Missouri Code of State Regulations › Title 13 - DEPARTMENT OF SOCIAL SERVICES › Division 70 - MO HealthNet Division › Chapter 40 - Optical Program › Section 13 CSR 70-40.010 - Optical Benefits and Limitations-MO HealthNet Program

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: This amendment updates the requirements
				  related to precertification of Optical Program services, adds record retention
				  language, clarifies provider enrollment requirements for certain services,
				  identifies optometrists as acceptable providers for prescribing contact lenses
				  for therapeutic purposes, and updates terminology as
				  appropriate.
(1)
				Administration. The Department of Social Services, MO HealthNet Division shall
				administer the Optical Program. The Department of Social Services, MO HealthNet
				Division shall determine, and include in the Optical Provider manual, the
				optical services covered and not covered, the program limitations, and the
				maximum allowable fees for all covered services. The Optical Provider manual is
				incorporated by reference and made a part of this rule as published by the
				Department of Social Services, MO HealthNet Division, 615 Howerton Court,
				Jefferson City, MO 65109, at its website at website at
http://manuals.momed.com/collections/collection_opt/print.pdf
November 24, 2020. This rule does not incorporate any subsequent amendment or
				additions. Services covered shall include only those which are clearly shown to
				be medically necessary.
(2)
				Participants Eligible. Any participant who is eligible for MO HealthNet
				benefits as determined by the Family Support Division and who is found to be in
				need of optical services as described in this regulation subject to the
				limitations set forth in subsections (7)(A)-(X).
(3) Provider Participation. To be eligible
				for participation in the MO HealthNet Optical Program, a provider must meet the
				criteria specified for his/her profession as follows:
(A) An optometrist must be a duly licensed
				Doctor of Optometry (OD) to participate in the MO HealthNet program, must be
				licensed in accordance with the licensing provisions of the state in which s/he
				practices, and must have a current MO HealthNet participation agreement and
				provider number;
(B) A physician
				must be a duly licensed Doctor of Medicine (MD) or Doctor of Osteopathy (DO) to
				participate in the MO HealthNet program, must be licensed in accordance with
				the licensing provisions of the state in which s/he practices, and must have a
				current MO HealthNet participation agreement and provider number;
(C) A clinic can participate in the Optical
				Program if it has a current MO HealthNet Program clinic number. In addition to
				the clinic number, each of the performing optometrists must have an effective
				participation agreement and MO HealthNet program provider number. Reimbursement
				may be made to the clinic for all covered services provided at the clinic;
				and
(D) An optician, optical
				dispenser, or manufacturer of prosthetic eyes must have a current MO HealthNet
				participation agreement and provider number.