Arkansas Administrative Code
Agency 016 - DEPARTMENT OF HUMAN SERVICES
Division 06 - Medical Services
Rule 016.06.09-009 - Visual Care Transmittal Update #120
Universal Citation: AR Admin Rules 016.06.09-009
Current through Register Vol. 49, No. 9, September, 2024
Section II Visual Care
214.200
Coverage and Limitations of the Under Age 21 Program
A. One examination and one pair of glasses
are available to eligible Medicaid beneficiaries every twelve months.
1. If repairs are needed, the eyeglasses must
have been originally purchased through the Arkansas Medicaid Program in order
for repairs to be made.
2. If the
glasses are lost or broken beyond repair within the twelve month benefit limit
period, one additional pair will be available through the optical laboratory.
After the first replacement pair, any additional pair will require prior
authorization.
3. All replacements
will be made by the optical laboratory and the doctor's office may make repairs
only when necessary.
B.
Prescriptive and acuity minimums must be met before glasses will be furnished.
Glasses should be prescribed only if the following conditions apply:
1. The strength of the prescribed lens (for
the poorer eye) should be a minimum of -75D + 1.00D spherical or a minimum of
.75 cylindrical or the unaided visual acuity of the poorer eye should be worse
than 20/30 at a distance.
2.
Reading glasses may be furnished based on the merits of the individual case.
The doctor should indicate why such corrections are necessary. All such
requests will be reviewed on a prior approval basis.
C. Plastic or polycarbonate lenses
only are covered under the Arkansas Medicaid
Program.
D. When the prescription
has met the prescriptive and acuity minimum qualifications, Medicaid will
purchase eyeglasses through a negotiated contract with an optical
laboratory.
E. The eyeglasses will
be forwarded to the doctor's office where he or she will be required to verify
the prescription and fit or adjust them to the patient's needs.
F. Eye prosthesis and polishing services
require a prior authorization.
G.
Contact lenses are covered if medically necessary with a prior authorization.
Please refer to section
212.000 for contact lens
guidelines.
H. Eyeglasses for
children diagnosed as having the following diagnoses must have a surgical
evaluation in conjunction with supplying eyeglasses:
1. Ptosis (droopy lid)
2. Congenital cataracts
3. Exotropia or vertical tropia
4. Children between the ages of twelve (12)
and twenty-one (21) exhibiting exotropia
Disclaimer: These regulations may not be the most recent version. Arkansas may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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