Source: https://apps.leg.wa.gov/wac/default.aspx?cite=182-544&full=true
Timestamp: 2020-07-13 16:00:27
Document Index: 514504531

Matched Legal Cases: ['§ 182', '§ 182', '§ 388', '§ 388', '§ 388', '§ 388', '§ 182', '§ 182', '§ 388', '§ 388', '§ 388', '§ 182', '§ 182', '§ 388', '§ 388', '§ 388', '§ 388', '§ 182', '§ 182', '§ 388', '§ 388', '§ 388', '§ 388', '§ 182', '§ 182', '§ 388', '§ 388', '§ 182', '§ 182', '§ 388', '§ 388', '§ 388', '§ 388', '§ 388', '§ 182', '§ 182', '§ 388', '§ 388', '§ 388', '§ 388', '§ 182', '§ 182', '§ 388', '§ 388', '§ 388', '§ 388', '§ 182', '§ 182', '§ 388', '§ 388', '§ 388', '§ 388', '§ 182', '§ 182', '§ 388', '§ 388', '§ 388', '§ 388']

Chapter 182-544 WAC:
WACs > Title 182 > Chapter 182-544
Chapter 182-544 WAC
VISION CARE—CLIENTS TWENTY YEARS OF AGE AND YOUNGER
HTMLPDF 182-544-0010 Vision care—General.
HTMLPDF 182-544-0050 Vision care—Definitions.
HTMLPDF 182-544-0100 Vision care—Eligible persons—Twenty years of age and younger.
HTMLPDF 182-544-0150 Vision care—Provider requirements.
HTMLPDF 182-544-0250 Vision care—Covered eye services (examinations, refractions, visual field testing, and vision therapy).
HTMLPDF 182-544-0300 Vision care—Covered eyeglasses (frames and lenses)—Clients age twenty and younger.
HTMLPDF 182-544-0325 Vision care—Covered eyeglass frames and repairs—Clients age twenty and younger.
HTMLPDF 182-544-0350 Vision care—Covered eyeglass lenses—Clients age twenty and younger.
HTMLPDF 182-544-0400 Vision care—Covered contact lenses—Clients age twenty and younger.
HTMLPDF 182-544-0500 Vision care—Covered ocular prosthetics.
HTMLPDF 182-544-0550 Vision care—Covered eye surgery.
HTMLPDF 182-544-0560 Vision care—Authorization.
HTMLPDF 182-544-0575 Vision care—Noncovered eyeglasses and contact lenses.
HTMLPDF 182-544-0600 Vision care—Payment methodology.
PDF182-544-0010
PDF182-544-0050
PDF182-544-0100
Vision care—Eligible persons—Twenty years of age and younger.
This section applies to eligible persons who are twenty years of age and younger.
(1) Vision care is available to persons who are eligible for services under one of the Washington apple health programs listed in the table in WAC 182-501-0060 or are eligible for the alien emergency medical (AEM) program as described in WAC 182-507-0110.
(2) Eligible persons who are enrolled in an agency-contracted managed care organization (MCO) are eligible under fee-for-service for covered vision care that is not covered by their plan, subject to the provisions of this chapter and other applicable WAC.
[Statutory Authority: RCW 41.05.021 and Patient Protection and Affordable Care Act (Public Law 111-148). WSR 14-07-042, § 182-544-0100, filed 3/12/14, effective 4/12/14. WSR 11-14-075, recodified as § 182-544-0100, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090. WSR 11-11-016, § 388-544-0100, filed 5/9/11, effective 6/9/11. Statutory Authority: RCW 74.08.090, 74.09.510, 74.09.520. WSR 08-14-052, § 388-544-0100, filed 6/24/08, effective 7/25/08. Statutory Authority: RCW 74.08.090, 74.09.510, 74.09.520 and 42 C.F.R. 440.120 and 440.225. WSR 05-13-038, § 388-544-0100, filed 6/6/05, effective 7/7/05. Statutory Authority: RCW 74.08.090, 74.09.510 and 74.09.520. WSR 01-01-010, § 388-544-0100, filed 12/6/00, effective 1/6/01.]
PDF182-544-0150
Vision care—Provider requirements.
