Section 360-5.2 - Definitions.

360-5.2 Definitions. 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 non-medical 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 II designation 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.

 

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