The National Health Service (Optical Charges and Payments) (Scotland) Regulations 1998

PART IVSPAYMENTS FOR COST OF SUPPLY OF OPTICAL APPLIANCES

Eligibility – supply of optical appliancesS

8.—(1) A payment shall be made as provided for by this Part of these Regulations to meet, or to contribute towards, the cost incurred (whether by way of charge under the Act or otherwise) for the supply of an optical appliance for which a prescription has been given in consequence of a testing of sight of an eligible person–

(a)which took place under the Act; or

(b)which took place otherwise than under the Act F1....

(2) An eligible person is a person who at the time of [F2the payment for] the supply of the optical appliance is any of the following:–

(a)a child;

(b)a person under the age of 19 years and receiving qualifying full-time education within the meaning of paragraph 7 of Schedule 11 to the Act(1);

(c)a person whose resources are treated, in accordance with paragraph (3), as being less than his requirements;

(d)a person whose income resources, as calculated in accordance with regulation [F38] of, and Schedule 1 to, the Remission Regulations for the purposes of remission of charges under the Act, are equal to or exceed his requirements as so calculated but whose patient’s contribution is nil or is less than the face value of a voucher issued to him under this Part of these Regulations and whose capital resources do not exceed the capital limit;

(e)a person to whom a prescription is issued for a complex appliance.

(3) A person’s resources shall be treated as being less than his requirements if–

(a)he is in receipt of income support;

(b)he is a member of the same family as a person who is in receipt of income support;

F4(c). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

F5(d). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(e)his income resources as calculated in accordance with regulation [F68] of, and Schedule 1 to, the Remission Regulations for the purposes of remission of charges under the Act, are less than his requirements as so calculated [F7 or exceeds his requirements as so calculated by fifty per cent or less of the amount of the charge [F8referred to in regulation 3(2)(b) (supply of drugs and appliances) of the National Health Service (Free Prescriptions and Charges for Drugs and Appliances) (Scotland) Regulations 2011(2)] and his capital resources as so calculated do not exceed the capital limit;

(f)he is a member of the same family as a person described in paragraph (e) of this paragraph;

F9(g). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

F10(h). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(i)he is in receipt of an income-based jobseeker’s allowance; or

(j)he is a member of the same family as a person described in sub-paragraph (i) of this paragraph.

[F11(k)he is a member of a family–

(i)one member of which is receiving–

(aa)working tax credit and child tax credit; or

(bb)working tax credit which includes a disability element [F12or severe disability element]; or

(cc)child tax credit, but is not eligible for working tax credit;”;

and

(ii)where the relevant income of the person or persons to whom an award of a tax credit is made under section 14 of the Tax Credits Act 2002 is determined at the time of the award not to exceed [F13£15,050]; or

(l)he is a member of a family in respect of whom there is a current notice of entitlement under regulation 12A].

[F14(m)he is in receipt of pension credit guarantee credit; or

(n)he is a member of the same family as a person described in sub-paragraph (m) of this paragraph.]

[F15(o)he is in receipt of income-related employment and support allowance; F16...

(p)he is a member of the same family as a person described in sub-paragraph (o) of this paragraph] [F17; or

[F18(q)in the relevant assessment period he—

(i)received universal credit, either as a single person or as a member of a couple, where he had earned income or, in the case of a couple, the couple had combined earned income, of £435.00 or less and—

(aa)the universal credit award did not include the child element; and

(bb)he or, in the case of a couple, both members of the couple, did not have limited capability for work;

(ii)received universal credit, either as a single person or as a member of a couple, where he had earned income or, in the case of a couple, the couple had combined earned income, of £935.00 or less and either, or both, of the following sub-paragraphs apply—

(aa)the universal credit award included the child element;

(bb)he or, in the case of a couple, either member or both members of the couple, had limited capability for work; or

(iii)was a qualifying young person for whom a recipient referred to in sub-paragraph (ii) was responsible (within the meaning of Part 1 of the Welfare Reform Act 2012 and regulations made thereunder).]

[F19(4) In paragraph (3)–

[F20(a)in sub-paragraphs (b), (f) and (n), “family” has the meaning given to it by section 137(1) of the Social Security Contributions and Benefits Act 1992, as it applies to income support;]

(b)in sub paragraph (j), “family” has the meaning given to it by section 35 of the Jobseekers Act 1995; and

(c)in sub paragraphs (k) and (l), “family” has the meaning given to it by regulation 2(2) of the Tax Credits (Definition and Calculation of Income) Regulations 2002.

[F21(d)in sub-paragraph (p), “family” has the meaning given to it by regulation 2 of the Employment and Support Allowance Regulations 2008.]

