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Program Manual (Early Intervention)

Table of Contents

Preface

This manual is designed to provide rehabilitation specialists and CRP or Qualified Independent Contractors with guidelines and procedures for case management of the Blind Babies (BB) program. The following case management responsibilities are addressed in this guide:

  • Outreach
  • Intake/Referral
  • Eligibility Determination
  • Needs Assessment
  • Plan Development
  • Service Provision
  • Progress/Service Documentation
  • Invoicing
  • Closure Documentation and
  • Additional Requirements.

Overview of the Blind Babies Program

The Blind Babies Program was established statewide by the Florida Legislature in State Statute 413.092 (1)(2)(3) effective July 1, 2000  to provide community-based early intervention education to parents, guardians or caregivers of eligible children with visual impairments ages birth through five. Families and caregivers are provided strategies and skills in their role as primary teacher of their child.  The goal of the Blind Babies Program is to maximize the overall development and independence of infants and toddlers who are blind or visually impaired by providing direct Early Intervention Services, information, and resources to the children and their caregivers.

The Blind Babies Program promotes early development of life skills that will help to maximize independence. The program places an emphasis on the development and use of functional vision to maximize skill acquisition in as timely a manner as possible.  Families are provided information on resources that will assist their babies in meeting developmental milestones and meaningful inclusion into the community. 

Early Intervention Services offered through the Blind Babies Program will be delivered by non-profit Community Rehabilitation Providers (CRPs) whenever possible.  The Blind Babies funding supports the implementation of local contracts established throughout the state.  Where no contract exists, qualified independent contractors may be authorized by DBS to provide early intervention services.  In the event that there is no CRP available to serve the child, DBS will assume primary case management responsibilities.

For quality assurance, DBS will survey clients and their families in the Blind Babies Program to determine if available services are helping these young children achieve their goals. A report of the results will be provided to the State Office and to the CRPs.

DBS Rehabilitation Specialists and District Administrators will collaborate with DBS state office and CRP staff to facilitate service delivery, ensure adequate case file documentation, participate in outreach activities, and carry out the DBS vision: “In partnership with others, create a barrier free environment in the lives of Floridians with visual disabilities.”

1.0 - Outreach

Outreach activities are to inform and educate community organizations in order to obtain referrals for individuals who may be eligible for DBS program services.   Activities include staying in touch with key community organizations that are able to identify and refer potential clients.  Outreach follow-up activities can include personal contacts, phone communications, news releases, mail-outs, special events, Public Service Announcements (PSAs), etc.

CRP Roles and Responsibilities:

The CRP will conduct community outreach activities to identify clients that can benefit from the program independently and in collaboration with DBS.

DBS Roles and Responsibilities:

DBS will conduct community outreach activities to identify clients that can benefit from the program independently and in collaboration with CRP.

2.0 - Intake / Referrals

A child may be referred to the Blind Babies program by letter, telephone, in person, or by other means.

CRP Roles and Responsibilities: It is the responsibility of the CRP to generate enough referrals to meet the contract deliverables for individuals served. The CRP will attempt to contact the referred child’s family or guardian.  It is recommended that attempts to contact the referral are documented and contain the following information:

  • The name of the person who attempted to contact the referral
  • The date of the attempted contact
  • If contact was made — with whom (name and relationship to referral)
  • If a message was left — by what means or name of the person contacted
  • Other pertinent information about the potential applicant

For children referred to the CRP who are under three years of age, the CRP will be responsible for providing information to the family for a possible referral to Early Steps. 

DBS Roles and Responsibilities: DBS will send referrals to the CRP to conduct intake procedures.  Referrals from DBS to local community CRPs will be made in accordance with the CRPs internal procedures.  In the event that there is no CRP available to serve the child, DBS will assume primary case management responsibilities.

2.1 - Applicants

CRP Roles and Responsibilities:  When a parent, caregiver, or guardian submits a signed application, a letter requesting services, or makes a verbal request, the child will be considered an applicant. The actual date of application should be entered on the Intake Page in AWARE. Application dates may be moved back or forward up to 45 days. This allows for data to be entered into AWARE at a convenient time while capturing the actual date that a client applied or wants to apply for services. (Note: Social Security number and legal residency are not required for a Blind Babies application.)