(a) Meet the requirements in chapter 182-502 WAC;
(c) Obtain all hardware (including the tinting of eyeglass lenses) and contact lenses for clients from the medicaid agency's designated supplier as published in the agency's current vision care billing instructions; and
(d) Return all unclaimed hardware and contact lenses to the agency's designated supplier using a postage-paid envelope furnished by the supplier.
(2) The following providers are to enroll/contract with the agency to provide and bill for vision care services furnished to clients:
[Statutory Authority: RCW 41.05.021, 41.05.160. WSR 17-14-067, § 182-544-0150, filed 6/29/17, effective 7/30/17. WSR 11-14-075, recodified as § 182-544-0150, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090, 74.09.510, 74.09.520. WSR 08-14-052, § 388-544-0150, filed 6/24/08, effective 7/25/08. Statutory Authority: RCW 74.08.090, 74.09.510, 74.09.520 and 42 C.F.R. 440.120 and 440.225. WSR 05-13-038, § 388-544-0150, filed 6/6/05, effective 7/7/05. Statutory Authority: RCW 74.08.090, 74.09.510 and 74.09.520. WSR 01-01-010, § 388-544-0150, filed 12/6/00, effective 1/6/01.]
PDF182-544-0250
Vision care—Covered eye services (examinations, refractions, visual field testing, and vision therapy).
See WAC 182-531-1000 Ophthalmic services.
[Statutory Authority: RCW 41.05.021, 41.05.160. WSR 17-14-067, § 182-544-0250, filed 6/29/17, effective 7/30/17. WSR 11-14-075, recodified as § 182-544-0250, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090. WSR 11-11-016, § 388-544-0250, filed 5/9/11, effective 6/9/11. Statutory Authority: RCW 74.08.090, 74.09.510, 74.09.520. WSR 08-14-052, § 388-544-0250, filed 6/24/08, effective 7/25/08. Statutory Authority: RCW 74.08.090, 74.09.510, 74.09.520 and 42 C.F.R. 440.120 and 440.225. WSR 05-13-038, § 388-544-0250, filed 6/6/05, effective 7/7/05. Statutory Authority: RCW 74.08.090, 74.09.510 and 74.09.520. WSR 01-01-010, § 388-544-0250, filed 12/6/00, effective 1/6/01.]
PDF182-544-0300
Vision care—Covered eyeglasses (frames and lenses)—Clients age twenty and younger.
(1) The medicaid agency covers eyeglasses once every twelve months for clients when the following clinical criteria are met:
(2) If the client has a diagnosis of accommodative esotropia or any strabismus correction, the limitations of subsection (1) of this section do not apply.
(3) The agency covers one pair of back-up eyeglasses for clients who wear contact lenses as their primary visual correction aid (see WAC 182-544-0400(1)) limited to once every two years.
[Statutory Authority: RCW 41.05.021, 41.05.160. WSR 17-14-067, § 182-544-0300, filed 6/29/17, effective 7/30/17. WSR 11-14-075, recodified as § 182-544-0300, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090. WSR 11-11-016, § 388-544-0300, filed 5/9/11, effective 6/9/11. Statutory Authority: RCW 74.08.090, 74.09.510, 74.09.520. WSR 08-14-052, § 388-544-0300, filed 6/24/08, effective 7/25/08. Statutory Authority: RCW 74.08.090, 74.09.510, 74.09.520 and 42 C.F.R. 440.120 and 440.225. WSR 05-13-038, § 388-544-0300, filed 6/6/05, effective 7/7/05. Statutory Authority: RCW 74.08.090, 74.09.510 and 74.09.520. WSR 01-01-010, § 388-544-0300, filed 12/6/00, effective 1/6/01.]
PDF182-544-0325
Vision care—Covered eyeglass frames and repairs—Clients age twenty and younger.
(1) The medicaid agency covers durable or flexible frames when the client has a diagnosed medical condition that contributes to broken eyeglass frames. To receive payment, the provider must order the "durable" or "flexible" frames through the agency's designated supplier.
(2) The agency covers all of the following for clients:
(a) Coating contract eyeglass frames to make the frames nonallergenic. Clients must have a medically diagnosed and documented allergy to the materials in the available eyeglass frames.