[F22(e)in sub-paragraph (q)—

(i)“assessment period” means the assessment period for the purposes of universal credit as specified in regulation 21 of the Universal Credit Regulations (assessment periods);

(ii)“child element” means the child element of universal credit within the meaning of regulation 24(1) of the Universal Credit Regulations (the child element);

(iii)“couple” has the meaning given in section 39 of the Welfare Reform Act 2012 (couples);

(iv)“earned income” means a person’s earned income within the meaning of Chapter 2 of Part 6 of the Universal Credit Regulations (earned income);

[F23(v) “limited capability for work” means limited capability for work or limited capability for work and work-related activity as construed in accordance with regulations 39 and 40 respectively of the Universal Credit Regulations 2013 (limited capability for work; limited capability for work and work-related activity);]

F24(vi). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(vii)“qualifying young person” has the meaning given in regulation 5 of the Universal Credit Regulations (meaning of “qualifying young person”);

[F25(viia)“relevant assessment period” means the assessment period immediately preceding that in which the supply of the optical appliance is paid for;]

(viii)“single person” has the meaning given in section 1(2)(a) of the Welfare Reform Act 2012 (universal credit); and

(ix)“the Universal Credit Regulations” means the Universal Credit Regulations 2013.]

F26(f). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .]

[F27(4A) In relation to paragraph (3)(q), where paragraph (4B) applies, a person is to be treated as a person of a description specified by regulation 8(2) for the purposes of regulation 20.

(4B) This paragraph applies where the conditions in heads (i), (ii) or (iii) of paragraph (3)(q) are satisfied in the assessment period in which the optical appliance is paid for and—

(a)there is no relevant assessment period; or

(b)none of those conditions were satisfied in the relevant assessment period.]

(5) For the purposes of regulation 10 and other provisions of this Part as they apply to payments where the testing of sight was by or on behalf of [F28a Health Board], a person is also an eligible person if, because of the frequency with which the condition of his eyes changes, he is considered by the F29... [F30Health Board] to be non-tolerant of his existing optical appliance.]]

Issue of vouchers by ophthalmic medical practitioners and opticiansS

9.—(1) An ophthalmic medical practitioner or optician who, following a testing of sight under the Ophthalmic Services Regulations, issues a prescription for an optical appliance to a patient–

(a)who has indicated that he is an eligible person; or

(b)who (whether or not he has so indicated) is issued with a prescription for a complex appliance,

shall, in the circumstances described in paragraph (3) but subject to paragraph (4), issue to the patient a voucher relating to the optical appliance prescribed on the same occasion as he issues the prescription in accordance with [F31paragraph 14(6)] of Schedule 1 to the Ophthalmic Services Regulations.

[F32(1A) Where–

(a)a patient has been supplied with an optical appliance following a testing of sight under the Ophthalmic Services Regulations or otherwise;

(b)the patient has indicated that he is an eligible person; and

(c)the ophthalmic medical practitioner or optician, having consulted any records which he has relating to the patient and having made such enquiry of the patient as he considers relevant, is satisfied that–

(i)the prescription relating to the patient’s existing optical appliance is unchanged; and

(ii)the patient requires a new optical appliance because his existing appliance has been rendered unserviceable by fair wear and tear,

the ophthalmic medical practitioner or optician may issue to the patient, in accordance with paragraph (2), a voucher relating to the optical appliance prescribed by the prescription.

(1B) Where–

(a)a patient has been issued with a prescription following a testing of sight under the Ophthalmic Services Regulations or otherwise;

(b)the patient has indicated that, following the issue of the prescription, he has become an eligible person; and

(c)an ophthalmic medical practitioner or optician, having consulted any records which he has relating to the patient and having made such enquiry of the patient as he considers relevant, is satisfied that–

(i)no voucher has been issued in respect of the prescription; and

(ii)the prescription is unchanged,

the ophthalmic medical practitioner or optician may issue to the patient a voucher relating to the optical appliance prescribed by the prescription.]

(2) The ophthalmic medical practitioner or optician issuing the voucher shall sign it and shall–

(a)mark on it the letter code specified in column 2 of Schedule 1 which relates to the type of optical appliance prescribed as set out in column 1 of that Schedule; and

(b)duly complete the relevant parts of the voucher with the name and address of the patient, the patient’s date of birth, particulars of the prescription issued to the patient, the date on which the patient’s sight was tested and the date of issue of the voucher.

(3) The circumstances referred to in paragraph (1) are where the ophthalmic medical practitioner or optician, having consulted any records which he has relating to the patient and made such enquiry of the patient as he considers relevant, is satisfied that–

(a)the patient requires an optical appliance for the first time or an optical appliance pursuant to a prescription the particulars of which differ from those relating to his existing appliance; or

(b)the patient requires an optical appliance because his existing optical appliance has been rendered unserviceable by fair wear and tear.

