The National Health Service (Optical Charges and Payments) Regulations 2013

PART 1 E+W GENERAL

Citation, commencement and interpretation E+W

1.—(1) These Regulations may be cited as the National Health Service (Optical Charges and Payments) Regulations 2013 and come into force on 1st April 2013 except for regulation 8(3)(j) and (4)(e) which comes into force on 29th April 2013.

(2) In these Regulations—

“the 2006 Act” means the National Health Service Act 2006;

“the 1997 Regulations” means the National Health Service (Optical Charges and Payments) Regulations 1997 M1 ;

“the Board” means the National Health Service Commissioning Board M2 ;

“capital limit” means the amount prescribed for the purpose of section 134(1) of the Social Security Contributions and Benefits Act 1992 M3 (exclusions from benefit) as it applies to income support;

“child tax credit” means child tax credit under Part 1 of the Tax Credits Act 2002 M4 ;

“complex appliance” means an optical appliance at least one lens of which––

(a)

has power in any one meridian of plus or minus 10 or more dioptres; or

(b)

is a prism-controlled bifocal lens;

“disability element” means the disability element of working tax credit as specified in section 11(3) of the Tax Credits Act 2002 (maximum rate);

[F1 “electronic form” means the submission of information electronically via a computer system approved by the Board;]

“eligible person” is to be construed––

(a)

for the purposes of Part 3 (payments toward cost of sight tests) in accordance with regulation 3(2);

(b)

for the purposes of Parts 4 (payments for cost of supply of optical appliances) and 5 (payments for cost of replacement or repair of optical appliances) in accordance with regulation 8(2) to (5);

“face value” means, in relation to a voucher on which is marked a letter code specified in column 2 of Schedule 1, the amount specified in relation to that letter code in column 3 of that Schedule, plus the amount of any increase provided for by paragraph 1 of Schedule 2;

“an income-based jobseeker's allowance” has the meaning given by section 1(4) of the Jobseekers Act 1995 M5 (the jobseeker's allowance);

“income-related employment and support allowance” means an employment and support allowance, entitlement to which is based on section 1(2)(b) of the Welfare Reform Act 2007 M6 (employment and support allowance);

“income support” means income support under Part VII of the Social Security Contributions and Benefits Act 1992;

“minimum complex appliance payment” means, in relation to an optical appliance, the amount specified as such for the appliance in paragraph 2 of Schedule 2;

“NHS sight test fee” means the fee for a sight test determined in accordance with directions given by the Secretary of State under section 120 of the 2006 Act (GOS contracts: payments), as those directions have effect at the time of making these Regulations and as amended subsequently M7 ;

“notice of entitlement” means a notice issued under regulation 8 of the Remission Regulations (notices of entitlement) for the purposes of remission of charges under the 2006 Act;

“ophthalmic list” has the meaning given in section 11(5) of the 2006 Act (arrangements to be treated as NHS contracts);

“ophthalmic performers list” means a list of ophthalmic medical practitioners and optometrists prepared in accordance with regulations made under section 123 of the 2006 Act M8 ;

“ophthalmic practitioner” means an ophthalmic medical practitioner or optometrist whose name is included in an ophthalmic performers list;

“patient contribution” means a contribution to be paid by a person whose eye sight has been tested, towards the cost of that sight test or towards the cost of the supply, replacement or repair of an optical appliance for which a prescription has been given in consequence of the sight test, and the amount of that contribution is to be calculated as follows––

(a)

for the purposes of Part 3, the contribution is to be the amount by which the person's resources exceed their requirements;

(b)

for the purposes of Parts 4 and 5, where a person's resources are treated as being less than their requirements, the contribution is to be nil;

(c)

for the purposes of Parts 4 and 5, where a person's resources exceed their requirements, the contribution is to be an amount equal to twice that excess, and a person's resources and their requirements are to be calculated in accordance with Part 4 of, and Schedule 1 to, the Remission Regulations;

“pension credit guarantee credit” shall be construed in accordance with sections 1 and 2 of the State Pension Credit Act 2002 M9 ;

“the POS Regulations” means the Primary Ophthalmic Services Regulations 2008 M10 ;

“prisoner” means a person who is detained in a prison, including a young offender institution but not a secure training centre or a naval, military or air force prison, but is, at the time of receiving any primary ophthalmic service, on leave from that prison, and for the purposes of this definition—

(a)

“secure training centre” means a place in which offenders subject to detention and training orders under section 100 of the Powers of Criminal Courts (Sentencing) Act 2000 M11 (offenders under 18: detention and training orders) may be detained and given training and education and prepared for their release; and

(b)

“young offender institution” means a place for the detention of offenders sentenced to detention in a young offender institution or to custody for life;

“redemption value” is to be construed––

(a)

for the purposes of Part 3, in accordance with regulation 7;

(b)

for the purposes of Part 4, in accordance with regulation 15;

