City, MO 65102–1527
Secretary of the Department of Health and Human Services (DHHS);
200 Independence Avenue, SW; Washington, DC, 20201.

The Health Insurance Portability and Accountability Act Complaint Form shall be provided to the complainant by the office where the complaint is lodged. The Privacy Officer will contact the facility from which the complaint originated and complete an investigation within thirty (30) days from the date it is received by the Department. Once completed, the Complaint Officer will issue a response letter to the complainant with the determination and any indicated corrective measures. If the complainant is not satisfied with possible resolutions, the Complaint Officer will provide information regarding the process of filing a complaint with the Secretary of DHHS.

IDB staff shall not intimidate, threaten or coerce, discriminate, or take other retaliatory actions against a person for exercising his or her HIPAA rights or for participating in a HIPAA-established process. Moreover, they shall lessen any known harmful effects the use or disclosure of PHI that violates the HIPAA privacy provisions causes any individual. It is IDB policy that staff will take appropriate action to prevent further inappropriate uses or disclosures, and pursue any feasible actions to lessen the harmful effects of any such violations. Staff shall contact the Privacy Officer for instructions if mitigation is necessary.

Documentation recording disclosures of PHI should be retained for a period of six years.

Records involved in any open investigation, audit, or litigation should not be destroyed. If notification is received that any of the above situations have occurred or there is the potential for any of these situations, the record retentions shall be suspended for these records until the situation has been resolved.

Destruction or disposal of PHI shall be done in accordance with federal and state law and IDB policies. This may include any record of consumer health information, regardless of medium or characteristic that can be retrieved at any time. This includes all original consumer records, documents, papers, letters, billing statements, x-rays, films, cards, photographs, sound and video recordings, microfilm, magnetic tape, electronic media, and other information recording media, regardless of physical form or characteristic, that are generated and received in connection with transacting consumer care or business.

Records scheduled for destruction or disposal shall be secured against unauthorized or inappropriate access until the destruction or disposal of consumer health information is complete. Health information media must be destroyed or disposed of using a method that ensures the health information cannot be recovered or reconstructed.

Rev. 05/19

Appendix W: Eye Diseases or Disorders – Eye Condition Terminology

The following list of eye diseases or disorders is provided as a guide to familiarize the ILR teacher with certain terminology which is associated with the blindness rehabilitation field.