(4) Where a patient requires an optical appliance pursuant to a prescription the particulars of which differ from those relating to his existing appliance only because the patient is non-tolerant of that appliance, and has been so since it was supplied to him, no voucher shall be issued unless the [F33Agency] being satisfied that the prescription for that existing appliance was clinically correct, has authorised the issue of a voucher.

(5) Unless [F34paragraph (1A) or] regulation 11 applies, not more than one voucher shall be issued to a patient in respect of any one optical appliance prescribed.

Issue of vouchers by F35... [F36Health Boards] in connection with the hospital eye serviceS

10.—(1) Where, following a testing of sight, a prescription for an optical appliance is issued to a patient–

(a)who has indicated that he is an eligible person;

(b)who (whether or not he has so indicated) is issued with a prescription for a complex appliance; or

(c)who is an eligible person by virtue of regulation 8(5),

the F37... [F38Health Board] by or on behalf of which the patient’s sight was tested shall issue to the patient a voucher relating to the optical appliance prescribed.

(2) The F39... [F40Health Board] issuing the voucher shall–

(a)mark on it the letter code specified in column 2 of Schedule 1 which relates to the type of optical appliance prescribed as set out in column 1 of that Schedule; and

(b)duly complete the relevant parts of the voucher with the name and address of the patient, the patient’s date of birth, particulars of the prescription issued to the patient, the date on which the patient’s sight was tested and the date of issue of the voucher.

[F41Issue of replacement vouchers by the Agency, F42... or [F43Health Boards] S

11.  Where, on an application by a patient within 2 years of a voucher having been issued to him under regulation 9(1) or 10(1), the AgencyF44... or [F45a Health Board] is satisfied, having made such enquiries as it considers relevant, that the voucher has been lost or destroyed without having been presented to a supplier of optical appliances, it may authorise an ophthalmic medical practitioner or optician to issue to the patient a replacement voucher completed in accordance with regulation 9(2)(a) and (b) or 10(2)(a) and (b), but with the date of issue of the voucher being that on which the replacement is issued.]

Use of vouchers for the supply of optical appliancesS

12.—(1) Subject to paragraphs (4) [F46, (5) and (6)], a patient to whom a voucher, duly completed in accordance with regulation 9, 10 or 11, has been issued may present it to a supplier who supplies or is to supply him with an optical appliance, provided that the arrangements for supply are made within [F472 years] of the date on which the voucher was issued.

(2) A supplier may accept the voucher in substitution for payment by the patient of an amount equal to its redemption value, being the whole or part of the cost incurred for the supply of an optical appliance.

(3) A voucher relating to glasses may be accepted in connection with the supply of contact lenses.

(4) Before presenting the voucher to the supplier the patient shall sign on the voucher–

(a)a declaration in writing to the effect that he is an eligible person indicating the grounds of his eligibility; and

(b)an undertaking in writing to the effect that, if he is unable to show that he is an eligible person, he will pay to the responsible authority an amount equal to the voucher’s redemption value.

(5) A patient who is an eligible person only by virtue of regulation 8(2)(d) or by virtue of his resources being treated in accordance with regulation 8(3)(e) or (f) as being less than his requirements shall–

(a)before presenting the voucher to the supplier, apply to the Secretary of State for a notice of entitlement; and

(b)on the same occasion as he presents the supplier with a voucher in accordance with paragraph (1), show a current notice of entitlement to the supplier and permit [F48the supplier] to copy such details as may be required for the purposes of regulation 13(2)(c)(iii) [F49or (2C)(c)(iii)].

[F50(6) When the patient presents the voucher–

(a)the supplier shall ask him to produce satisfactory evidence that he is an eligible person, unless the supplier, in cases other than where the patient is an eligible person by virtue of regulation 8(2)(c) or (d) already has satisfactory evidence of entitlement available to him;

(b)if the patient has been asked for but, not produced satisfactory evidence of entitlement, the supplier shall record the fact on the voucher.]

[F51Notice of entitlementS

12A.—(1) Where a person is entitled to the payment of, or a contribution towards, the cost incurred for the supply of an optical appliance because he is a member of a family described in regulation 8(3)(k), the Scottish Ministers shall issue a notice of entitlement under this regulation to that family.

(2) Such a notice of entitlement shall apply to–

(a)any family member who is named in the notice of entitlement; and

(b)any other member of such a person’s family.

(3) A notice of entitlement issued under paragraph (1) shall be effective–

(a)from such date; and

(b)for such period,

as the Scottish Ministers may determine.

(4) Any change in the financial or other circumstances of a person who is a member of a family in respect of which a notice of entitlement has been issued under paragraph (1), during the period for which the notice of entitlement has been issued, shall not affect the validity of the notice of entitlement in respect of that period.

(5) A notice of entitlement means a notice issued under this regulation and not under regulation [F529] of the Remission Regulations.]