DBS Roles and Responsibilities:  In the event that there is no CRP available to serve the child, DBS will assume primary case management responsibilities and requires a signed application to be considered an applicant.

2.2 - Initial Interview (II)

The purpose of the initial interview is to gather information about the child and their family that will be used to determine service needs.

CRP Roles and Responsibilities: At the time of the interview the CRP will gather information for the AWARE Intake Page and other parts of the Participant Module.

DBS Roles and Responsibilities: In the event that there is no CRP available to serve the child, DBS will assume primary case management responsibilities.  The initial interview will be completed in the letter section in AWARE.

3.0 - Eligibility Determination

An eye medical report completed by a licensed optometrist or ophthalmologist should be obtained to make an eligibility determination.  Presumed eligibility may be established for a period of 12 months by which time an eye medical report and/or documentation must be obtained.

CRP Roles and Responsibilities: CRP staff will enter the eye report and complete the required information on the Eligibility Determination screen. If an eye report is unavailable, eligibility may be established if it is clear from observations or other professional records that the child has a bilateral visual impairment. Observations of the child’s functioning must be clearly documented in the Case Notes section of AWARE or on the Eligibility Determination page.

Once all required information is gathered, an eligibility determination can be made. Only DBS specialists, supervisors, DA’s or program staff are authorized to make eligibility determinations. When CRP staff complete the intake process, they will send an E-mail to the Rehabilitation Specialist requesting an eligibility determination.  In cases where the client is obviously totally blind, CRP must provide documentation in the electronic case file to justify the absence of an eye report (e.g. observation, statement from medical doctor, etc.)

DBS Roles and Responsibilities:  When the CRP is the provider, the Rehabilitation Specialist has five (5) business days from the time of CRP notification within which to make an eligibility decision. The Rehabilitation Specialist will review the case for completeness of information before making a determination. It must be clear by eye report, case note or other documentation, that the client has a bilateral visual impairment and that he or she can benefit from services

Eligibility is established when a DBS representative enters a Signature Start Date on the Eligibility Determination Data page in AWARE. This action will cause the system to change the status of the child from applicant to eligible. DBS staff must send an E-mail back to the CRP noting that eligibility has been established. At this point, the CRP may begin the process of developing an Individualized Plan of Services.

In the event that there is no CRP available to serve the child, DBS will assume primary case management responsibilities.  Eligibility must be determined within 60 days of an application.

3.1 - Eligibility Criteria

There are two main criteria for eligibility that must be met:

  1. The documented presence of a diagnosed bilateral visual impairment or eye condition which, with best correction for that child, constitutes or results in a substantial impediment to the child’s ability to learn  and function independently; and
  2. A reasonable expectation that the child and family can benefit from services in terms of education, developmental growth, independence, advocacy, or transition.

3.2 - Ineligibility

CRP Roles and Responsibilities:  After notified by DBS the CRP will contact the child’s parent/guardian to discuss the findings and indicate that a Certificate of Ineligibility (CI) Letter will be electronically placed in the client’s AWARE file from DBS explaining the reasons for ineligibility and the client’s rights.  The CRP must notify DBS that this discussion took place.

DBS Roles and Responsibilities:  If a rehabilitation specialist or another authorized DBS representative determines that a child does not have a bilateral visual impairment or eye condition and is not eligible, they will notify the CRP of this decision by email. The CRP will discuss reasons for ineligibility with the parent/guardian. This discussion must take place before closure can occur. DBS must provide the child’s parent/guardian with a written ineligibility letter along with a copy of client’s Rights. The DBS representative will record the reasons why the child is ineligible and enter into the Certificate of Ineligibility Letter (CI) section in the AWARE system. AWARE will produce a letter titled Certificate of Ineligibility Letter (CI). An electronic copy of this letter will be placed in the client’s AWARE file.

Data on the Eligibility Determination screen must be completed (except for the signature start date) reflecting the ineligibility decision when closing a case from Application Status. Note that without the signature start date, the Eligibility Determination page will remain in Draft status.

Although children with single eye pathologies are not eligible for DBS services, DBS and/or CRP staff will refer those individuals to an appropriate organization whenever possible.

4.0 - Needs Assessment

Needs Assessment includes the Comprehensive Developmental Assessment, Functional Vision Assessment and Orientation & Mobility Screening and is used to establish goals for the child.

