Section 140.416 Optometric Services and Materials

Section 140

TITLE 89: SOCIAL SERVICES

CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES

SUBCHAPTER d: MEDICAL PROGRAMS

PART 140 MEDICAL PAYMENT

SECTION 140.416 OPTOMETRIC SERVICES AND MATERIALS

Section 140.416  Optometric

Services and Materials

a)         Payment for optometric services and materials shall be made to

physicians, optometrists, opticians and optical companies.

b)         Payment shall be made for the following optometric services

and materials:

1)         An eye examination by a physician or an optometrist for the

purpose of determining the condition of the eye including the refractive state.

2)         Frame repairs, contact lenses, artificial eyes and low vision

devices provided by physicians, optometrists, opticians and optical companies.

3)         Dispensing of optical materials.

4)         Lenses, frame parts and frames provided by the Department of

Corrections (DOC) laboratory.

c)         Optometric

services and materials for which payment shall not be made include:

1)         Services which are not provided to address a recipient's

particular visual problems or complaints.

2)         Lenses, frames and frame parts obtained from a source other

than the DOC laboratory.

3)         Trifocals.

4)         Tinted lenses.

5)         Provider's transportation costs.

d)         Payment for services and materials shall be at the lesser of

the provider's usual and customary charge or the maximums established by the

Department pursuant to Section 140.400.

e)         Lenses,

Frames and Frame Parts Requirements that Began During a Public Health

Emergency

DOC laboratory.

3)         Trifocals.

4)         Tinted lenses.

5)         Provider's transportation costs.

d)         Payment for services and materials shall be at the lesser of

the provider's usual and customary charge or the maximums established by the

Department pursuant to Section 140.400.

e)         Lenses,

Frames and Frame Parts Requirements that Began During a Public Health

Emergency. Notwithstanding subsections (b)(4) and (c)(2) of this Section and

Section 140.418, and any other provision to the contrary in this Part, the

Department will reimburse for lenses, frame parts and frames provided by the

Department's laboratory vendors for dates of service on or after March 9, 2020

until the Department determines any or all of the services provided by the

Department's laboratory vendors are no longer necessary or until the DOC

laboratory resumes production of lenses, frames and frame parts.