Payments to suppliersS

13.—[F53(1) Subject to paragraph (2B), the responsible authority must make a payment of a voucher’s redemption value to a supplier if—

(a)the supplier has accepted the voucher from a patient in accordance with regulation 12; and

(b)the conditions specified in paragraph (2) are fulfilled.]

(2) The conditions referred to in paragraph (1) [F54(b)] are that–

(a)the patient has signed the declaration and undertaking referred to in regulation 12(4) and acknowledged receipt on the voucher of the optical appliance supplied to him;

(b)the optical appliance is not sold or supplied in contravention of section [F5527(1)] of the Optician’s Act 1989(2); and

(c)the supplier has–

(i)made and kept a written record of the supply and issued to the patient a receipt for any money received from the patient;

(ii)made a claim for a payment [F56by means of electronic communication in accordance with paragraph (2A)] to the responsible authority, within the period of 3 months beginning with the date of supply of the optical appliance;

(iii)where the patient has shown a notice of entitlement to him, informed the responsible authority of the amount of the patient’s contribution, if any; and

(iv)where the claim relates to a voucher the value of which is increased in accordance with paragraph 1(1)(e) of Schedule 3, certified that the glasses supplied were small glasses.

[F57(2A) A claim [F58as mentioned in paragraph (2)(c)(ii) must]—

(a)be submitted using such computer programme as the responsible authority has approved as suitable for that purpose;

(b)confirm the matters referred to in paragraph (2)(c)(iii) and (iv), where applicable; and

(c)contain the personal identification number that has been allocated to the supplier by the responsible authority.]

[F59(2B) Where a voucher has been issued by a Health Board in accordance with regulation 10 the responsible authority must make a payment of a voucher’s redemption value to a supplier if—

(a)the supplier has accepted the voucher from a patient in accordance with regulation 12; and

(b)the conditions specified in paragraph (2C) are fulfilled.

(2C) The conditions referred to in paragraph (2B)(b) are that—

(a)the patient has signed the declaration and undertaking referred to in regulation 12(4) and acknowledged receipt on the voucher of the optical appliance supplied to them;

(b)the optical appliance is not sold or supplied in contravention of section 27(1) of the Optician’s Act 1989; and

(c)the supplier has—

(i)made and kept a written record of the supply and issued to the patient a receipt for any money received from the patient;

(ii)made a claim for a payment either by means of electronic communication in accordance with paragraph (2D) or on a duly completed voucher to the responsible authority, within the period of 3 months beginning with the date of supply of the optical appliance;

(iii)where the patient has shown a notice of entitlement to the supplier, informed the responsible authority of the amount of the patient’s contribution, if any; and

(iv)where the claim relates to a voucher the value of which is increased in accordance with paragraph 1(1)(e) of schedule 3, certified that the glasses supplied were small glasses.

(2D) A claim as mentioned in paragraph (2C)(c)(ii) which is made by means of electronic communication must—

(a)be submitted using such computer programme as the responsible authority has approved as suitable for that purpose;

(b)confirm the matters referred to in paragraph (2C)(c)(iii) and (iv), where applicable; and

(c)contain the personal identification number that has been allocated to the supplier by the responsible authority.]

[F60(3) The responsible authority shall also make a payment, to be determined by the Scottish Ministers, to the supplier to meet or contribute to the cost incurred by the supplier in order to comply with regulation 12(6).]

Redemption value of voucher for supply of optical appliancesS

14.—(1) Where an optical appliance was supplied otherwise than under the Act the redemption value of a voucher is, subject to paragraphs (3) to (5), the lesser of–

(a)the full cost which would have been payable by the patient for the supply but for this Part of these Regulations;

(b)the face value of the voucher.

(2) Where an optical appliance was supplied under the Act, the redemption value of a voucher is, subject to paragraphs (3) to (5), the lesser of–

(a)the amount of the charge for the time being determined pursuant to regulation 2 which would have been payable by the patient for the supply but for this Part;

(b)the face value of the voucher.

(3) In relation to payments to be made because of a person’s eligibility by virtue of regulation 8(2)(d), the amounts taken for the purposes of paragraph (1)(a) and (b) or paragraph (2)(a) and (b) shall, subject to paragraph (4), be reduced by the patient’s contribution.

(4) If a reduction made under paragraph (3) in the case of a patient to whom a prescription was issued for a complex appliance would render the redemption value of the voucher less than the minimum complex appliance payment, that value shall be the minimum complex appliance payment.

(5) Where the patient was an eligible person only because a prescription was issued to him for a complex appliance, the redemption value of a voucher shall be the minimum complex appliance payment, except that where–

(a)the appliance was supplied under the Act; and

(b)in accordance with directions given pursuant to regulation 2(1), the amount of a charge made for the supply under section 70(1) of the Act would, but for any maximum charge specified in the directions, have exceeded by any amount the charge actually made,

the redemption value shall be reduced by the amount of the excess.