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 10.09.14.04 - Covered Services
Universal Citation: MD Code Reg 10.09.14.04
Current through Register Vol. 51, No. 19, September 20, 2024
A. The program covers the following vision care services:
(1) A maximum of one optometric examination
every 2 years for recipients 21 years old or older and a maximum of one every
year for recipients younger than 21 years old, to determine the extent of
visual impairment or the correction required to improve visual acuity, unless
the time limitations are waived by the Department, based on medical
necessity;
(2) Subject to §B,
of this regulation, a maximum of one pair of eyeglasses every year, unless the
time limitations are waived by the Department, based on medical
necessity;
(3) Examination and
eyeglasses for a recipient with a medical condition, other than normal
physiological change necessitating a change in eyeglasses (before the normal
time limits specified in §§A and B of this regulation have been met)
when a preauthorization has been procured;
(4) Visually necessary optometric care
rendered by an optometrist when these services are:
(a) Provided by the optometrist or a licensed
employee;
(b) Related to the
patient's health needs as diagnostic, preventive, curative, palliative, or
rehabilitative services; and
(c)
Adequately described in the patient's record; and
(5) Optician services when the services are:
(a) Provided by the optician, optometrist, or
ophthalmologist, or by an employee under the optician's, optometrist's, or
ophthalmologist's supervision and control;
(b) Adequately described in the patient's
record;
(c) Ordered or prescribed
by an ophthalmologist or optometrist.
B. Eyeglasses.
(1) The eyeglasses under §A(2) of this
regulation shall have first quality, impact resistant lenses, except in cases
where prescription requirements cannot be met with impact resistant lenses.
Frames shall be made of fire-resistant, first-quality material.
(2) In order to be entitled to receive
eyeglasses under §A(2) of this regulation, a recipient shall meet at least
one of the following conditions:
(a) The
recipient requires a diopter change of at least 0.50;
(b) The recipient requires a diopter
correction of less than 0.50 and this has been preauthorized according to
Regulation .06, of this chapter, based on medical necessity;
(c) The recipient's present eyeglasses have
been damaged to the extent that they affect visual performance and cannot be
repaired to effective performance standards, or are no longer usable due to a
change in head size or anatomy; or
(d) The recipient's present eyeglasses have
been lost or stolen.
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