Vision Care Services Policy Update

 

Effective for dates of services on or after January 1, 2014, Robertson Optical will no longer be the contracted provider of eye wear for South Carolina Medicaid fee for service (FFS) participants.  The South Carolina Department of Health and Human Services (SCDHHS) will no longer be acquiring this service through an exclusive contract.  Beginning with dates of service on or after January 1, 2014, any enrolled and qualified provider producing eye wear may bill for this service.  

All vision providers will be required to display an age appropriate selection of frames for beneficiaries under the age of 21.  SCDHHS will reimburse providers $50.00 for metal, nickel free and plastic frames.  For all special needs/oversized frames SCDHHS will reimburse $65.00 and frame selection must be readily available at the point of sale for children enrolled in the Medicaid FFS program.  All services must be medically necessary and documented in the patient’s chart for auditing purposes.  Providers must file for payment using the examination date as the date of service for frames/lenses.  In the event that glasses are lost or destroyed, SCDHHS will allow for repairs as needed and/or one replacement within a twelve consecutive month period.  Ophthalmologists and Optometrists that provide comprehensive eye exams for Medicaid FFS patients must also notify the beneficiaries that they may choose any enrolled South Carolina Medicaid optician service provider for producing their eye wear needs.

Opticians wishing to provide eye wear for Medicaid FFS participants on or after January 1, 2014 may enroll as a provider through the SCDHHS Provider Service Center website at https://providerservices.scdhhs.gov/ProviderEnrollmentWeb/. This automated provider enrollment web-based application ensures the security of providers’ information and is accessible from any computer that has internet access.

For any Medicaid participants enrolled in a Managed Care Organization (MCO), the MCO is responsible for providing all vision care services to their enrolled participants.  Please refer all questions regarding coverage policy and benefits to the participants MCO plan.

The appropriate provider manuals have been updated to reflect the changes associated with the discontinuation of a single source vendor for eye wear products.  Providers are encouraged to visit www.scdhhs.govto view the most current version of this policy located in the Physicians, Laboratory, and Other Medical Professionals manual. 

If you have any questions regarding this bulletin, contact the Provider Service Center at (888) 289-0709. Thank you for your continued support of the South Carolina Healthy Connections Medicaid Program.

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