Services Provided outside the Office

(A) Member's Home. The MassHealth agency pays for vision care services provided to a member in the member's home. A medical record must be kept on file at the provider's office. (B) Nursing Facility. The MassHealth agency pays for vision care services for a member residing in a nursing facility only when the service is specifically requested by the medical director, the nursing director, or responsible staff member at the facility, or by the member's personal physician. The request must be documented in the member's record at the facility. If eyeglasses or other visual aids are to be dispensed to a member in the facility, the facility must document in the member's record that a consultation has occurred between the facility's staff member and the vision care provider, and that they have determined that the member is able to benefit from eyeglasses or other visual aids. A copy of the eye examination results, including the prescription, must be filed in the member's record at the facility and at the vision care provider’s primary office location. (C) Other Facilities. The MassHealth agency pays for vision care services provided to a member residing in a public or private facility, if payment for these services is not included in the facility's rate. A medical record must be kept on file at the provider's office. (D) Other Locations of Service. The MassHealth agency pays for vision care services provided to eligible members at other places of service as approved by the MassHealth agency. (E) Claims for Payment. (1) A vision care examination performed for a member outside of the office must be claimed using the appropriate service codes. (See Subchapter 6 of the Vision Care Manual.) (2) The MassHealth agency pays separately for transportation once per member per date of service for each member for whom the provider delivered or picked up eyeglasses, or to whom vision care services were provided out of the office in accordance with 130 CMR 402.418(A) through (D). (130 CMR 402.419 through 402.425 Reserved)