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Chapter 40—Optical Program Rules of Department of Social Services Division 70—MO HealthNet Division Chapter 40—Optical Program Title Page 13 CSR 70-40.010 Optical Benefits and Limitations—MO HealthNet Program............................3 JOHN R. ASHCROFT (9/30/21) CODE OF STATE REGULATIONS 1 Secretary of State Chapter 40—Optical Program 13 CSR 70-40 Title 13—DEPARTMENT OF specified for his/her profession as follows: (E) Temple. SOCIAL SERVICES (A) An optometrist must be a duly licensed (F) Lenses, single vision. Division 70—MO HealthNet Division Doctor of Optometry (OD) to participate in (G) Lenses, bifocal. Chapter 40—Optical Program the MO HealthNet program, must be licensed (H) Lenses, trifocal. in accordance with the licensing provisions of (I) Lenses, cataract. 13 CSR 70-40.010 Optical Benefits and the state in which s/he practices, and must (J) Special frames. Limitations—MO HealthNet Program have a current MO HealthNet participation (K) Special lenses. agreement and provider number; (L) Miscellaneous repairs. PURPOSE: This rule establishes the basis for (B) A physician must be a duly licensed (M) Scleral cover shell, stock, or custom. administering the Optical Program under the Doctor of Medicine (MD) or Doctor of (N) Prosthetic eye, plastic, or custom. MO HealthNet program, including the desig- Osteopathy (DO) to participate in the MO (O) Prosthetic eye, refitting. nation of professional persons who may per- HealthNet program, must be licensed in (P) Prosthetic eye check/polishing/cleaning. form optical services; services which are cov- accordance with the licensing provisions of (Q) Rose I and Rose II tints. ered, noncovered, and limitations within the the state in which s/he practices, and must (R) Photochromatic lenses. program; and the method of reimbursement. have a current MO HealthNet participation (S) Orthoptic and/or pleoptic training, with agreement and provider number; continuing optometric direction and evalua- PUBLISHER’S NOTE: The secretary of state (C) A clinic can participate in the Optical tion (visual therapy/training). has determined that the publication of the Program if it has a current MO HealthNet (T) Fitting of contact lens for treatment of entire text of the material which is incorpo- Program clinic number. In addition to the disease, including supply of lens (therapeutic rated by reference as a portion of this rule clinic number, each of the performing bandage lens). would be unduly cumbersome or expensive. optometrists must have an effective participa- (U) Visual field examination with optomet- This material as incorporated by reference in tion agreement and MO HealthNet program ric diagnostic evaluation; tangent screen, this rule shall be maintained by the agency at provider number. Reimbursement may be autoplot, or equivalent. its headquarters and shall be made available made to the clinic for all covered services (V) Electro-oculography, with medical to the public for inspection and copying at no provided at the clinic; and diagnostic evaluation. more than the actual cost of reproduction. (D) An optician, optical dispenser, or man- (W) Visually evoked potential (response) This note applies only to the reference mate- ufacturer of prosthetic eyes must have a cur- study, with medical diagnostic evaluation. rial. The entire text of the rule is printed rent MO HealthNet participation agreement (X) Quantitative perimetry, for example, here. and provider number. several isopters on Goldmann perimeter or equivalent. (1) Administration. The Department of Social (4) Types of Service Reimbursed by the MO (Y) Static and kinetic perimetry or equiva- Services, MO HealthNet Division shall HealthNet Program for Each Profession. lent. administer the Optical Program. The Depart- (A) Optometrist or Clinic. (Z) Serial tonometry with optometric diag- ment of Social Services, MO HealthNet Divi- 1. Eye examinations. nostic evaluation (separate procedure), one sion shall determine, and include in the Opti- 2. Refractions. (1) or more sessions, same day. cal Provider manual, the optical services 3. Eyeglasses. (AA) Tonography with optometric diag- covered and not covered, the program limita- 4. Prosthetic eyes. nostic evaluation, recording indentation tions, and the maximum allowable fees for all 5. Special ophthalmological services. tonometer method or perilimbal suction covered services. The Optical Provider man- (B) Opticians or Optical Dispensers. method. ual is incorporated by reference and made a 1. Eyeglasses. (BB) Color vision examination, extended, part of this rule as published by the Depart- 2. Prosthetic eyes. for example, anomaloscope or equivalent. ment of Social Services, MO HealthNet Divi- (C) Manufacturers of Prosthetic Eyes— (CC) Dark adaptation examination, with sion, 615 Howerton Court, Jefferson City, Prosthetic Eyes. optometric diagnostic evaluation. MO 65109, at its website at (D) Physicians (MD or DO). http://manuals.momed.com/collections/col- 1. Eye examinations. (7) Program Limitations. lection_opt/print.pdf November 24, 2020. 