CRP Roles and Responsibilities: The CRP will complete a Comprehensive Developmental Assessment, Functional Vision Assessment and Orientation & Mobility Screening or document all exceptions.  All assessments and screenings must be completed face-to-face within 90 days of eligibility determination unless otherwise documented.  The assessments are to be documented in an AWARE case note or actual services description.  The summary of assessment findings will be shared with the family. 

DBS Roles and Responsibilities: In the event that there is no CRP available to serve the child, DBS will assume primary case management responsibilities by securing a qualified independent contractor to perform the needs assessment. These assessments are to be documented in an AWARE case note.  The summary of assessment findings will be shared with the family. 

5.0 - Plan Development

An individualized plan is developed within 90 days of eligibility determination based on assessment results and family input.

CRP Roles and Responsibilities: The CRP will develop an individualized plan within 90 days of eligibility determination based on assessment results and family input.  The Plan should be driven by curriculum-referenced services. Identify Attachment F services that, when delivered, will enable the client to achieve the designated goal.  Create the plan in AWARE.  (Note: Assessments can be entered as actual services in AWARE prior to formal plan development as well as included as a service on the plan).   Initial and amended plans are to be signed by the parent/guardian.

DBS Roles and Responsibilities:  In the event that there is no CRP available to serve the child, DBS will assume primary case management responsibilities.  The plan will be developed by the DBS Rehabilitation Specialist based on the assessment results and family input. Create the plan in AWARE.  Initial and amended plans are to be signed by the parent/guardian. In the event the DBS Rehabilitation Specialist cannot approve the Plan, the District Administrator, supervisor or state office Client Services staff will approve the Plan in AWARE.

6.0 - Service Provision

Services identified in the client’s plan will be provided individually or in small groups in the least restrictive environment agreed upon by the family. 

Children turning three years old may be encouraged to participate in the preschool programs established in local public schools and also to become familiar with the Florida School for the Deaf and Blind (FSDB).  These public schools may have a vision program established to provide individualized support for the child’s educational setting.  This is accomplished by developing Individualized Education Program (IEP) or Individualized Family Service Plan (IFSP).  CRP’s Early Interventionists or DBS representative will be available for consultation to a child’s IFSP or team upon request to provide recommendations for functional outcome strategies.

CRP Roles and Responsibilities: The CRP is to initiate services within 30 days of a signed plan and services are to be provided continuously (monthly) until all planned services are completed and the client's case is closed unless a reason for the interruption can be clearly documented.  The CRP will review cases in which clients have not received services for more than ninety days to determine continuation or closure and document the decision in the case record. The CRP is to utilize the curriculum (e.g. Oregon, VIISA, Callier Azusa, etc.) in developing lesson plans to customize services that meet client's needs.

CRPs must maintain an electronic record of service in AWARE as outlined in this manual and their contract with DBS. A paper file is recommended to be kept with documents which require a signature.

DBS Roles and Responsibilities:  In the event that there is no CRP available to serve the child, DBS will assume primary case management responsibilities. DBS is to initiate services within 30 days of a signed plan and services are to be provided continuously (monthly) until all planned services are completed and the client's case is closed unless a reason for the interruption can be clearly documented.  DBS will review cases in which clients have not received services for more than ninety days to determine continuation or closure and document the decision in the case record. DBS is to utilize the curriculum (e.g. Oregon, VIISA, Callier Azusa, etc.) in developing lesson plans to customize services that meet client's needs.  DBS must maintain an electronic record of service in AWARE as outlined in this manual and their contract with DBS.  A paper file is required to be kept with documents which require a signature, all authorizations and invoices, eye medical reports and release forms.  Copies must be provided, upon request, to the client‘s representative or to the DBS District or State Office.

7.0 - Progress / Service Documentation

Service documentation contains information related to training provided and/or client’s progress toward their identified goal as outlined in their Plan.

CRP Roles and Responsibilities: The CRP will document monthly progress information in AWARE on each client receiving services that substantiates each service listed on the monthly invoice. Progress notes must include:

  1. Date(s) service(s)/activities provided
  2. Specific service(s)/activities provided
  3. Progress toward client's Plan Goal(s)

The CRP will document monthly progress information in the Case Note Page or the Description box of the Actual Services Page.  The CRP will update and keep current Personal Information, Eye Medical Reports and Plan into the appropriate AWARE module for each client and his/her family.

