AGENCY FOR HEALTH CARE ADMINISTRATION
RULE NO.:RULE TITLE:
59G-4.210Optometric 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. 39, No. 234, December 4, 2013 issue of the Florida Administrative Register.
The following changes have been made to the Optometric Services Coverage and Limitations Handbook.
Page 2-4 Limitations:
The fourth paragraph is deleted.
Page 2-7 Special Ophthalmological Services:
The second paragraph will now read:
In a nursing facility, an intermediate care facility for individuals with intellectual disabilities (ICF/IID), a recipient’s home, or a custodial care facility, general and special ophthalmological services are not reimbursed, except for determination of refractive state, fitting of contact lens for treatment of ocular surface disease, and extended ophthalmoscopy with retinal drawing, interpretation, and report.
Page 2-7 Documentation Requirements:
A fourth bullet is added that reads:
- Retinal drawing, if applicable
Page 2-8, the label will now read:
Eyeglasses and Refractions in a Recipient’s Home, Custodial Care Facility, Nursing Facility, or Intermediate Care Facility for Individuals with Intellectual Disabilities
In the second paragraph, ICF/DD is changed to ICF/IID.
The fourth bullet is deleted.
The last bullet now reads:
The recipient’s primary care physician or facility physician must order a referral for medically necessary optometric services to be performed in a recipient’s home, custodial care facility, nursing facility, or ICF/IID.
Page 2-9, the continued label is revised as on page 2-8.
The first paragraph, first sentence will now read:
Verbal orders, including telephone orders, shall be immediately recorded, dated, and signed by the person receiving the order.
In the fourth, fifth, and sixth paragraphs, ICF/DD is changed to ICF/IID.
Page 2-12 Place of Service
The last bullet now reads:
- ICF/IID
The paragraph after the bulleted list is deleted.
Page 2-13 Home Visits
The second paragraph now reads:
A referral for optometric services must be ordered in writing by the recipient’s primary care physician. The services must be fully documented and maintained in the recipient’s medical record at the optometrist’s office location and made available upon request.
Page 2-15, the first label now reads:
Custodial Care Facility, Nursing Facility, and Intermediate Care Facility for Individuals with Intellectual Disabilities Visits
In the second paragraph ICF/DD is changed to ICF/IID.
The third paragraph now reads:
Services rendered must be requested in writing by the recipient’s primary care physician.
The fourth paragraph now reads:
Documentation must be maintained in the recipient’s medical record at the optometrist’s office and a copy provided to the facility to be maintained in the recipient’s record.
The sixth and seventh paragraphs are deleted.
Page 2-15 Visit Limitations
In the second paragraph, ICF/DD is changed to ICF/IID.
A third paragraph is added and reads:
Custodial care facility, nursing facility, and ICF/IID visits are limited to one per month, per provider or provider group, per recipient. Additional visits may be reimbursed by submitting the claim with modifier 22 and a report documenting the care provided.
Page 2-26 Service Requirements
Five additional dashes are added under the first bullet that read:
– Lagophthalmos
– Chemical burns
– Ocular pemphigus
– Severe punctate keratitis
– Other similar serious anterior segment conditions
