WAC 388-544-0250   Vision care -- Covered eye services (examinations, refractions, visual field testing, and vision therapy).  (1) The department covers, without prior authorization, eye examinations and refraction services with the following limitations:

     (a) Once every twenty-four months for asymptomatic clients twenty-one years of age or older;

     (b) Once every twelve months for asymptomatic clients twenty years of age or younger; or

     (c) Once every twelve months, regardless of age, for asymptomatic clients of the division of developmental disabilities.

     (2) The department covers additional examinations and refraction services outside the limitations described in subsection (1) of this section when:

     (a) The provider is diagnosing or treating the client for a medical condition that has symptoms of vision problems or disease;

     (b) The client is on medication that affects vision; or

     (c) The service is necessary due to lost or broken eyeglasses/contacts. In this case:

     (i) No type of authorization is required for clients twenty years of age or younger or for clients of the division of developmental disabilities, regardless of age.

     (ii) Providers must follow the department's expedited prior authorization process to receive payment for clients twenty-one years of age or older. Providers must also document the following in the client's file:

     (A) The eyeglasses or contacts are lost or broken; and

     (B) The last examination was at least eighteen months ago.

     (3) The department covers visual field exams for the diagnosis and treatment of abnormal signs, symptoms, or injuries. Providers must document all of the following in the client's record:

     (a) The extent of the testing;

     (b) Why the testing was reasonable and necessary for the client; and

     (c) The medical basis for the frequency of testing.

     (4) The department covers orthoptics and vision training therapy. Providers must obtain prior authorization from the department.



[Statutory Authority: RCW 74.08.090, 74.09.510, 74.09.520. 08-14-052, § 388-544-0250, filed 6/24/08, effective 7/25/08. Statutory Authority: RCW 74.08.090, 74.09.510, 74.09.520 and 42 C.F.R. 440.120 and 440.225. 05-13-038, § 388-544-0250, filed 6/6/05, effective 7/7/05. Statutory Authority: RCW 74.08.090, 74.09.510 and 74.09.520. 01-01-010, § 388-544-0250, filed 12/6/00, effective 1/6/01.]