Prescription and Dispensing Requirements

(A) Eyeglasses and other visual aids may be dispensed only upon a written and dated prescription. The prescription must be based upon the results of a vision examination performed by the prescriber. The prescription must include all information that is necessary to enable a dispensing practitioner to order the prescription. (B) The prescriber must provide the member with a signed copy of the prescription without extra charge. The date or dates on which the prescription is filled or refilled must be recorded in the member's medical record. (C) The prescriber may order the prescription eyeglasses or other visual aids or may refer the member to another provider to order and dispense eyeglasses or other visual aids. (D) A practitioner may be paid for either fitting or dispensing an eyeglass prescription involving ophthalmic materials and services, but not both. (E) For a vision care provider to be paid for fitting or dispensing an eyeglass prescription involving ophthalmic materials and services available through the optical supplier, all such materials and services must be ordered from the optical supplier, with a copy of the order form kept in the patient records. These ophthalmic materials include a specific selection of eyeglass frames for men, women, and children. Members must choose from this selection of frames. Information describing all of the ophthalmic materials and services furnished by the optical supplier is published by the optical supplier and is distributed to vision care providers by the MassHealth agency. (F) In order to receive payment for fitting or dispensing an item, the practitioner must take all necessary measurements, verify lens characteristics, and adjust the completed appliance to the individual. At no additional charge, the dispensing practitioner must continue to make necessary adjustments to the completed appliance for six months after the dispensing date. (G) The optical supplier must replace free of charge any lens containing any defect or error caused by the optical supplier. Such defects or errors include lenses that are broken, scratched, or chipped at the time of receipt by the dispensing practitioner, or lenses that deviate from the dispensing practitioner's prescription beyond the deviation standards permitted in the American National Standards Institute Z80 rulings. This provision is effective only if the defective or incorrect lens is received by the optical supplier from the dispensing practitioner within seven working days after the date on which the optical supplier sent the completed order to the dispensing practitioner, and only if it is accompanied by a copy of the original order form containing a notation of the defect or error. In the event of a dispute between the optical supplier and a dispensing practitioner about lens deviation, the MassHealth agency determines whether the lens in dispute exceeds deviation standards. (H) Although contractual arrangements are in effect between the MassHealth agency and the optical supplier, all regulations about reimbursable and nonreimbursable services, including prior authorization requirements, are applicable to all dispensing practitioners. (I) An order to the optical supplier for prescribed items constitutes a representation by the dispensing practitioner that the person for whom the prescribed item is ordered is an eligible member as of the date of the order.