Visual Services  

  •  

    AGENCY FOR HEALTH CARE ADMINISTRATION
    Medicaid

    RULE NO: RULE TITLE
    59G-4.340: Visual Services

    NOTICE OF CHANGE

    Notice is hereby given that the following changes have been made to the proposed rule in accordance with subparagraph 120.54(3)(d)1., F.S., published in Vol. 32, No. 49, December 8, 2006 issue of the Florida Administrative Weekly.

    These changes are in response to written comments received prior to the public hearing. The rule incorporates by reference Update January 2007 to the Florida Medicaid Visual Services Coverage and Limitations Handbook. The following changes were made to the handbook update.

    Page 1-3, Provider Enrollment, General Enrollment Requirements, we added a sentence to clarify that physicians must be currently licensed as ophthalmologists in order to have Category of Service 62 (Visual Services) added to their provider files.

    Page 2-4, Covered and Excluded Services, Excluded Services, we added glass lenses to the list of services that Medicaid does not reimburse.

    Page 2-5, Covered and Excluded Services, Criteria For Providing Eyeglasses in a Nursing Facility, Custodial Care Facility, or Recipient’s Home, second bullet, we rewrote the instructions for verbal orders to bring them into compliance with Rule 59A-107, F.A.C. The revised bullet reads, “The medical need for the exception is ordered by the recipient’s primary-care physician and is documented in the recipient’s medical record in the provider’s office and at the facility. The physician’s order is valid up to 90 days after the order is given. If additional care is needed by the provider, then another order must be written by the recipient’s primary care physician. Pursuant to Rule 59A-4.107, F.A.C., the order may be given verbally by the licensed nurse or attending physician at the facility. The verbal order, including telephone orders, shall be immediately recorded, dated, and signed by the person receiving the order. All verbal treatment orders shall be countersigned by the primary care physician on the next visit to the facility and must be filed in the recipient’s medical record at both the facility and the visual services provider’s office.”

    Page 2-10, Eyeglasses and Lenses, Multifocal Lenses, first paragraph, last sentence, we revised the sentence to read, “Progressive addition lenses are not reimbursable.”

    Page 2-11, Eyeglasses and Lenses, Polycarbonate Lenses, second bullet, we deleted, “the sight in the poorer eye being 20/50 or worse.”  The revised bullet reads, “The recipient has significant amblyopia.”

    Page 2-11, Eyeglasses and Lenses, Polycarbonate Lenses Reimbursement Information, second bullet, we added “single vision, bifocal or trifocal.” The revised bullet reads, “The appropriate procedure code for polycarbonate single vision, bifocal or trifocal lens fees.”

    We added page 2-13 to the handbook update. On page 2-13, Eyeglasses and Lenses, Special Order Frame and Lenses, first sentence, we added that the medical reasons must be “stated and written.” We revised the second sentence to read, “The provider must submit sufficient information to cost the items with the prior authorization request, including the following: . . .”

    We added page 2-14 to the handbook update. On page 2-14, Eyeglasses and Lenses, Lab Order Form, we added “prescriptive data” to the information that must be included on the lab order form.

    On page 2-14, Contact Lenses, Description, we added a new sentence that reads, “It must be clearly stated and written on the prior authorization request form whether it is a new fitting or replacement lenses.

    Page 2-14, Contact Lenses, Who May Receive Contact Lenses, we revised the first sentence to read, “Medicaid reimburses for contact lenses only for recipients who have the following conditions,” and deleted the second sentence. We added the following conditions as the first and second bullets, “unilateral aphakia or bilateral aphakia, but not pseudophakia,” and “keratoconus (conical cornea).

Document Information

Related Rules: (1)
59G-4.340. Visual Services