DBS Roles and Responsibilities:  In the event that there is no CRP available to serve the child, DBS will assume primary case management responsibilities. DBS Rehabilitation Specialist will receive and review monthly progress reports from the authorized qualified independent contractor and then enter information into AWARE case notes.

In the event that there is no CRP available or qualified independent contractor to serve the child, DBS will continue contact with the family and consider referral to the Children’s Program (CP).

7.1 - Interrupted Services

CRP Roles and Responsibilities: Services may be interrupted from time to time for many reasons. When services are interrupted for any reason, a case note must be entered into AWARE providing an explanation for the interruption. If the duration of the interruption exceeds 90 days, the case should be reviewed in order to determine continuation or closure. If the individual will be able to resume participation in the foreseeable future, the specifics should be documented in a case note and the case should remain open. If service resumption is uncertain, the case should be submitted to DBS for closure decision.        

DBS Roles and Responsibilities: When the CRP refers a client for closure decision (based on the 90 day inactivity), DBS will review with the CRP and a determination will be made on whether or not to close the case.
In the event that there is no CRP available to serve the child, DBS will assume primary case management responsibilities. When services are interrupted for any reason, a case note must be entered into AWARE providing an explanation for the interruption. If the duration of the interruption exceeds 90 days, the case should be reviewed. If the individual will be able to resume participation in the foreseeable future, the specifics should be documented in a case note and the case should remain open. If service resumption is uncertain, the case should be considered for closure.

8.0 - Invoicing

Instructions for compliance with billing procedures are addressed in the BB contracts and should be referenced for details. The procedures listed here will help guide CRPs and DBS through invoicing for services and will require individual follow-up for specifics on each scenario presented. 

8.1 - Monthly Contract Invoicing

CRP Roles and Responsibilities: CRP’s are required to use the DBS AWARE Case Management System to draft and submit their electronic invoices. See the AWARE procedure manual for details on performing this task. DBS recommends that CRPs draft invoices to check their own work, then submit to DBS to review and approve if there are no issues or concerns.
 
The CRP will submit their invoice electronically in AWARE by the 15th of the month (or next business day if the 15th is a non-business day) for services provided in the previous month.  (Special Notice: The invoice for May services must be submitted by June 10th (or next business day if the 10th is a non-business day) to ensure that the payment is made on time before the fiscal year closeout process).

DBS Roles and Responsibilities: DBS District Office staff will review a sampling of client cases, as determined by the State Office, to ensure that all invoiced activities are being completed timely and accurately.

Payment will be made at the monthly fixed rate as specified in this contract Attachment B, unless it is determined that the Contractor is out of compliance according to the Remedy Table in Section II.  DBS District office will review and forward to Contract Manager with signed Invoice Review Checklist within 2 days of invoice submission in AWARE. Contract Managers will review the invoice within 5 days of submission in AWARE and approve or cancel.  DBS will contact the CRP prior to canceling an invoice.   DBS Fiscal Office will release the invoice for payment in the AWARE within 5 business days from invoice approval. (Note: Department of Financial Services may issue a warrant within 10 business days of release).

8.2 - Non-contract Authorization Invoicing

Invoices from independent providers for service delivery are paid through the Client Services invoicing process from the Client Services Budget subject to the availability of funds.  Individuals or entities seeking payment for services rendered to clients participating in the BB Program must be vendors of the State of Florida. This may be accomplished by applying online at the MYFloridaMarketPlace.com website.  Also, the independent contractor must become a vendor in AWARE.

DBS Roles and Responsibilities: All authorizations must be prior approved.  Authorizations can only be created in AWARE by a DBS staff member. Invoices for these purchases or services must be signed by the DBS Rehabilitation Specialist, supervisor or District Administrator verifying that the services were provided.

9.0 - Closure Documentation

Closure will occur when the child and family will no longer be receiving services from the Blind Babies Program. The case may be closed as “Goals Met” from the Blind Babies Program under the following circumstances:

  • The child successfully achieves at least one planned skill or goal and/or
  • Child is successfully transitioning into a school program.  

The case may also be closed “Goals Not Met” from the Blind Babies Program when neither the parent/guardian nor the child have benefited from the planned services.  

