Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 2
Subtitle 09 - MEDICAL CARE PROGRAMS
Chapter 10.09.14 - Vision Care Services
Section 10.09.14.01 - Definitions
Universal Citation: MD Code Reg 10.09.14.01
Current through Register Vol. 51, No. 19, September 20, 2024
A. In this chapter, the following terms have the meanings indicated.
B. Terms Defined.
(1) "Acquisition cost" means actual cost of a
product to a provider.
(2) "Board"
means the State Board of Examiners in Optometry.
(3) "Department" means the State Department
of Health and Mental Hygiene, the single State agency designated to administer
the Maryland Medical Assistance Program pursuant to Title XIX of the Social
Security Act, 42 U.S.C.
§ 1396 et seq.
(4) "Diagnostically certified optometrist"
means a licensed optometrist who is certified by the Board to administer
topical ocular diagnostic pharmaceutical agents to the extent permitted under
Health Occupations Article, §11-404, Annotated
Code of Maryland.
(5) "EPSDT
partial screen" means less than the complete package of various screening
procedures required by the State Periodicity Schedule that an EPSDT participant
receives at a given age.
(6) "EPSDT
screen" means EPSDT screen as defined in COMAR
10.09.23.01A.
(7) "Invoice" means a form
designated by the Department for use by providers in submitting bills for
payment.
(8) "Medically necessary"
means that the service or benefit is:
(a)
Directly related to diagnostic, preventive, curative, palliative,
rehabilitative, or ameliorative treatment of an illness, injury, disability, or
health condition;
(b) Consistent
with current accepted standards of good medical practice;
(c) The most cost efficient service that can
be provided without sacrificing effectiveness or access to care; and
(d) Not primarily for the convenience of the
consumer, family, or provider.
(9) "Ophthalmologist" means a physician
skilled in diseases of the eye.
(10) "Ophthalmic lenses or optical aids"
means a lens, contact lens, prism, or vision aid which has a therapeutic effect
on a patient, or which will contribute to the visual welfare of a
patient.
(11) "Optician" means an
individual, partnership, or company which meets applicable licensing
requirements as a qualified grinder or dispenser of ophthalmic lenses or
optical aids, and which is capable of translating, filling, and adapting
ophthalmic prescriptions, products, and accessories.
(12) "Optometric clinic or center" means a
facility, which provides services for patients under the supervision of a
licensed optometrist.
(13)
Optometric Examination.
(a) "Optometric
examination" means a series of tests and measurements used to determine the
extent of visual impairment, or the correction required to improve visual
acuity, performed by a licensed optometrist.
(b) "Optometric examination" includes as a
minimum:
(i) Reviewing a patient's history,
past prescriptions, and specifications when available;
(ii) Visual analysis;
(iii) Ophthalmoscopy of internal
eye;
(iv) Tonometry without
anesthetic when indicated or for a patient 40 years old or older;
(v) Muscle balance examination;
(vi) Gross visual field testing when
indicated;
(vii) Writing of lens
formula and other prescription data when needed, as well as specific
instructions for future care;
(viii) Other tests when indicated by
§B(12)(b)(i)-(vii) of this regulation; and
(ix) Subsequent progress evaluations when
indicated.
(14) "Optometrist" means an individual who is
licensed by the Board to practice optometry or by the state in which the
service is rendered.
(15)
"Orthoptic treatment" means the use of instruments to measure and enhance the
binocular coordination of the eyes (a category of "visual training").
(16) Practice Optometry.
(a) "Practice optometry" means, subject to
Health Occupations Article, §§11-404 and
11-404.2,
Annotated Code of Maryland, to use any means known in the science of optics or
eye care, except surgery, to:
(i) Detect,
diagnose, and treat any optical or diseased condition in the human
eye;
(ii) Prescribe eyeglasses or
lenses to correct any optical or visual condition in the human eye;
(iii) Give advice or direction on the fitness
or adaptation of eyeglasses or lenses to an individual for the correction or
relief of a condition for which eyeglasses or lenses are worn; and
(iv) Use, or permit the use of an instrument,
test card, test type, test eyeglasses, test lenses, or other device to aid in
choosing eyeglasses or lenses for an individual to wear.
(b) "Practice optometry" includes, subject to
Health Occupations Article, §§11-404 and
11-404.2,
Annotated Code of Maryland:
(i) The
administration of topical ocular diagnostic pharmaceutical agents;
(ii) The administration and prescription of
therapeutic pharmaceutical agents; and
(iii) The removal of superficial foreign
bodies from the cornea and conjunctiva.
(17) "Preauthorization" means an approval
required from the Department or its designee before providing
services.
(18) "Prescriber" means a
physician or optometrist licensed to prescribe optical aids, and authorized by
the Department to participate in the Program.
(19) "Prescription" means a written order for
treatment or optical aids, or both, signed by the prescriber.
(20) "Program" means the Maryland Medical
Assistance Program.
(21) "Progress
evaluation" means a follow-up visit, when indicated, to determine the
effectiveness of an eye examination, prescription, or series of orthoptic
treatments.
(22) "Provider" means a
physician (when dispensing ophthalmic lenses or visual aids), optometrist,
optometric clinic or center, or optician, recognized by the Department to
participate in the Program.
(23)
"Recipient" means a person who is certified as eligible for, and is receiving,
Medical Assistance benefits.
(24)
"Routine adjustment" means an adjustment made to an optical aid other than an
adjustment required because of damage.
(25) "Screening" means tests or measurements,
other than an eye examination, performed to discover the possibility of
difficulty in vision.
(26)
"Therapeutically certified optometrist" means a licensed optometrist who is
certified by the Board to administer or prescribe therapeutic pharmaceutical
agents or remove superficial foreign bodies from a human eye, adnexa, or
lacrimal system to the extent permitted under Health Occupations Article,
§11-404.2,
Annotated Code of Maryland.
(27)
"Visual training" means use of instruments or other means to measure and
enhance the binocular coordination of the eyes and visual perceptual
functions.
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