2. Refractions. (A) Optical Program services require pre- This rule does not incorporate any subse- 3. Eyeglasses (Must be enrolled as an certification. Pre-certification serves as a uti- quent amendment or additions. Services cov- Optical provider). lization management tool, allowing payment ered shall include only those which are clear- 4. Prosthetic eyes (Must be enrolled as for services that are medically necessary, ly shown to be medically necessary. an Optical provider). appropriate, and cost effective without com- 5. Special ophthalmological services. promising the quality of care to participants. (2) Participants Eligible. Any participant who An enrolled optical provider must initiate is eligible for MO HealthNet benefits as (5) Reimbursement. MO HealthNet reimburse- requests for pre-certification and MO Health- determined by the Family Support Division ment will be the lower of the provider’s usual Net must issue approval before delivery of and who is found to be in need of optical ser- and customary charge to the general public or service. The pre-certification medical criteria vices as described in this regulation subject to the MO HealthNet allowable amount. can be found in the Optical Provider Manual the limitations set forth in subsections identified in section (1) of this rule. (7)(A)–(X). (6) Covered Services. (B) One (1) comprehensive or one (1) lim- (A) Complete or limited eye examination. ited eye examination is allowed per two (2) (3) Provider Participation. To be eligible for (B) Eye refraction. years (within a twenty-four- (24-) month peri- participation in the MO HealthNet Optical (C) Eyeglasses. od of time) under the MO HealthNet pro- Program, a provider must meet the criteria (D) Frames. gram. Eligible children, pregnant women, JOHN R. ASHCROFT (9/30/21) CODE OF STATE REGULATIONS 3 Secretary of State 13 CSR 70-40—DEPARTMENT OF SOCIAL SERVICES Division 70—MO HealthNet Division individuals residing in a nursing home, and 4.00 diopters for one (1) eye or plus or minus 1. Child age twenty (20) and under who blind persons are allowed one (1) comprehen- 4.00 diopters for each eye, cataract lenses, or requires glasses for school performances; sive or one (1) limited eye examination per special bifocal lenses (for example, plastic 2. Visual acuity 20/40 or less; or year (within a twelve- (12-) month period of Executive lenses). 3. Protective eyewear for participants time) under the MO HealthNet program. Pay- (J) Plastic lenses may be dispensed under with sight in only one (1) eye. ment for a comprehensive eye examination the MO HealthNet program. Reimbursement (R) Any warranties extended by optical will be made only if six (6) or more of the will be at the same rate as comparable glass companies for optical materials to private-pay following procedures have been performed: lenses. Additional payment will be allowed patients must also apply to those same mate- 1. Refraction far point and near point; for plastic lenses that meet the definition of rials dispensed to MO HealthNet partici- 2. Case history; special lenses and are medically justified. pants. 3. Visual acuity testing; (K) Photochromatic lenses are covered (S) The MO HealthNet program allows 4. External eye examination; only if medically necessary. one (1) prosthetic eye per eye (one (1) left 5. Pupillary reflexes; (L) Tinted lenses (Rose I and Rose II) are and one (1) right) within a five- (5-) year 6. Ophthalmoscopy; covered if medically necessary. period. If the prosthetic eye is lost, 7. Ocular motility testing; (M) Replacement of optical materials and destroyed, cracked, or deteriorated, payment 8. Binocular coordination; repairs in excess of program limitations may will be allowed for replacement. 9. Vision fields; be covered if medically necessary, or (T) Optometrists may be reimbursed for 10. Biomicroscopy (slit lamp); required for employment training, or educa- visual therapy training when there is a prog- 11. Tonometry; tional purposes, as follows: nosis for substantial improvement or correc- 12. Color vision; and 1. Replacement of complete eyeglasses tion of an ocular or vision condition. These 13. Depth perception. (frames and lenses). conditions include amblyopia, eccentric (non- (C) If fewer than six (6) of these are per- A. Lenses and frames broken (partic- foveal) monocular fixation, suppression, formed, a limited examination must be billed. ipant must show provider the broken glasses inadequate motor or sensory fusion, and stra- (D) Eligible children, pregnant women, or the MO HealthNet program
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