• Accommodation: The ability of the eye to adjust for varying distances.
• Acetylcholine: Chemical compound essential for the transmission of nerve impulses.
• Albinism: Ocular; complete absence of pigment in eyes.
• Amaurosis: Blindness occurring without any apparent lesion of the eye.
• Amblyopia: Severe loss of vision with no detectable organic lesion of the eye.
• Aneurysm: A sac formed by the dilation of the walls of an artery or vein, and filled with blood.
• Angiitis: Inflammation of the blood vessels.
• Angle of anterior chamber: Junction between iris and cornea through which the aqueous flows.
• Angoid streaks: Bands appearing in the retina, often associated with systemic disease.
• Aniridia: Absence of the iris.
• Anisekomia: A condition in which the image of an object seen by one eye differs in size and shape from that seen by the other eye.
• Anisometropia: A difference in the refractive power of each eye, resulting in a difference in the apparent size of objects seen.
• Antibody: Part of the body’s defense mechanism against disease.
• Antigen: Substance which induces formation of antibodies.
• Aphakia: Having no lens in the eye, e.g., after cataract removal.
• Aqueous humor: Fluid in the anterior chamber of the eye.
• Arcus senilis: A white ring around the margin of the cornea, especially in the aged.
• Asthenopia: Weakness or tiring of the eyes, dimness of vision.
• Astigmatism: Visual defect caused by abnormal curvature of the cornea.
• Atropine: Drug that paralyzes parasympathetic nerve action; applied locally to the eye to dilate the pupil and paralyze ciliary muscle.
• Autoimmunity: Allergy to one’s own tissue.
• Blepharitis: Inflammation of the eyelids.
• Blepharospasm: Spasm of eyelid muscles.
  Blind spot: Normal defect in visual field due to position at which optic nerve enters the eye.
• Buphthalmos: Enlargement of the eye.
• Canaliculus: (Lacrimal) narrow tubular passage, tear duct.
• Canthus: The angle at either end of the slit between the eyelids.
• Cataract: An opacity of the lens.
  Incipient: Any cataract in its early stages, or one which has sectors of opacity with clear spaces intervening.
  Mature: A cataract in which the lens is completely opaque and ready for operation.
  Hypermature: A cataract in which the lens has become either solid and shrunken or soft and liquid.
• Congenital: Any eye abnormality like a cataract, which originates before birth.
• Senile: A hard opacity of the lens in the aging eye.
• Traumatic: Any eye abnormality like a cataract, which follows injury.
• Choked disc: Swelling of the optic nerve.
• Chorioretinitis: Inflammation of the choroid and retina.
• Choroid: Vascular layer of the eyes, the function of which is to nourish the retina.
• Ciliary body: Portion of vascular layer of eye whose function is secretion of aqueous humor.
• Coloboma: A congenital defect in which a portion of a structure of the eye is absent.
• Cone, retinal: A specialized visual cell in the retina, responsible for sharpness of vision and color vision.
• Conical cornea, keratoconus: A conical protrusion of the cornea.
• Conjunctiva: The delicate membrane that lines the eyelids and covers the exposed surface of the eyeball.
• Contact lens, corneal: Contact lens molded to the cornea.
  Contact lens, scleral: Contact lens molded to the sclera.
• Corticosteroids: Cortisone derivatives.
  Cryosurgery: Use of low temperatures in surgery.
• Cup, optic: Depression in the center of the optic nerve.
  Cyclitis: Inflammation of the ciliary body.
• Cycloplegia: Paralysis of the ciliary body.
• Cytomegalic inclusion disease: Retinal viral inflammation.
• Dacryocystitis: Inflammation of the lacrimal sac.
• Detachment of retina: A condition in which the inner layers of the retina are separated from the pigment layer.
• Diabetic retinopathy: Refer to retinopathy.
• Diopter: A unit designating the refractive power of a lens.
• Diplopia: Double vision.
• Disc, optic: The optic nerve within the eye.
• Electroretinogram: A record of changes or electrical potential in the retina after stimulation of light.
• Emmetropia: Perfect vision.
• Endophthalmitis: Inflammation of the interior structures of the eye.
• Enucleation: Surgical removal of the eye.
• Estropia: Actual deviation of the visual axis of one eye toward the other, “crossed eyes”.
• Esphoria: A tendency to deviation of the visual axis of one eye toward the other.
• Exophoria: A tendency to deviation of the axis of one eye away from the other.
• Exophthalmos: Abnormal protrusion of the eyeball.
  Exotropia: Actual deviation of the axis of one eye away from the other, “walleyes”.
• Flash blindness: Loss of vision resulting from intense light, such as that of atomic blast.
• Fovea centralis: A tiny depression in the center of the macula, the area of greatest visual acuity.
• Fundus: The base or remote interior of an organ such as the eye.
  Glaucoma: A condition of the eye characterized by increased intraocular pressure.
  Acute: Closed angle glaucoma is caused by obstruction of the filtration angle at the base of the iris.
  Chronic Simple: Open angle occurs when the angle of the anterior chamber is open and free from obstruction.
  Congenital Glaucoma: Glaucoma that’s present at birth because of a defect in the angle of the anterior chamber.
  Absolute: A final stage in which vision is completely and permanently lost.
• Gonioscopy: Examination of the anterior chamber of the eye.
• Gonorrheal ophthalmia: Blinding eye disease of newborn infants acquired in the birth canal.
