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10.09.14.00.htm 10.09.14.00. Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE Subtitle 09 MEDICAL CARE PROGRAMS Chapter 14 Vision Care Services Authority: Health-General Article, §2-104(b) 15-103, and 15-105, Annotated Code of Maryland
10.09.14.01.htm 10.09.14.01. 01 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) "Acquisition cost" means actual cost of a product to a provider.. 2) "Board" means the State Board of Examiners in Optometry.. 3) "Department" means the State Department of Health and Mental Hygiene, the single State agency designated to administer the Maryland Medical Assistance Program pursuant to Title XIX of the Social Security Act, 42 U.S.C. §134) "Diagnostically certif
10.09.14.02.htm 10.09.14.02. 02 License Requirements.. A. An optometrist shall be licensed to practice optometry in the state in which service is provided.. B. An optician shall meet the legal requirements of the state in which the service is provided.. C. An ophthalmologist shall be licensed to practice medicine in the state in which the service is provided.
10.09.14.03.htm 10.09.14.03. 03 Conditions for Participation.. To participate in the Program, the provider shall:. A. Apply for participation in the Program using the application form designated by the Department;. B. Be approved for participation by the Department;. C. Verify the recipient's eligibility;. D. Maintain adequate records for a minimum of 6 years and make them available, upon request, to the Department or its designee;E. Provide service without regard to race, creed, color, age, sex, national
10.09.14.04.htm 10.09.14.04. 04 Covered Services.. 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
10.09.14.05.htm 10.09.14.05. 05 Limitations.. A. The following are not covered:. 1) Eyeglasses, ophthalmic lenses, optical aids, and optician services rendered to recipients 21 years old and older;2) Eyeglasses, ophthalmic lenses, optical aids, and optician services rendered to recipients which were not ordered as a result of a full or partial EPSDT screen;3) Repairs, except when repairs to eyeglasses are more cost-effective than replacing with new eyeglasses;
10.09.14.06.htm 10.09.14.06. 06 Preauthorization Requirements.. A. The following services require written preauthorization:. 1) Optometric examinations to determine the extent of visual impairment or the correction required to improve visual acuity before expiration of the normal time limitations;2) Replacement of eyeglasses due to medical necessity or because the eyeglasses were lost, stolen, or damaged before expiration of the normal time limitations;4) Subnormal vision aid examination and fitting;.
10.09.14.07.htm 10.09.14.07. 07 Payment Procedures.. A. Form for Request for Payment.. 1) The provider shall submit a request for payment on the form designated by the Department.. 2) The request for payment shall document the following, when applicable:. a) Preauthorization;. b) Prescriptions;. c) Need for combination or metal frame;. d) Laboratory invoices.. B. The Department reserves the right to return to the provider, before payment, all invoices not properly completed.C. The provider shall cha
10.09.14.08.htm 10.09.14.08. 08 Recovery and Reimbursement.. A. If the recipient has insurance or other coverage, or if any other person is obligated, either legally or contractually, to pay for or to reimburse the recipient for services covered by this chapter, the provider shall seek payment from that source first. If an insurance carrier rejects the claim or pays less than the amount allowed by the Medical Assistance Program, the provider may submit a claim to the Program. The provider shall submit a co
10.09.14.09.htm 10.09.14.09. 09 Cause for Suspension or Removal and Imposition of Sanctions.. A. If the Department determines that a provider, ophthalmologist, optometrist, optician, any agent or employee of the provider, or any person with an ownership interest in the provider has failed to comply with applicable federal or State laws or regulations, the Department may initiate one or more of the following actions against the responsible party:1) Suspension from Program;.
10.09.14.10.htm 10.09.14.10. 10 Appeal Procedures.. Providers filing appeals from administrative decisions made in connection with these regulations shall do so according to COMAR 10.09.36.09.
10.09.14.11.htm 10.09.14.11. 11 Interpretive Regulation.. Except when the language of a specific regulation indicates an intent by the Department to provide reimbursement for covered services to Program recipients without regard to the availability of federal financial participation, State regulations shall be interpreted in conformity with applicable federal statutes and regulations.
10.09.14.9999.htm 10.09.14.9999. Administrative History Effective date: January 1, 1976 (2:29 Md. R. 1740). Chapter revised September 14, 1977 (4:19 Md. R. 1469). Regulations .01, .04, and .05 amended as an emergency provision effective January 1, 1993 (20:2 Md. R. 108) amended permanently effective July 1, 1993 (20:12 Md. R. 996)Regulation .01 amended effective November 29, 1999 (26:24 Md. R. 1858). Regulation .01A amended effective March 12, 1984 (11:5 Md. R. 463).
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