CRP Roles and Responsibilities: The CRP will enter a final AWARE Case note titled Transition Exit Report containing recommendations for future services for each client transitioning to the next educational level or turning six, whichever comes first.  If the client exits the program (i.e. moving, death, failure to cooperate, etc,) before transitioning to the next chosen educational level, CRP will enter a final AWARE Case Note titled Exit Report explaining the reasons for exit and recommendation for next steps. The CRP completes all information on the AWARE Closure screen except the closure date.   When the case is closed, it is recommended that the CRP notifies the family that a closure letter will be sent by DBS. 

DBS Roles and Responsibilities: DBS receives closure notification from the CRP.   DBS will review either the Transition Exit Report or the Exit Report.  The AWARE Closure screen is reviewed and the closure date is entered when it is appropriate to close the case.  DBS will also send the AWARE Closure letter to the family.

In the event that there is no CRP available and a qualified independent contractor is providing services to the child and family, DBS will enter a final AWARE Case note titled Transition Exit Report containing recommendations for future services for each client transitioning to the next educational level or turning six, whichever comes first.  If the client exits the program (i.e. moving, death, failure to cooperate, etc,) before transitioning to the next chosen educational level, DBS will enter a final AWARE Case Note titled Exit Report explaining the reasons for exit and recommendation for next steps. DBS completes all information on the AWARE Closure screen including the closure date.  DBS will also send the closure letter.

10.0 - Additional Requirements

10.1 - Qualified Staff

CRPs providing services to clients need to be accredited and maintain accreditation by either the National Accreditation Council for Agencies Serving People with Blindness or Visual Impairment (NAC) or the Commission on Accreditation of Rehabilitation Facilities (CARF).  Independent contractors providing services will be required to have the same credentialing as CRP staff as referenced in the current contract.

CRP Roles and Responsibilities: The CRP will be accredited and maintain accreditation by either NAC or CARF.    The CRP will provide all services to DBS clients with staff who meet the certification qualifications as stated in Attachment G, Personnel Training/Qualifications. Exceptions must be requested in writing to the DBS Director who will forward to the Joint DBS/CRP Credentials Committee for determination.

DBS Roles and Responsibilities: The District Administrator will secure credentials for any Independent Contractor providing non-contract services.  Credentials must meet the standards in Attachment G of the current contract.  If the credentials do not meet the current standards, the District Administrator will contact the Bureau Chief of Client Services to discuss exception and determination. 