• Hemianopia: Deflective vision or blindness in half of the visual field.
• Herpes simplex: An acute viral disease marked by groups of watery blisters on the skin and mucous membranes; the most common cause of blindness due to a corneal disease.
• Histoplasmosis: Parasitic inflammation affecting the eye.
• Hyperopia: Farsightedness.
• Hyphaema: Hemorrhage into the anterior chamber of the eye.
• Intraocular pressure: The pressure of the fluid within the eye.
• Iridectomy: Surgical removal of part of the iris.
• Iridocyclitis: Inflammation of the iris and the ciliary body.
• Iritis: Inflammation of the iris.
• Keratitis: Inflammation of the cornea, usually characterized by loss of transparency and dullness.
• Keratoconus: Conical cornea, a conical protrusion of the cornea.
  Keratoprosthesis: Corneal implant, usually of plastic material, artificial cornea.
• Lagophthalmos: A condition in which the eye cannot be completed closed.
• Lens: Lens of the eye; a transparent biconvex body, situated between the posterior chamber and the vitreous, through which the light rays are focused on the retina.
• Lenticular: Pertaining to or shaped like a lens.
• Leukoma: A dense white opacity of the cornea.
• Levator muscle: Muscle which raises the eyelid.
• Limbus: A border; the edge of the cornea where it joins the sclera.
• Macular degeneration: Involves loss of central or reading vision, loss of clarity of color; cause and cure not known; peripheral vision is never affected.
• Macula lutea: An oval area in the center of the retina devoid of blood vessels.
• Microphthalmos: A rare developmental defect in which the eyeballs are abnormally small.
• Miosis: Reduction in the size of the pupil.
• Miotic: Drug which causes a reduction in the size of the pupil.
• Muscae volitantes: Small floating spots when looking at a bright uniform field, such as the sky; attributed to minute remnants of embryonic structure in the vitreous humor.
• Mydriasis: Increase in pupil size.
• Myopia: Nearsightedness.
• Myopic degeneration: A form of nearsightedness which may lead to blindness.
• Needling (of cataract): A surgical procedure in which the lens is punctured to allow the absorption of the lens substance.
• Neuritis, optic: Inflammation of a nerve, e.g., the optic nerve.
• Nystagmus: A regular, rapid, characteristically involuntary movement or rotation of the eyes.
• Oculist: Ophthalmologist.
• Oculomotor: Pertaining to the movement of the eye.
• Opacity: The condition of being opaque.
• Ophthalmodynamometer: An instrument for measuring the blood pressure in the retinal artery.
• Ophthalmologist: A medical practitioner specializing in the field of medical and surgical care of the eye.
• Ophthalmoscopy, direct: The mirrored observation of the upright image of the interior of the eye.
  Ophthalmoscopy, indirect: The observation of an inverted image of the interior of the eye.
• Optic atrophy: Degeneration of the optic nerve fibers; visual loss usually accompanies this condition.
• Optic chiasm: An arrangement of nerve fibers in which the optic nerves of both eyes cross at a junction near the pituitary gland.
• Optic disc: The portion of the optic nerve within the eye which is formed by the meeting of all retinal nerve fibers at the level of the retina.
• Optic neuritis: Inflammation of the optic nerve.
• Optician: one who designs or manufactures optical instruments, glasses.
• Optometrist: An expert in optometry; nonmedical visual care.
• Orbicularis: An eyelid muscle which closes the eye.
  Orbit: The cavity in the skull which contains the eyeball.
• Orthoptics: The teaching and training process for the elimination of strabismus.
• Pallor of disc: Paleness of the optic nerve, suggesting atrophy.
• Palpebral: Pertaining to the eyelid.
• Panophthalmitis: Inflammation of all the structures of the eye.
• Papilledema: Non-inflammatory edema of the optic nerve head.
• Pathway: Visual–the neural path of visual impulses.
• Pemphigus: A progressive and often fatal condition of blistering and scarring of the mucous membranes and the skin which can affect the eye.
• Perimeter: An instrument for measuring the field of vision.
• Phakoma: A small grayish white tumor in the retina.
• Phlycetenule: A minute ulcerated nodule of the cornea or conjunctiva.
• Phoria: A tendency to deviation of the eyes from normal.
• Photophobia: Abnormal sensitivity to and discomfort from light.
• Phthisis bulb: Shrinking, wasting, and atrophy of the eyeball.
• Pigment ephithelium: A layer of cells in the retina containing pigment granules.
• Pilocarpine: A substance that cause the pupil to contract.
• Pituitary ablation: Destruction of the pituitary gland.
• Pleoptics: A technique of eye exercises designed to develop fuller vision and binocular cooperation.
• Posterior pole of eye: The center of the posterior curvature of the eye.
• Presbyopia: Severe loss of vision due to advancing years or old age.
  Pterygium: A growth of the conjunctiva considered to be due to a degenerative process caused by long-continued irritation as from exposure to wind and dust.
  Ptosis: A paralytic drooping of the upper eyelid.
• Pupil: The opening of the center of the iris of the eye for the transmission of light.
• Rectus muscle: A muscle attached to the eyeball which controls eye movements.
• Reflex, corneal: Blinking or winking in response to tactile stimulation of the cornea; reflection of light from the cornea.
• Reflex, pupillary: Constriction of the pupil when stimulated by light.
