Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 402.000 - Vision Care Services › Section 402.416 - Prescription and Dispensing Requirements

Current through Register 1525, July 5, 2024
(A)
			 Eyeglasses and other visual aids may be dispensed only upon a written and dated
			 prescription. The prescription must be based upon the results of a vision
			 examination performed by the prescriber. The prescription must include all
			 information that is necessary to enable a dispensing practitioner to order the
			 prescription.
(B) The prescriber
			 must provide the member with a signed copy of the prescription without extra
			 charge. The date or dates on which the prescription is filled or refilled must
			 be recorded in the member's medical record.
(C) The prescriber may order the prescription
			 eyeglasses or other visual aids or may refer the member to another provider to
			 order and dispense eyeglasses or other visual aids.
(D) A practitioner may be paid for either
			 fitting or dispensing an eyeglass prescription involving ophthalmic materials
			 and services, but not both.
(E) For
			 a vision care provider to be paid for fitting or dispensing an eyeglass
			 prescription involving ophthalmic materials and services available through the
			 optical supplier, all such materials and services must be ordered from the
			 optical supplier, with a copy of the order form kept in the patient records.
			 These ophthalmic materials include a specific selection of eyeglass frames for
			 men, women, and children. Members must choose from this selection of frames.
			 Information describing all of the ophthalmic materials and services furnished
			 by the optical supplier is published by the optical supplier and is distributed
			 to vision care providers by the MassHealth agency.
(F) In order to receive payment for fitting
			 or dispensing an item, the practitioner must take all necessary measurements,
			 verify lens characteristics, and adjust the completed appliance to the
			 individual. At no additional charge, the dispensing practitioner must continue
			 to make necessary adjustments to the completed appliance for six months after
			 the dispensing date.
(G) The
			 optical supplier must replace free of charge any lens containing any defect or
			 error caused by the optical supplier. Such defects or errors include lenses
			 that are broken, scratched, or chipped at the time of receipt by the dispensing
			 practitioner, or lenses that deviate from the dispensing practitioner's
			 prescription beyond the deviation standards permitted in the American National
			 Standards Institute Z80 rulings. This provision is effective only if the
			 defective or incorrect lens is received by the optical supplier from the
			 dispensing practitioner within seven working days after the date on which the
			 optical supplier sent the completed order to the dispensing practitioner, and
			 only if it is accompanied by a copy of the original order form containing a
			 notation of the defect or error. In the event of a dispute between the optical
			 supplier and a dispensing practitioner about lens deviation, the MassHealth
			 agency determines whether the lens in dispute exceeds deviation
			 standards.
(H) Although contractual
			 arrangements are in effect between the MassHealth agency and the optical
			 supplier, all regulations about reimbursable and nonreimbursable services,
			 including prior-authorization requirements, are applicable to all dispensing
			 practitioners.
(I) An order to the
			 optical supplier for prescribed items constitutes a representation by the
			 dispensing practitioner that the person for whom the prescribed item is ordered
			 is an eligible member as of the date of the order.