Glossary - Definitions for BB and OB/AP Manual

ACCESSIBLE WEB-BASED ACTIVITY REPORTING ENVIRONMENT (AWARE)
The electronic case management system that is used by DBS and selected contract providers
ACUITY
Measure of the eye’s ability to distinguish object details and shape.  It is assessed by the smallest identifiable object that can be seen at a specified distance.
ADULT PROGRAM (AP)
DBS Program that serves adults under age 55 years who do not have an employment goal.
ADVOCACY
Speaking or writing in support of something
AMENDMENT
A change or addition to an existing plan.
APPEAL
The process a client can use when they disagree with a decision that affects their plan of services.
APPLICANT
An individual/parent/guardian who has requested services. (Note: for DBS, a signed application is required).
BILATERAL VISION IMPAIRMENT
Eye condition that involves both eyes.
COMMISSION ON ACCREDITATION OF REHABILITATION FACILITIES (CARF)
Organization that accredits rehabilitation facilities.
CASE FILE
Record of Service -may be electronic or paper.
CHILDREN AND FAMILIES PROGRAM (CP)
Division of Blind Services program offering services to children with bilateral visual impairments ages 6-14 and in some cases through age 21.
COMMUNICATION SKILLS
Instruction to include Braille, touch-typing, handwriting, telephone dialing, use of talking books, or any type of communication aids.
COMMUNITY REHABILITATION PROVIDER (CRP)
Private not-for-profit service organizations that provide or facilitate the provision of services enabling individuals with bilateral visual impairments to maximize their opportunities to function independently in their community.
COMPREHENSIVE DEVELOPMENTAL ASSESSMENT (CDA)
It is the process of evaluating and measuring through observations the client's age appropriate level in Communication Skills, Daily Living Skills, Sensory and Cognitive Abilities and Motor Skills.
COMPREHENSIVE FUNCTIONAL ASSESSMENT (CFA)
The process of evaluating and measuring through observation and interview the client's level of independence in their home and community.
COUNSELING
Advice or guidance regarding issues related to vision loss: rehabilitation, attitudes, social or economic circumstances, etc.
DISABILITY RIGHTS FLORIDA
A non-profit advocacy organization providing services under federally-funded programs to persons with disabilities. (Website: www.Disabilityrightsflorida.org)
DISTRICT ADMINISTRATOR
DBS manager that is responsible for the activities of a full service rehabilitation office in an assigned geographic area.
DIVISION OF BLIND SERVICES (DBS)
It is the designated state agency for receiving state and federal funds to provide services to those individuals with bilateral visual impairments.
EARLY INTERVENTION
Individualized programs of education and counseling developed for young children and their families to help minimize the effects of conditions that can delay development and learning.
EARLY STEPS EARLY INTERVENTION PROGRAM (EIP)
Special program funded by Children's Medical Services. Provides early intervention services to children ages birth to three who have a disability and a developmental delay.
ECONOMIC NEED ASSESSMENT
Application (DBS 007) to ensure that economic need is applied uniformly and equitably. Economic need requirements are different for each DBS program.
ELIGIBILITY
Two (2) components which must be met: 1) Bilateral visual impairment which, with best correction, constitutes or results in a substantial impediment to the client's ability to learn and function independently; and 2) A reasonable expectation the client will benefit from services.
FUNCTIONAL VISION ASSESSMENT (FVA)
It is the process of evaluating and measuring through observations the client's usable sight.
INDEPENDENT LIVING (IL)
A federal program that provides funds for DBS Older Blind Program.
INDIVIDUALIZED FAMILY SUPPORT PLAN (IFSP)
The written document that is created by Early Steps that describes the early intervention program (ages birth to three) to be provided for a child with disabilities. Contains long- and short-term goals and short-term objectives; a statement of the child's current level of functioning; and decisions about the setting where the child is to receive services (in a regular classroom, at home, in a school for the blind).
INDIVIDUALS WITH DISABILITIES EDUCATION ACT - (IDEA)
The law that guarantees children with disabilities a free, appropriate public education in the least restrictive environment.
INDIVIDUAL EDUCATION PLAN (IEP)
The written plan that describes the special education program placement for a child with disabilities who enters the public school system. The plan contains a description of services, goals and objectives.
INTAKE
Processing client applications to determine eligibility for services.
INITIAL INTERVIEW (II)
The first meeting with the client to review the program and gather information to be used to identify objectives and plan services to be offered.
LEGAL BLINDNESS
A visual acuity of 20/200 or less in the better eye with best correction, and/or a visual field which is no greater than 20 degrees in the better eye.
LOW VISION
A bilateral impairment to vision that significantly impairs the functioning of the individual and cannot be adequately corrected with medical, surgical, therapy, conventional eyewear or contact lenses.
LOW VISION AIDS
Optical and non-optical devices used to improve visual performance in people with low vision.
LOW VISION SERVICES
Evaluation and/or instruction in the use of optical and non-optical visual aids and devices.
MOBILITY
The ability to move safely through the environment.
NATIONAL ACCREDITATION COUNCIL FOR AGENCIES SERVING PEOPLE WITH BLINDNESS OR VISUAL IMPAIRMENT (NAC)
Organization that accredits agencies and schools providing services to the blind.
NO LIGHT PERCEPTION (NLP)
Total blindness.
OLDER BLIND (OB) PROGRAM
DBS Program that serves adults 55 years and older who do not have an employment goal.
OPTOMETRIST
A doctor of optometry (O.D.) who is qualified to measure visual acuity and visual fields and to prescribe eyeglasses.
OPHTHALMOLOGIST
A medical doctor (M.D. or D.O.) who has specialized training in diagnosing and treating diseases and conditions of the eye.
ORIENTATION
Knowing where you are, where you are going, and how to get where you want to be by interpreting information available in your environment.
ORIENTATION AND MOBILITY (O&M) SPECIALIST
An individual who has received specialized training in order to teach visually impaired people to travel safely and independently.
OUTCOME
The indicator of the actual impact or benefit of a goal.
RECORD OF SERVICE
Electronic or paper case file.
REFERRAL
Request information in regards to services.
VISUAL IMPAIRMENT
Is severe reduction in vision that cannot be corrected with standard glasses or contact lenses and reduces the person's ability to function at certain tasks.