Visual Services  

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    AGENCY FOR HEALTH CARE ADMINISTRATION

    Medicaid

    RULE NO.:RULE TITLE:

    59G-4.340Visual 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. 41 No. 85, May 1, 2015 issue of the Florida Administrative Register.

    (2) All providers of visual aid services must be in compliance with the provisions of the Florida Medicaid Visual Aid Services Coverage Policy, _______________, incorporated by reference. The policy is available from the Medicaid fiscal agent’s Web site at http://portal.flmmis.com/flpublic www.mymedicaid-florida.com. Select Public Information for Providers, then on Provider Support, and then on Provider Handbooks.

     

    The following changes have been made to the Florida Medicaid Visual Aid Services Coverage Policy:

    Table of Contents has been renumbered and updated accordingly.

    Section 1.1.1 Medicaid Policies, the title is Florida Medicaid Policies, and now reads:

    This policy is intended for use by visual aid services providers that render services to eligible Florida Medicaid recipients. It must be used in conjunction with Florida Medicaid’s general policy and any applicable service-specific and claim reimbursement policies with which providers must comply.

    Note: Policies are available on the Florida Medicaid fiscal agent’s Web site at http://portal.flmmis.com/flpublic. 

    Section 1.1.2 Statewide Medicaid Managed Care Plans, Florida was added to all Medicaid references.

    Section 1.3 Definitions, alphabetized subsection title and renumbered based on coverage policy update.

    Section 1.3.1 Claim Reimbursement Policy, section added and now reads:

    A policy document handbook that provides instructions on how to bill for services.

    Section 1.3.1 Coverage and Limitations Handbook or Coverage Policy, Florida added before Medicaid reference.

    Section 1.3.5 General Policy, section added and now reads:

    A collective term for Florida Medicaid policy documents found in Rule Chapter 59G-1 containing information that applies to all providers including all basic requirements of the Florida Medicaid program.

    Section 1.3.8 Provider General Handbook, deleted.

    Section 1.3.10 Reimbursement Handbook, deleted.

    Section 2.2 Who Can Receive, first sentence now reads:

    Florida Medicaid recipients requiring medically necessary visual aid services.

    Section 3.2 Who Can Provide, the phrase “Visual aid services providers must be one of the

    following:” is deleted.

    Section 4.2.1 Eyeglasses, now reads:

    Florida Medicaid reimburses for two pairs per 365 days for recipients under the age of 21 years.

    For recipients age 21 years and older, Florida Medicaid reimburses for the following:

    One frame every two years

    Two lenses every 365 days

    Florida Medicaid also reimburses the following:

    Polycarbonate or thermoplastic lens materials for a recipient’s safety or documented medical condition (when necessary)

    Metal frames when plastic frames are medically inappropriate

    Florida Medicaid may reimburse for additional frames, lenses, pairs of glasses, and special order frames with prior authorization.

    Section 4.2.2 Fitting, Dispensing, and Adjustment of Eyeglasses, added Services to the end of title and now reads:

    Florida Medicaid reimburses for services for new Medicaid-provided glasses and after factory repairs.

    Section 4.2.3 Eyeglass Repair Service, now reads:

    Florida Medicaid reimburses for repairs when performed in an office or by a licensed authorized dealer.

    Only elements of the frames or lenses that are damaged beyond repair may be replaced.

    Section 4.2.4 Contact Lenses, “Florida” added before Medicaid.

    Section 4.2.5 Prosthetic Eyes, added “Florida” before Medicaid reference, and second paragraph, second sentence now reads:

    Prosthetic eyes may also be reimbursed through Florida Medicaid’s durable medical equipment and medical supply services.

    Section 4.3 Place of Service, deleted.

    Section 5.2 Specific Non-Covered Criteria, “Florida” added before Medicaid, and the sixth bullet now reads:

    Glass lenses (including clear, absorptive tint, photogrey, photogrey extra, photosun, photochromic, or any glass lens product).

    Section 6.1 General Criteria, now reads:

    For information on general documentation requirements, please refer to the Florida Medicaid’s general policy.

    Section 7.1 General Criteria, second paragraph, second sentence now reads:

    For recipients receiving services through the fee-for-service delivery system, providers should request authorization through the Quality Improvement Organization.

    Section 7.2 Specific Criteria, second paragraph, leading sentence now reads:

    Providers must obtain authorization when the following applies:

    Section 8.1 General Criteria, now reads:

    The reimbursement information below is applicable to the fee-for-service delivery system, unless otherwise specified.

    Section 8.2 Specific Criteria, now reads:

    The provider must forward the claim for reimbursement only after the fitting and dispensing is complete and the recipient has received the eyeglasses. The provider must enter the date when the eyeglasses were dispensed as the date of service on the claim form. An exception can be made to this whereby a provider may use the order date on the claim form if the recipient loses eligibility from one month to the next.

    Section 8.6 Rate, now reads:

    For a schedule of rates, as incorporated by reference in Rule 59G-4.002, F.A.C., visit the Florida Medicaid fiscal agent’s Web site at http://portal.flmmis.com/flpublic.

Document Information

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