Regulation .05 Limitations.
Regulation .05 Limitations.LinkCopy Citation
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;
(4)
Combination or metal frames except when required for proper fit;
(5)
Cost of travel by the provider;
(6)
A general screening of a Medical Assistance population;
(7)
Visual training sessions which do not include orthoptic treatment;
(8)
Routine adjustment.
B.
An optometrist certified by the Board as qualified to administer diagnostic pharmaceutical agents may use the following agents in strengths not greater than the strengths indicated:
(1)
Agents directly or indirectly affecting the pupil of the eye, including the mydriatics and cycloplegics listed below:
(a)
Phenylephrine hydrochloride (2.5 percent);
(b)
Hydroxyamphetamine hydrobromide (1 percent);
(c)
Cyclopentolate hydrochloride (0.5—2 percent);
(d)
Tropicamide (0.5 and 1 percent);
(e)
Cyclopentolate hydrochloride (0.2 percent) with Phenylephrine hydrochloride (1 percent);
(f)
Dapiprazole hydrochloride (0.5 percent); and
(g)
Hydroxyamphetamine hydrobromide (1 percent) and Tropicamide (0.25 percent); and
(2)
Agents directly or indirectly affecting the sensitivity of the cornea including the:
(a)
Topical anesthetics listed below:
(i)
Proparacaine hydrochloride (0.5 percent); and
(ii)
Tetracaine hydrochloride (0.5 percent); and
(b)
Diagnostic topical anesthetic and dye combinations listed below:
(i)
Benoxinate hydrochloride (0.4 percent) — Fluorescein sodium (0.25 percent); and
(ii)
Proparacaine hydrochloride (0.5 percent) — Fluorescein sodium (0.25 percent).
C.
An optometrist certified by the Board as qualified to administer and prescribe topical therapeutic pharmaceutical agents is limited to:
(1)
Ocular antihistamines, decongestants, and combinations of them, excluding steroids;
(2)
Ocular antiallergy pharmaceutical agents;
(3)
Ocular antibiotics and combinations of ocular antibiotics, excluding specially formulated or fortified antibiotics;
(4)
Anti-inflammatory agents, excluding steroids;
(5)
Ocular lubricants and artificial tears;
(6)
Tropicamide;
(7)
Homatropine;
(8)
Nonprescription drugs that are commercially available; and
(9)
Primary open-angle glaucoma medications, in accordance with a written treatment plan developed jointly between the optometrist and an ophthalmologist.