In this update we remind accredited assessors about:

• the requirements for submitting general and exceptional circumstance (G&E) requests
• the need to consider cost-effective frames and lenses.

Genuine and exceptional circumstance requests

We are receiving a considerable number of G&E requests. G&E requests are for children whose vision is assessed as being outside the clinical guidelines. However, many of these requests are within the clinical guidelines and so do not need to be submitted as a G&E request.

Clinical guidelines

Please familiarise yourself with the Children’s Spectacle Subsidy clinical guidelines and criteria for prescribing outside the guidelines.

Exclusions

Please ensure you understand the items that are excluded, for example, sunglasses of any kind.  Note: Tinted lenses may be applied for through the G&E process if the person has symptoms of severe photophobia associated with ocular pathology.

Reason and clinical rationale required

When completing a G&E application in the Enable Specs App, please provide your reason and the clinical rationale for prescribing outside of the clinical guidelines.

Higher level subsidy funding

It is important you consider cost-effective frames and lenses in cases where they can meet the clinical need. This is to ensure there is funding available in the budget for all those who need it.

MOH will contribute a maximum of $250 towards frames unless:

• there is a significant clinical need for higher cost frames, or
• there are no other frames in your service that will meet the clinical needs.

Clinical reasoning is required.

Please contact us if you have any questions about this notice.

Children’s Spectacle Subsidy Service

Enable New Zealand

Phone: 0800 ENABLE (362 253)

Email: enable@enable.co.nz