Sec. 10.09.14.01. Definitions

A. In this chapter, the following terms have the meanings indicated.

B. Terms Defined.

(1) "Acquisition cost" means actual cost of a product to a provider.

(2) "Board" means the State Board of Examiners in Optometry.

(3) "Department" means the Maryland Department of Health, the single State agency designated to administer the Maryland Medical Assistance Program pursuant to Title XIX of the Social Security Act, 42 U.S.C. §1396 et seq.

(4) "Diagnostically certified optometrist" means a licensed optometrist who is certified by the Board to administer topical ocular diagnostic pharmaceutical agents to the extent permitted under Health Occupations Article, §11-404, Annotated Code of Maryland.

(5) "EPSDT partial screen" means less than the complete package of various screening procedures required by the State Periodicity Schedule that an EPSDT participant receives at a given age.

(6) "EPSDT screen" means EPSDT screen as defined in COMAR 10.09.23.01.

(7) "Invoice" means a form designated by the Department for use by providers in submitting bills for payment.

(8) "Medically necessary" means that the service or benefit is:

(a) Directly related to diagnostic, preventive, curative, palliative, rehabilitative, or ameliorative treatment of an illness, injury, disability, or health condition;

(b) Consistent with current accepted standards of good medical practice;

(c) The most cost efficient service that can be provided without sacrificing effectiveness or access to care; and

(d) Not primarily for the convenience of the consumer, family, or provider.

(9) "Ophthalmologist" means a physician skilled in diseases of the eye.

(10) "Ophthalmic lenses or optical aids" means a lens, contact lens, prism, or vision aid which has a therapeutic effect on a patient, or which will contribute to the visual welfare of a patient.

(11) "Optician" means an individual, partnership, or company which meets applicable licensing requirements as a qualified grinder or dispenser of ophthalmic lenses or optical aids, and which is capable of translating, filling, and adapting ophthalmic prescriptions, products, and accessories.

(12) "Optometric clinic or center" means a facility, which provides services for patients under the supervision of a licensed optometrist.

(13) Optometric Examination.

(a) "Optometric examination" means a series of tests and measurements used to determine the extent of visual impairment, or the correction required to improve visual acuity, performed by a licensed optometrist.

(b) "Optometric examination" includes as a minimum:

(i) Reviewing a patient's history, past prescriptions, and specifications when available;

(ii) Visual analysis;

(iii) Ophthalmoscopy of internal eye;

(iv) Tonometry without anesthetic when indicated or for a patient 40 years old or older;

(v) Muscle balance examination;

(vi) Gross visual field testing when indicated;

(vii) Writing of lens formula and other prescription data when needed, as well as specific instructions for future care;

(viii) Other tests when indicated by §B(12)(b)(i)-(vii) of this regulation; and

(ix) Subsequent progress evaluations when indicated.

(14) "Optometrist" means an individual who is licensed by the Board to practice optometry or by the state in which the service is rendered.

(15) "Orthoptic treatment" means the use of instruments to measure and enhance the binocular coordination of the eyes (a category of "visual training").

(16) Practice Optometry.

(a) "Practice optometry" means, subject to Health Occupations Article, §§11-404 and 11-404.2, Annotated Code of Maryland, to use any means known in the science of optics or eye care, except surgery, to:

(i) Detect, diagnose, and treat any optical or diseased condition in the human eye;

(ii) Prescribe eyeglasses or lenses to correct any optical or visual condition in the human eye;

(iii) Give advice or direction on the fitness or adaptation of eyeglasses or lenses to an individual for the correction or relief of a condition for which eyeglasses or lenses are worn; and

(iv) Use, or permit the use of an instrument, test card, test type, test eyeglasses, test lenses, or other device to aid in choosing eyeglasses or lenses for an individual to wear.

(b) "Practice optometry" includes, subject to Health Occupations Article, §§11-404 and 11-404.2, Annotated Code of Maryland:

(i) The administration of topical ocular diagnostic pharmaceutical agents;

(ii) The administration and prescription of therapeutic pharmaceutical agents; and

(iii) The removal of superficial foreign bodies from the cornea and conjunctiva.

(17) "Preauthorization" means an approval required from the Department or its designee before providing services.

(18) "Prescriber" means a physician or optometrist licensed to prescribe optical aids, and authorized by the Department to participate in the Program.

(19) "Prescription" means a written order for treatment or optical aids, or both, signed by the prescriber.

(20) "Program" means the Maryland Medical Assistance Program.

(21) "Progress evaluation" means a follow-up visit, when indicated, to determine the effectiveness of an eye examination, prescription, or series of orthoptic treatments.

(22) "Provider" means a physician (when dispensing ophthalmic lenses or visual aids), optometrist, optometric clinic or center, or optician, recognized by the Department to participate in the Program.

(23) "Recipient" means a person who is certified as eligible for, and is receiving, Medical Assistance benefits.

(24) "Routine adjustment" means an adjustment made to an optical aid other than an adjustment required because of damage.

(25) "Screening" means tests or measurements, other than an eye examination, performed to discover the possibility of difficulty in vision.

(26) "Therapeutically certified optometrist" means a licensed optometrist who is certified by the Board to administer or prescribe therapeutic pharmaceutical agents or remove superficial foreign bodies from a human eye, adnexa, or lacrimal system to the extent permitted under Health Occupations Article, §11-404.2, Annotated Code of Maryland.

(27) "Visual training" means use of instruments or other means to measure and enhance the binocular coordination of the eyes and visual perceptual functions.