• Refractive error: A defect in the eye that prevents light waves from being brought to a single focus exactly on the retina.
• Retina: The innermost of the three tunics of the eyeball, surrounding the vitreous body and continuous posteriorly with the optic nerve.
• Retinal hole: A space where the retina has pulled away from the underlying choroid tissue.
• Retinitis pigmentosa: A hereditary degeneration and atrophy of the retina.
• Retinobalstoma: A tumor arising from retinal germ cells.
• Retino-choroiditis: Inflammation of the retina and choroid.
• Retinopathy: A disease of the retina due to various causes.
  Diabetic Retinopathy: Changes in the retina due to diabetes mellitus.
  Hypertensive: A disease of the retina associated with essential or malignant hypertension.
• Retinoscope: An instrument for measuring the refractive state of the eye.
  Retrobulbar: Situated or occurring behind the eyeball.
• Retrolental fibroplasia: A disease of the retina in which a mass of scar tissue forms in back of the lens; associated with premature birth and oxygen inhalation.
• Rubeosis iridis: Condition characterized by a new formation of vessels and connective tissue on the surface of the eye.
• Sac, conjunctival: The potential space, lined by conjunctiva, between the eyelids and the eyeball.
• Sac, lacrimal: The dilated upper end of the
  nasolacrimal canal.
• Schlemm’s canal: A circular channel at the junction of the sclera and cornea through which aqueous humor leaves the eye.
• Sclera: The tough, white, protective coat of the eye.
• Scotoma: A blind or partially blind area in the visual field.
• Separation of Retina: Separation of the retina from its pigment epithelium layer.
• Slit-lamp: An instrument producing a slender beam of light for illuminating any reasonably transparent structure, such as the cornea.
• Spasm, lid: (Blepharospasm) a sudden, violent, involuntary contraction of the eyelid; attended by pain.
• Squint, accommodative: That which is due to excessive or deficient accommodative effort.
  Convergent: That in which the visual axes converge; cross-eyed.
  Divergent: That in which the visual axes diverge.
  Paralytic: Due to paralysis of an eye muscle.
• Staphyloma: Protrusion of the cornea or sclera resulting from inflammation.
• Stereopis: Visual perception of depth or three-dimensional space.
• Stereotactic surgery: Use of three-dimensional localization in surgery.
• Strabismus: Squint; failure of the two eyes simultaneously to direct their gaze at the same object because of muscle imbalance.
• Sty (hordeolum): Inflammation of one or more of the sebaceous glands of the eyelids.
• Subluxation: Incomplete dislocation of the lens.
• Sympathetic Ophthalmia: Inflammation of one eye because of an injury in the other eye.
• Syndrome: A set of symptoms which occur together; a symptom complex
• Synechia: Adhesions, usually of the iris to the cornea or lens.
• Tarsal plate: The framework of connective tissue which gives shape to the eyelid.
• Tarsorrphaphy: Surgical attachment of upper and lower lids.
• Tear film: Microscopic film which constantly bathes the cornea.
• Tenon’s capsule: The fibrous membrane surrounding the sclera.
• Tonography: The recording of changes in intraocular pressure produced by the constant application of a known weight on the globe of the eye.
• Tonometer: An instrument for measuring the pressure inside the eye.
• Trachoma: A chronic, contagious, viral infection of the conjunctiva and the cornea.
• Tumbling: Technique of removing a cataract.
• Ulcer, corneal: Pathological loss of substance of the surface of the cornea, due to progressive erosion and death of tissues.
• Uniocular: Pertaining to or affecting one eye.
  Uveitis: Inflammation of the vascular coat of the eye (choroid, ciliary body, and the iris).
• Vision, central: Vision elicited by stimuli impinging directly on the macula.
• Vision, distant: Vision for objects at a distance, usually twenty to 200 feet.
• Vision, near: Vision for objects at a distance corresponding to normal reading distance, usually thirteen to sixteen inches.
• Vision, peripheral: Vision elicited by stimuli falling on areas of the retina distant from the macula.
• Vision, photopic: Vision attributed to cone function, characterized by the ability to discriminate colors and small detail; daylight vision.
  Vision, scotopic: Vision attributed to rod function, characterized by the lack of ability to discriminate colors and small detail, and effective primarily in the detection of movement and low luminous intensities.
• Visual acuity: Ability of the eye to perceive the shape of objects in the direct line of vision; sharpness of sight.
• Visual axis: The line of gaze, a straight line from the object seen, through the center of the pupil to the macula lutea.
• Visual cortex: Final station of visual impulses in the brain; sensory area of brain responsible for vision.
• Visual Field: The area of physical space visible to any eye in a given position.
• Vitreous, or vitreous body: Transparent, colorless mass of soft gelatinous material filling the eyeball behind the lens.
• Water drinking test: Provocative test for glaucoma in which the patient drinks one quart of water after fasting and the intraocular pressure is measured every fifteen minutes.
• Xerophthalmia: Conjunctivitis with atrophy and no liquid discharge that produces a dry, lusterless condition of the eyeball.
  Zonule of Zinn: The suspensory apparatus of the lens.

From the book Your Sight: Folklore, Fact, and Common Sense by Bernard Seeman.

1/12/2022