Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 101 - MAINECARE BENEFITS MANUAL (FORMERLY MAINE MEDICAL ASSISTANCE MANUAL) › Chapter II - Specific Policies By Service › Section 144-101-II-75 - Vision Services › Subsection 144-101-II-75.04 - VISION SERVICE PROVIDER REQUIREMENTS

Current through 2024-29, July 17, 2024
75.04-1
Chapter I Requirements
Vision service providers must comply with all provisions
						of Chapter I, Section 1, General Administrative Policies and Procedures, of the
						MaineCare Benefits Manual.
75.04-2
Vision Care Volume Purchase
					 Contractor
A.
Sole
					 Supplier
Vision service providers must use MaineCare's designated
						Vision Care Volume Purchase Contractor (the Contractor) as the sole supplier of
						all eyeglasses for MaineCare members with no Medicare or other third party
						coverage, except as noted in Section 75.04-4(D). This includes lenses, frames,
						associated parts and cases.
For those contract services/articles that require prior
						authorization, the provider must request prior authorization from the MaineCare
						Prior Authorization Unit or its authorized agent before placing an order with
						the Contractor. If the request is approved, the MaineCare Authorization Unit or
						its authorized agent will send written notification to both the provider and
						the Contractor.
The Contractor will not fill any provider orders without
						receiving notice of approval and a prior authorization number from the
						MaineCare Authorization Unit or its authorized agent.
If a MaineCare member has coverage for eyeglasses from
						Medicare or any other third party, the provider must follow his/her customary
						practice for the acquisition of these items rather than the above rules
						relating to acquisition from the Contractor. If these items are to be covered
						by MaineCare only, however, then they must be acquired in accordance with the
						above rules relating to acquisitions from the Contractor.
B.
Vision Care Volume Purchase
					 Warranty
1. The Contractor must
					 warrantee all articles purchased under the Vision Care Volume Purchase Contract
					 for a minimum of one (1) year after delivery to the member. This warranty need
					 not cover patient abuse or damage from normal wear and tear.
If the dispensing provider finds any article supplied
						under the contract to be unsatisfactory due to defective materials or
						workmanship, the provider may return the article to the Contractor and the
						Contractor will correct, adjust or replace the defective article at the
						Contractor's expense for a period of up to one year after delivery to the
						member. Such defects or errors may include but are not limited to:
a. Lenses that are broken, scratched, or
					 chipped at the time of receipt by the provider; or
b. Lenses that deviate from the provider's
					 prescriptions beyond the deviation standards permitted by the ANSI Z80
					 Committee on Ophthalmic Standards.
The provider must return such articles to the Contractor.
						The Contractor must mail corrected or replacement articles to the provider
						within seven (7) working days of receipt of the unsatisfactory
						materials.
2.
					 The provider must honor and enforce any express manufacturer warranties in
					 excess of one (1) year.
C.
Responsibility for Materials Lost in
					 Transit
The sender (either the Contractor or the provider) must
						replace materials lost in transit, at no charge to MaineCare or the MaineCare
						member. The Contractor is responsible for furnishing postage-paid mailers to
						MaineCare providers for use in returning defective materials to the Contractor.
						The Contractor is solely responsible for the cost of materials lost in transit
						when the provider uses the Contractor's postage-paid mailers to return
						defective materials. The provider is responsible for the cost of replacing the
						materials lost in transit when the provider does not use Contractor
						postage-paid mailers to return defective materials.