Ill. Admin. Code tit. 89, § 140.416 - Optometric Services and Materials

a) Payment for optometric services and materials shall be made to physicians, optometrists, opticians and optical companies.

b) Payment shall be made for the following optometric services and materials:

1) An eye examination by a physician or an optometrist for the purpose of determining the condition of the eye including the refractive state.

2) Frame repairs, contact lenses, artificial eyes and low vision devices provided by physicians, optometrists, opticians and optical companies.

3) Dispensing of optical materials.

4) Lenses, frame parts and frames provided by the Department of Corrections (DOC) laboratory.

c) Optometric services and materials for which payment shall not be made include:

1) Services which are not provided to address a recipient's particular visual problems or complaints.

2) Lenses, frames and frame parts obtained from a source other than the DOC laboratory.

3) Trifocals.

4) Tinted lenses.

5) Provider's transportation costs.

d) Payment for services and materials shall be at the lesser of the provider's usual and customary charge or the maximums established by the Department pursuant to Section 140.400.

e) Lenses, Frames and Frame Parts Requirements that Began During a Public Health Emergency. Notwithstanding subsections (b)(4) and (c)(2) of this Section and Section 140.418, and any other provision to the contrary in this Part, the Department will reimburse for lenses, frame parts and frames provided by the Department's laboratory vendors for dates of service on or after March 9, 2020 until the Department determines any or all of the services provided by the Department's laboratory vendors are no longer necessary or until the DOC laboratory resumes production of lenses, frames and frame parts.

Notes

Ill. Admin. Code tit. 89, § 140.416

Amended at 25 Ill. Reg. 6665, effective May 11, 2001

Amended at 45 Ill. Reg. 8958, effective 6/29/2021