Minnesota Administrative Rules
Agency 196 - Human Services Department
Chapter 9505 - HEALTH CARE PROGRAMS
MEDICAL ASSISTANCE PAYMENTS
Part 9505.0277 - EYEGLASS SERVICES
Universal Citation: MN Rules 9505.0277
Current through Register Vol. 49, No. 13, September 23, 2024
Subpart 1. Definitions.
The following terms used in this part have the meanings given them.
A. "Comprehensive vision
examination" means a complete evaluation of the visual system.
B. "Dispensing services" means the technical
services necessary for the design, fitting, and maintenance of eyeglasses as
prescribed by an optometrist or ophthalmologist.
C. "Eyeglass services" means comprehensive
and intermediate vision examinations provided by and within the scope of
practice of a provider who is an optometrist or ophthalmologist and the
eyeglasses provided by an optician, optometrist, or ophthalmologist.
D. "Eyeglasses" means a pair of lenses
mounted in a frame and other aids to vision prescribed by an optometrist or
ophthalmologist.
E. "Intermediate
vision examination" means an evaluation of a specific visual problem.
F. "Medically necessary eyeglasses" means
that:
(1) for initial eyeglasses, there is a
correction of .50 diopters or greater in either sphere or cylinder power in
either eye; or
(2) for a change in
eyeglasses, there is a change in correction of .50 diopters or greater in
either sphere or cylinder power in either eye, or a shift in axis of greater
than ten degrees in either eye. For purposes of this item, "diopter" means the
unit of refracting power of the lens.
G. "Ophthalmologist" means a physician who
has academic training in ophthalmology beyond the requirements for licensure
under Minnesota Statutes, chapter 147, and experience in the treatment and
diagnosis of diseases of the eye.
H. "Optician" means a supplier of eyeglasses
to a recipient as prescribed by the recipient's optometrist or
ophthalmologist.
I. "Optometrist"
means a person licensed under Minnesota Statutes, sections
148.52 to
148.62.
Subp. 2. Covered eyeglass services.
The eyeglass services in items A to E are eligible for medical assistance payment.
A.
Comprehensive vision examinations.
B. Intermediate vision
examinations.
C. An initial pair of
medically necessary eyeglasses.
D.
A pair of eyeglasses that are an identical replacement of a pair of eyeglasses
that was misplaced, stolen, or irreparably damaged.
E. A new pair of eyeglasses due to a change
in the recipient's head size, a change in vision after a comprehensive or
intermediate vision examination shows that a change in eyeglasses is medically
necessary, or an allergic reaction to the eyeglass frame material. For purposes
of this part, "change in eyeglasses" means a change in prescription.
Subp. 3. Excluded services.
The following eyeglass services are not eligible for payment under the medical assistance program.
A. Services provided for cosmetic reasons.
Examples are:
(1) contact lenses prescribed
for reasons other than aphakia, keratoconus, aniseikonia, marked acuity
improvement over correction with eyeglasses, or therapeutic application;
and
(2) replacement of lenses or
frames due to the recipient's personal preference for a change of style or
color.
B. Dispensing
services related to noncovered services.
C. Fashion tints and polarized lenses, unless
medically necessary.
D. Protective
coating for plastic lenses.
E. Edge
and antireflective coating of lenses.
F. Industrial or sport eyeglasses unless they
are the recipient's only pair and are necessary for vision
correction.
G. Eyeglasses, lenses,
or frames that are not medically necessary.
H. Invisible bifocals or progressive
bifocals.
I. An eyeglass service
for which a required prior authorization was not obtained.
J. Replacement of lenses or frames due to the
provider's error in prescribing, frame selection, or measurement. The provider
making the error is responsible for bearing the cost of correcting the
error.
K. Services or materials
that are determined to be experimental or nonclinically proven by prevailing
community standards or customary practice.
L. Repair of eyeglasses during the warranty
period if the repair is covered by warranty.
M. Purchase of eyeglasses or lenses not
covered by a contract obtained through the competitive bidding process under
part
9505.0200.
N. Backup eyeglasses.
O. Photochromatic lenses except for a person
who has a diagnosis of albinism, achromatopsia, aniridia, blue cone
monochromatism, cystinosis, or retinitis pigmentosa, or any other condition for
which such lenses are medically necessary.
P. Transition lenses.
Statutory Authority: MS s 256B.04; 256B.0625
Disclaimer: These regulations may not be the most recent version. Minnesota 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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