New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter B - Public Assistance › Article 2 - Determination of Eligibility-Categorical › Part 360 - MEDICAL ASSISTANCE › Subpart 360-5 - Eligibility Based On Disability › Section 360-5.2 - Definitions

Current through Register Vol. 46, No. 28, July 10, 2024
When used in this Subpart, unless otherwise expressly
				stated or unless the context or subject matter requires a different
				interpretation, the following mean:
(a) Blindness for MA purposes is defined as
			   the total lack of vision or residual vision being no better than 20/200 in both
			   eyes with best correction, or restriction of the visual fields, or other
			   factors which affect the usefulness of vision as prescribed in the appropriate
			   medical criteria published by the department.
(b) Disability is the inability to engage in
			   any substantial gainful activity by reason of any medically determinable
			   physical or mental impairment which can be expected to result in death or has
			   lasted or can be expected to last for a continuous period of not less than 12
			   months.
(c) Disability review team.
			   The disability review team must be composed of a medical or psychological
			   consultant and another person who is qualified to interpret and evaluate
			   medical reports and other evidence relating to an individual's physical or
			   mental impairments. As necessary, the other person also must be able to
			   determine the individual's capacity to perform substantial gainful activity.
			   The review team must review the medical report, which must include a diagnosis,
			   and medical and nonmedical evidence sufficient to determine whether the
			   individual's condition meets the definition of disability.
(d) Substantial gainful activity is any work
			   of a nature generally performed for remuneration or profit, involving the
			   performance of significant physical or mental duties or a combination of both.
			   Work may be considered substantial even if performed part-time, and even if it
			   is less responsible than the individual's former work, and it may be considered
			   gainful if it pays less than former work. The application of this definition
			   and of the amount of earnings that could result in a finding or deeming of
			   substantial gainful activity must be in accordance with applicable Federal
			   regulations.
(e) Group I. This
			   classification includes persons who show no possibility of engaging in a useful
			   occupation because they have permanent impairments which are totally disabling
			   and definitely irreversible.
(f)
			   Group II. Individuals having permanent impairments which, while totally
			   disabling at the time of initial determination, are such that the conditions
			   may be arrested or a remission may occur, or for which therapeutic advances are
			   occurring or where rehabilitation is deemed feasible. Group IIdesignation is
			   limited to those persons who are expected to show a change in physical or
			   mental status or improved functioning which will enable them to become capable
			   of substantial gainful activity.