(c)

for the purposes of Part 5, in accordance with regulation 20;

“relevant income” has the same meaning as in section 7(3) of Part 1 of the Tax Credits Act 2002 (income test);

“the Remission Regulations” means the National Health Service (Travel Expenses and Remission of Charges) Regulations 2003 M12 and reference to those Regulations is to be construed as a reference to them as they have effect on the making of these Regulations and as amended subsequently;

“replacement” does not include the replacement of an optical appliance rendered unserviceable by fair wear and tear;

“severe disability element” means the severe disability element of working tax credit specified in section 11(6)(d) of the Tax Credits Act 2002 (maximum rate);

“small glasses” means glasses––

(a)

having a frame which is either custom made or a stock frame requiring extensive adaptation to ensure an adequate fit; and

(b)

having a boxed centre distance of no more than 55 millimetres, and for this purpose “box centre” is to be construed in accordance with the British Standard BS EN ISO 8624:2011 (Ophthalmic Optics. Spectacle Frames. Measuring System and Terminology) published on 28th February 2011 M13 ;

“supplier” includes a person replacing or repairing an optical appliance;

“supply” includes the replacement of an optical appliance rendered unserviceable by fair wear and tear;

[F2 “voucher” for the purposes of enabling a payment to be made under these Regulations means—

(a)

in Part 3, a voucher form approved by the Secretary of State or the Board which is used by a person with whom the Board has entered into a general ophthalmic services contract under section 117 of the 2006 Act (general ophthalmic services contracts: introductory);

(b)

in Part 4, a voucher form—

(i)

where a sight test is carried out by an NHS trust or NHS foundation trust, supplied by that NHS trust or NHS foundation trust; and

(ii)

in any other case, approved by the Secretary of State or the Board and used by the person who carries out the sight test;

(c)

in Part 5, a voucher form—

(i)

where an optical appliance is repaired or replaced by an NHS trust or NHS foundation trust, supplied by that NHS trust or NHS foundation trust;

(ii)

in any other case, approved by the Secretary of State or the Board]; and

“working tax credit” means working tax credit under Part 1 of the Tax Credits Act 2002.

Textual Amendments

F1 Words in reg. 1(2) inserted (1.12.2017) by The National Health Service (Primary Dental Services and General Ophthalmic Services) (Amendment) Regulations 2017 (S.I. 2017/1056), regs. 1(2), 8(2)(a)

F2 Words in reg. 1(2) substituted (1.12.2017) by The National Health Service (Primary Dental Services and General Ophthalmic Services) (Amendment) Regulations 2017 (S.I. 2017/1056), regs. 1(2), 8(2)(b)

Marginal Citations

M1 S.I. 1997/818; amended by S.I. 1997/2488, 1998/499, 1999/609 and 2562, 2000/594 and 3029, 2001/414, 749 and 3066, 2002/35, 547 and 2469, 2003/657 and 2381, 2004/696, 2008/553, 1657 and 2449, 2009/409 and 2010/22 and 634.

M2 The National Health Service Commissioning Board is established by section 1H of the 2006 Act. Section 1H is inserted by section 9(1) of the Health and Social Care Act 2012.

M3 1992 c.4.

M4 2002 c.21.

M5 1995 c.18. This definition in section 1(4) of the Jobseekers Act 1995 was amended by paragraphs 1 and 2 of Schedule 7 to the Welfare Reform and Pensions Act 1999 (c.30).

M6 2007 c.5.

M7 The Secretary of State has made the General Ophthalmic Services Contracts (Payments) Directions 2010, signed on 3^rd March 2010. The Directions are available on the Department of Health website at http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsLegislation/DH_114692 and from Department of Health Publications, PO Box 777, London SE1 6XH.

M8 Section 123 was amended by paragraph 60 of Schedule 4 to the Health and Social Care Act 2012.

M9 2002 c.16. Section 2 of the State Pension Credit Act 2002 was amended by paragraphs 140 and 141 of Schedule 24 to the Civil Partnerships Act 2004 (c.33).

M10 S.I. 2008/1186, amended by S.I. 2008/1700 and 2449, 2009/409, 2010/634, and 2013/365.

M11 2000 c.6. Section 100 of the Powers of Criminal Courts (Sentencing) Act 2000 was amended by paragraphs 90 and 111 of Schedule 32 to the Criminal Justice Act 2003 (c.44).

M12 S.I. 2003/2382; relevant amending instruments are S.I. 2004/663, 2005/26 and 578, 2006/675, 1065 and 2171, 2007/1975 and 2590, 2008/2868, 2009/1599, 2010/620 and 1727, 2011/1587, and 2012/1650.

M13 British Standard BS EN ISO 8624:2011 is available from the British Standards Institution, at http://shop.bsigroup.com or BSI Customer Services, 389, Chiswick High Road, London W4 4AL.