Provider Eligibility

Payment for services described in 130 CMR 402.000 will be made only to providers of vision care services who are participating in MassHealth on the date of service. The eligibility requirements for providers of vision care services are as follows. (A) In State. (1) Optometrists. A Massachusetts optometrist is eligible to participate in MassHealth only if licensed to practice by the Massachusetts Board of Registration in Optometry. (a) A Level I optometrist is one who is not qualified to apply topical agents. (b) A Level II optometrist is one who has obtained a Certificate of Qualification for the Use of Diagnostic Pharmaceutical Agents (DPAs) from the Board of Registration in Optometry. (c) A Level III optometrist is one who has obtained a Certificate of Qualification for the Use of Therapeutic Pharmaceutical Agents (TPAs) from the Board of Registration in Optometry. (2) Opticians. A Massachusetts optician is eligible to participate in MassHealth only if licensed to practice by the Massachusetts Board of Registration of Opticians. (3) Ophthalmologists. A Massachusetts ophthalmologist is eligible to participate in MassHealth only if licensed to practice by the Massachusetts Board of Registration in Medicine. An ophthalmologist is governed by 130 CMR 402.000 only with respect to the dispensing of ophthalmic materials. All other vision care services provided by an ophthalmologist must be in compliance with 130 CMR 433.000: Physician Services. (4) Ocularists. A Massachusetts ocularist is eligible to participate in MassHealth only if certified by the National Examining Board of Ocularists. (5) Acute Hospital Outpatient Departments and Hospital-licensed Health Centers and Other Satellite Clinics. An acute hospital outpatient department or hospital-licensed health center or other satellite clinic that participates in MassHealth pursuant to the Executive Office of Health and Human Services (EOHHS) Acute Hospital Request for Applications (RFA) and contract is eligible to provide services under 130 CMR 402.000. Acute hospital outpatient departments and hospital-licensed health centers or other satellite clinics are paid pursuant to 130 CMR 402.000 for services described as ophthalmic materials dispensing in Subchapter 6 of the Vision Care Manual. All other vision care services provided by an acute hospital outpatient department or hospital-licensed health center or other satellite clinic are paid in accordance with the RFA and contract. (6) Community Health Center. A community health center with a current provider agreement with EOHHS for the provision of community health center services is eligible to provide services under 130 CMR 402.000. Community health centers are paid pursuant to 130 CMR 402.000 for services described as ophthalmic materials dispensing in Subchapter 6 of the Vision Care Manual. All other vision care services provided by a community health center are paid in accordance with the community health center regulations at 130 CMR 405.000: Community Health Center Services. (B) Out of State. (1) Optometrists. An optometrist located outside of Massachusetts is eligible to receive payment for vision care services provided to MassHealth members only if the optometrist is licensed to practice by the appropriate state's board of registration. (2) Opticians. An optician located outside of Massachusetts is eligible to receive payment for vision care services provided to MassHealth members only if the optician is licensed to practice by the appropriate state's board of registration. (3) Ophthalmologists. An ophthalmologist located outside of Massachusetts is eligible to receive payment for vision care services provided to MassHealth members only if the ophthalmologist is licensed to practice by the appropriate state's board of registration. An ophthalmologist is governed by 130 CMR 402.000 only with respect to the dispensing of ophthalmic materials. All other vision care services provided by ophthalmologists must be in compliance with 130 CMR 433.000: Physician Services. (4) Ocularists. An ocularist located outside of Massachusetts is eligible to receive payment for vision care services provided to MassHealth members only if the ocularist has been certified by the National Examining Board of Ocularists.