(iii) The cost of the repair does not exceed the agency's cost for replacement frames and a fitting fee.
(c) Up to two replacement eyeglass frames in a calendar year when the eyeglass frames have been lost or broken. Lost or broken eyeglass frames must be documented in the client's medical record.
[Statutory Authority: RCW 41.05.021, 41.05.160. WSR 17-14-067, § 182-544-0325, filed 6/29/17, effective 7/30/17. WSR 11-14-075, recodified as § 182-544-0325, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090. WSR 11-11-016, § 388-544-0325, filed 5/9/11, effective 6/9/11. Statutory Authority: RCW 74.08.090, 74.09.510, 74.09.520. WSR 08-14-052, § 388-544-0325, filed 6/24/08, effective 7/25/08.]
PDF182-544-0350
Vision care—Covered eyeglass lenses—Clients age twenty and younger.
(1) The medicaid agency covers the following plastic scratch-resistant eyeglass lenses:
(c) Flat top trifocals;
(2) Eyeglass lenses covered under subsection (1) of this section must be placed into a frame that is, or was, purchased by the agency.
(3) The agency covers the following high index lenses for clients when clinical criteria are met. The client's medical need in at least one eye must be diagnosed and documented as:
(a) A spherical refractive correction of plus or minus six diopters or greater; or
(b) A cylinder correction of plus or minus three diopters or greater.
(4) The agency covers the tinting of plastic lenses when the client's medical need is diagnosed and documented as one or more of the following chronic (expected to last longer than three months) eye conditions causing photophobia:
(j) Optic atrophy or optic neuritis;
(5) The agency covers up to four replacement lenses in a calendar year when the lenses are lost or broken. Lost or broken lenses must be documented in the client's medical record.
(6) The agency covers replacement lenses when the client meets one of the following clinical criteria:
(b) Headaches, blurred vision, or visual difficulty in school or at work. In this case, all of the following must be documented in the client's medical record:
[Statutory Authority: RCW 41.05.021, 41.05.160. WSR 17-14-067, § 182-544-0350, filed 6/29/17, effective 7/30/17. WSR 11-14-075, recodified as § 182-544-0350, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090. WSR 11-11-016, § 388-544-0350, filed 5/9/11, effective 6/9/11. Statutory Authority: RCW 74.08.090, 74.09.510, 74.09.520. WSR 08-14-052, § 388-544-0350, filed 6/24/08, effective 7/25/08. Statutory Authority: RCW 74.08.090, 74.09.510, 74.09.520, and 42 C.F.R. 440.120 and 440.225. WSR 05-17-153, § 388-544-0350, filed 8/22/05, effective 9/22/05; WSR 05-13-038, § 388-544-0350, filed 6/6/05, effective 7/7/05. Statutory Authority: RCW 74.08.090, 74.09.510 and 74.09.520. WSR 01-01-010, § 388-544-0350, filed 12/6/00, effective 1/6/01.]
PDF182-544-0400
Vision care—Covered contact lenses—Clients age twenty and younger.
(1) The medicaid agency covers contact lenses as the client's primary refractive correction method when the client has a spherical correction of plus or minus 6.0 diopters or greater in at least one eye. See subsection (4) of this section for exceptions to the plus or minus 6.0 diopter criteria. The spherical correction may be from the prescription for the glasses or the contact lenses and may be written in either "minus cyl" or "plus cyl" form.
(2) The agency covers the following contact lenses:
(3) The agency covers soft toric contact lenses for clients with astigmatism when the following clinical criteria are met:
(a) The client's cylinder correction is plus or minus 1.0 diopter in at least one eye; and
(b) The client meets the spherical correction listed in subsection (1) of this section.
(4) The agency covers contact lenses when the following clinical criteria are met. In these cases, the limitations in subsection (1) of this section do not apply.
(a) For clients diagnosed with high anisometropia.
(i) The client's refractive error difference between the two eyes is at least plus or minus 3.0 diopters between the sphere or cylinder correction; and
(b) Specialty contact lens designs for clients who are diagnosed with one or more of the following:
(5) The agency covers replacement contact lenses for clients when lost or damaged.
