SOCIAL AND HEALTH SERVICES
(Health and Recovery Services Administration)
Purpose: Amending subsection (3)(b), changing the words "eight" to "three." This subsection will now read: "(b) A cylinder correction of plus or minus three diopters or greater."
Citation of Existing Rules Affected by this Order: Amending WAC 388-544-0350.
Statutory Authority for Adoption: RCW 74.08.090, 74.09.510, 74.09.520.
Other Authority: 42 C.F.R. 440.120, 42 C.F.R. 440.225.
Adopted under notice filed as WSR 05-14-121 on July 1, 2005.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 1, Repealed 0.
Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 1, Repealed 0.
Date Adopted: August 18, 2005.
Andy Fernando, Manager
Rules and Policies Assistance Unit3592.1
(a) Single vision lenses;
(b) Round or flat top D-style bifocals;
(c) Flat top trifocals; and
(d) Slab-off and prism lenses (including Fresnel lenses).
(2) MAA allows bifocal lenses to be replaced with single vision or trifocal lenses or trifocal lenses to be replaced with bifocal or single vision lenses when all of the following apply:
(a) A client has attempted to adjust to the bifocals or trifocals for at least sixty days;
(b) The client is unable to make the adjustment; and
(c) The bifocal or trifocal lenses being replaced are returned to the provider.
(3) MAA covers high index lenses for clients who require one of the following in at least one eye:
(a) A spherical refractive correction of plus or minus eight diopters or greater; or
(b) A cylinder correction of plus or minus ((
three diopters or greater.
To receive payment, providers must follow the expedited prior authorization process.
(4) MAA covers the tinting of plastic lenses through MAA's contracted lens supplier. The client's medical need must be diagnosed and documented as one or more of the following chronic (expected to last longer than three months) eye conditions causing photophobia:
(b) Chronic corneal keratitis;
(c) Chronic iritis, iridocyclitis;
(d) Diabetic retinopathy;
(e) Fixed pupil;
(f) Glare from cataracts;
(g) Macular degeneration;
(h) Migraine disorder;
(i) Ocular albinism;
(j) Optic atrophy and/or optic neuritis;
(k) Rare photo-induced epilepsy conditions; or
(l) Retinitis pigmentosa.
(5) MAA covers plastic photochromatic lenses when the client's medical need is diagnosed as relating to ocular albinism or retinitis pigmentosa.
(6) MAA covers polycarbonate lenses as follows:
(a) For clients who are blind in one eye and need protection for the other eye, regardless of whether a vision correction is required;
(b) Infants and toddlers with motor ataxia;
(c) For clients twenty years of age or younger who are diagnosed with strabismus or amblyopia; or
(d) For clients with developmental disabilities.
(7) MAA covers requests for lenses only when the client owns frames not purchased by MAA, when:
(a) The eyeglass frames are serviceable (MAA and MAA's contractor do not accept responsibility for these frames); and
(b) The size and style of the required lenses meet MAA's contract requirements.
(8) MAA covers replacement lenses as follows:
(a) Due to lost or broken lenses according to WAC 388-544-0300(6); and
(b) Due to refractive changes, without regard to time limits, when caused by one of the following:
(i) Eye surgery, the effects of prescribed medication, or one or more diseases affecting vision. In this case, all of the following must be documented in the client's file:
(A) The client has a stable visual condition;
(B) The client's treatment is stabilized;
(C) The lens correction must have a 1.0 or greater diopter change between the sphere or cylinder correction in at least one eye; and
(D) The previous and new refraction.
(ii) Headaches, blurred vision, or difficulty with school or work. In this case, all of the following must be documented in the client's file:
(A) Copy of current prescription (less than eighteen months old);
(B) Date of last dispensing, if known;
(C) Absence of a medical condition that is known to cause temporary visual acuity changes (e.g., diabetes, pregnancy, etc.); and
(D) A refractive change of at least .75 diopter or greater between the sphere or cylinder correction in at least one eye.
(c) To receive payment for replacement lenses, providers must follow the expedited prior authorization process.
[Statutory Authority: RCW 74.08.090, 74.09.510, 74.09.520 and 42 C.F.R. 440.120 and 440.225. 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. 01-01-010, § 388-544-0350, filed 12/6/00, effective 1/6/01.]