Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.14 - Vision Care Services › Section 10.09.14.01 - Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
A. In this chapter,
				  the following terms have the meanings indicated.
B. Terms Defined.
(1) "Acquisition cost" means actual cost of a
				  product to a provider.
(2) "Board"
				  means the State Board of Examiners in Optometry.
(3) "Department" means the State Department
				  of Health and Mental Hygiene, the single State agency designated to administer
				  the Maryland Medical Assistance Program pursuant to Title XIX of the Social
				  Security Act, 42 U.S.C.
				  §
												1396 et seq.
(4) "Diagnostically certified optometrist"
				  means a licensed optometrist who is certified by the Board to administer
				  topical ocular diagnostic pharmaceutical agents to the extent permitted under
				  Health Occupations Article, §
											11-404, Annotated
				  Code of Maryland.
(5) "EPSDT
				  partial screen" means less than the complete package of various screening
				  procedures required by the State Periodicity Schedule that an EPSDT participant
				  receives at a given age.
(6) "EPSDT
				  screen" means EPSDT screen as defined in COMAR
				  10.09.23.01A.
(7) "Invoice" means a form
				  designated by the Department for use by providers in submitting bills for
				  payment.
(8) "Medically necessary"
				  means that the service or benefit is:
(a)
				  Directly related to diagnostic, preventive, curative, palliative,
				  rehabilitative, or ameliorative treatment of an illness, injury, disability, or
				  health condition;
(b) Consistent
				  with current accepted standards of good medical practice;
(c) The most cost efficient service that can
				  be provided without sacrificing effectiveness or access to care; and
(d) Not primarily for the convenience of the
				  consumer, family, or provider.
(9) "Ophthalmologist" means a physician
				  skilled in diseases of the eye.
(10) "Ophthalmic lenses or optical aids"
				  means a lens, contact lens, prism, or vision aid which has a therapeutic effect
				  on a patient, or which will contribute to the visual welfare of a
				  patient.
(11) "Optician" means an
				  individual, partnership, or company which meets applicable licensing
				  requirements as a qualified grinder or dispenser of ophthalmic lenses or
				  optical aids, and which is capable of translating, filling, and adapting
				  ophthalmic prescriptions, products, and accessories.
(12) "Optometric clinic or center" means a
				  facility, which provides services for patients under the supervision of a
				  licensed optometrist.
(13)
				  Optometric Examination.
(a) "Optometric
				  examination" means a series of tests and measurements used to determine the
				  extent of visual impairment, or the correction required to improve visual
				  acuity, performed by a licensed optometrist.
(b) "Optometric examination" includes as a
				  minimum:
(i) Reviewing a patient's history,
				  past prescriptions, and specifications when available;
(ii) Visual analysis;
(iii) Ophthalmoscopy of internal
				  eye;
(iv) Tonometry without
				  anesthetic when indicated or for a patient 40 years old or older;
(v) Muscle balance examination;
(vi) Gross visual field testing when
				  indicated;
(vii) Writing of lens
				  formula and other prescription data when needed, as well as specific
				  instructions for future care;
(viii) Other tests when indicated by
				  §B(12)(b)(i)-(vii) of this regulation; and
(ix) Subsequent progress evaluations when
				  indicated.
(14) "Optometrist" means an individual who is
				  licensed by the Board to practice optometry or by the state in which the
				  service is rendered.
(15)
				  "Orthoptic treatment" means the use of instruments to measure and enhance the
				  binocular coordination of the eyes (a category of "visual training").
(16) Practice Optometry.
(a) "Practice optometry" means, subject to
				  Health Occupations Article, §§
												11-404 and
				  11-404.2,
				  Annotated Code of Maryland, to use any means known in the science of optics or
				  eye care, except surgery, to:
(i) Detect,
				  diagnose, and treat any optical or diseased condition in the human
				  eye;
(ii) Prescribe eyeglasses or
				  lenses to correct any optical or visual condition in the human eye;
(iii) Give advice or direction on the fitness
				  or adaptation of eyeglasses or lenses to an individual for the correction or
				  relief of a condition for which eyeglasses or lenses are worn; and
(iv) Use, or permit the use of an instrument,
				  test card, test type, test eyeglasses, test lenses, or other device to aid in
				  choosing eyeglasses or lenses for an individual to wear.
(b) "Practice optometry" includes, subject to
				  Health Occupations Article, §§
												11-404 and
				  11-404.2,
				  Annotated Code of Maryland:
(i) The
				  administration of topical ocular diagnostic pharmaceutical agents;
(ii) The administration and prescription of
				  therapeutic pharmaceutical agents; and
(iii) The removal of superficial foreign
				  bodies from the cornea and conjunctiva.
(17) "Preauthorization" means an approval
				  required from the Department or its designee before providing
				  services.
(18) "Prescriber" means a
				  physician or optometrist licensed to prescribe optical aids, and authorized by
				  the Department to participate in the Program.
(19) "Prescription" means a written order for
				  treatment or optical aids, or both, signed by the prescriber.
(20) "Program" means the Maryland Medical
				  Assistance Program.
(21) "Progress
				  evaluation" means a follow-up visit, when indicated, to determine the
				  effectiveness of an eye examination, prescription, or series of orthoptic
				  treatments.
(22) "Provider" means a
				  physician (when dispensing ophthalmic lenses or visual aids), optometrist,
				  optometric clinic or center, or optician, recognized by the Department to
				  participate in the Program.
(23)
				  "Recipient" means a person who is certified as eligible for, and is receiving,
				  Medical Assistance benefits.
(24)
				  "Routine adjustment" means an adjustment made to an optical aid other than an
				  adjustment required because of damage.
(25) "Screening" means tests or measurements,
				  other than an eye examination, performed to discover the possibility of
				  difficulty in vision.
(26)
				  "Therapeutically certified optometrist" means a licensed optometrist who is
				  certified by the Board to administer or prescribe therapeutic pharmaceutical
				  agents or remove superficial foreign bodies from a human eye, adnexa, or
				  lacrimal system to the extent permitted under Health Occupations Article,
				  §
											11-404.2,
				  Annotated Code of Maryland.
(27)
				  "Visual training" means use of instruments or other means to measure and
				  enhance the binocular coordination of the eyes and visual perceptual
				  functions.