[Statutory Authority: RCW 41.05.021, 41.05.160. WSR 17-14-067, § 182-544-0400, filed 6/29/17, effective 7/30/17. WSR 11-14-075, recodified as § 182-544-0400, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090. WSR 11-11-016, § 388-544-0400, filed 5/9/11, effective 6/9/11. Statutory Authority: RCW 74.08.090, 74.09.510, 74.09.520. WSR 08-14-052, § 388-544-0400, filed 6/24/08, effective 7/25/08. Statutory Authority: RCW 74.08.090, 74.09.510, 74.09.520 and 42 C.F.R. 440.120 and 440.225. WSR 05-13-038, § 388-544-0400, filed 6/6/05, effective 7/7/05. Statutory Authority: RCW 74.08.090, 74.09.510 and 74.09.520. WSR 01-01-010, § 388-544-0400, filed 12/6/00, effective 1/6/01.]
PDF182-544-0500
Vision care—Covered ocular prosthetics.
See WAC 182-531-1000 Opthalmic services.
[Statutory Authority: RCW 41.05.021, 41.05.160. WSR 17-14-067, § 182-544-0500, filed 6/29/17, effective 7/30/17. WSR 11-14-075, recodified as § 182-544-0500, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090. WSR 11-11-016, § 388-544-0500, filed 5/9/11, effective 6/9/11. Statutory Authority: RCW 74.08.090, 74.09.510, 74.09.520. WSR 08-14-052, § 388-544-0500, filed 6/24/08, effective 7/25/08. Statutory Authority: RCW 74.08.090, 74.09.510, 74.09.520 and 42 C.F.R. 440.120 and 440.225. WSR 05-13-038, § 388-544-0500, filed 6/6/05, effective 7/7/05. Statutory Authority: RCW 74.08.090, 74.09.510 and 74.09.520. WSR 01-01-010, § 388-544-0500, filed 12/6/00, effective 1/6/01.]
PDF182-544-0550
Vision care—Covered eye surgery.
[Statutory Authority: RCW 41.05.021, 41.05.160. WSR 17-14-067, § 182-544-0550, filed 6/29/17, effective 7/30/17. WSR 11-14-075, recodified as § 182-544-0550, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090. WSR 11-11-016, § 388-544-0550, filed 5/9/11, effective 6/9/11. Statutory Authority: RCW 74.08.090, 74.09.510, 74.09.520. WSR 08-14-052, § 388-544-0550, filed 6/24/08, effective 7/25/08. Statutory Authority: RCW 74.08.090, 74.09.510, 74.09.520 and 42 C.F.R. 440.120 and 440.225. WSR 05-13-038, § 388-544-0550, filed 6/6/05, effective 7/7/05. Statutory Authority: RCW 74.08.090, 74.09.510 and 74.09.520. WSR 01-01-010, § 388-544-0550, filed 12/6/00, effective 1/6/01.]
PDF182-544-0560
PDF182-544-0575
PDF182-544-0600
Vision care—Payment methodology.
(1) To receive payment, vision care providers must bill the agency according to this chapter, chapters 182-501 and 182-502 WAC, and the medicaid agency's published billing instructions and numbered memoranda.
(2) The agency pays one hundred percent of the agency contract price for covered eyeglass frames, lenses, and contact lenses when these items are obtained through the agency's approved contractor.
(3) See WAC 182-531-1850 for professional fee payment methodology.
[Statutory Authority: RCW 41.05.021, 41.05.160. WSR 17-14-067, § 182-544-0600, filed 6/29/17, effective 7/30/17. WSR 11-14-075, recodified as § 182-544-0600, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090. WSR 11-11-014, § 388-544-0600, filed 5/9/11, effective 6/9/11. Statutory Authority: RCW 74.08.090, 74.09.510, 74.09.520. WSR 08-14-052, § 388-544-0600, filed 6/24/08, effective 7/25/08. Statutory Authority: RCW 74.08.090, 74.09.510, 74.09.520 and 42 C.F.R. 440.120 and 440.225. WSR 05-13-038, § 388-544-0600, filed 6/6/05, effective 7/7/05. Statutory Authority: RCW 74.08.090, 74.09.510 and 74.09.520. WSR 01-01-010, § 388-544-0600, filed 12/6/00, effective 1/6/01.]