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53	53	STATE OF OKLAHOMA
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55	55	2nd Session of the 59th Legislature (2024)
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57	57	HOUSE BILL 3882 By: Ford
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59	59
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63	63	AS INTRODUCED
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65	65	An Act relating to Medicaid; providing for Medicaid
66	66	coverage for eye exams and eyeglasses for adults;
67	67	providing for codification; and providing an
68	68	effective date.
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75	75	BE IT ENACTED BY THE PEOPLE OF T HE STATE OF OKLAHOMA:
76	76	SECTION 1. NEW LAW A new section of law to be codified
77	77	in the Oklahoma Statutes as Section 4005 of Title 56, unless there
78	78	is created a duplication in numbering, reads as follows:
79	79	Payment for adult members is made to optometrists through
80	80	SoonerCare as set forth in this section.
81	81	A. Eye examinations are covered when medically necessary.
82	82	Determination of the refractive state is covered when medi cally
83	83	necessary.
84	84	B. Payment can be made for medical services that are reasonabl e
85	85	and necessary for the diagnosis and treatment of illness or injury
86	86	up to the patient's maximum number of allowed office visits per
87	87	month.
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90	90	Req. No. 9681 Page 2 1
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139	139	1. Payment is made for tr eatment of medical or surgical
140	140	conditions which affect the eyes ;
141	141	2. The global surgery fee allowance includes preoperative
142	142	evaluation and management services rendered the day before or the
143	143	day of surgery, the surgical procedure, and routine postoperative
144	144	period. Co-management for cataract surgery is filed using
145	145	appropriate CPT codes, modifier s, and guidelines. If an optometrist
146	146	has agreed to provide postoperative care, the surgeon 's information
147	147	must be in the referring provider 's section of the claim ; and
148	148	3. Payment for laser surgery to optometrist is limited to those
149	149	optometrists certified b y the Board of Optometry as eligible to
150	150	perform laser surgery ; and
151	151	C. When medically necessary, payment will be made for lenses,
152	152	frames, low vision aids, and certain tints for adults. Coverage
153	153	includes lenses and frames to protect adults with monocular vision.
154	154	Coverage includes two sets of non -high-index polycarbonate lenses
155	155	and frames per year. Any lenses and frames beyond this limit must
156	156	be prior authorized and determined t o be medically necessary. All
157	157	non-high-index lenses must be polycarbonate .
158	158	D. Corrective lenses must be based on medical need. Medical
159	159	need includes a significant change in prescription or replacement
160	160	due to normal lens wear .
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212	212	E. SoonerCare provides fram es when medically necessary. Frames
213	213	are expected to last at least one year and must be reusable. If a
214	214	lens prescription changes, the same frame must be used if possible .
215	215	F. Providers must accept SoonerCare reimbursement as payment in
216	216	full for services rendered, except when authorized by SoonerCare ,
217	217	including but not limited to , copayments or other cost sharing
218	218	arrangements authorized by the state:
219	219	1. Providers must be able to dispense standard lenses and
220	220	frames which SoonerCare would fully reimburse wit h no cost to the
221	221	eligible member; and
222	222	2. If the member wishes to select lenses and frames with
223	223	special features which exceed the SoonerCare allowable fee, and are
224	224	not medically necessary, the member may be billed the excess cost.
225	225	The provider must obtain signed consent from the member
226	226	acknowledging that they are selecting lenses an d/or frames that will
227	227	not be covered in full by SoonerCare and that they will be
228	228	responsible to pay the excess cost. The signed consent must be
229	229	included in the member 's medical record;
230	230	G. Replacement of or additional lenses and frames are allowed
231	231	when medically necessary. The Oklahoma Health Care Authority does
232	232	not cover lenses or frames meant as a backup for the initial
233	233	lenses/frames. Prior authorization is not req uired unless the
234	234	number of glasses exceeds two per year. The provider must always
235	235	document in the member's record the reason for the replacement or
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287	287	additional lenses and frames. The OHCA or its designated agent will
288	288	conduct ongoing monitoring of replacement frequencies to ensure OHCA
289	289	policy is followed. Payment adjustments will be made on c laims not
290	290	meeting these requirements ;
291	291	H. A fitting fee will be paid if there is documentation in the
292	292	record that the provider or technician took measurements of the
293	293	member's anatomical facial characteristics, recorded lab
294	294	specifications and made final adj ustment of the spectacles to the
295	295	visual axes and anato mical topography. A fitting fee can only be
296	296	paid in conjunction with a pair of covered lenses and frames .
297	297	I. Bifocal lenses for the treatment of accommodative esotropia
298	298	are a covered benefit. Progressive lenses, trifocals, photochromic
299	299	lenses, and tints for adults require prior authorization and must
300	300	satisfy the medical necessity standard. Payment is limited to two
301	301	glasses per year. Any glasses beyond this limit must be prior
302	302	authorized and determin ed to be medically necessary.
303	303	J. Replacement of lenses and frames due to abuse and neglect by
304	304	the member is not covered .
305	305	K. Bandage contact lenses are a covered benefit for ad ults.
306	306	Contact lenses for medically necessary treatment of conditions such
307	307	as aphakia, keratoconus, following keratoplasty,
308	308	aniseikonia/anisometropia or albinism are a covered benefit for
309	309	adults. Other contact lenses for children require prior
310	310	authorization and must satisfy the medical necessity standard.
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362	362	SECTION 2. This act shall become effective November 1, 2024.
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364	364	59-2-9681 TJ 01/10/24

Oklahoma 2024 Regular Session

Oklahoma House Bill HB3882 Compare Versions