1 STATE OF OKLAHOMA
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2 2nd Session of the 59th Legislature (2024)
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3 HOUSE BILL 3882 By: Ford
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6 AS INTRODUCED
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7 An Act relating to Medicaid; providing for Medicaid
7 coverage for eye exams and eyeglasses for adults;
8 providing for codification; and providing an
8 effective date.
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12 BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
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13 SECTION 1. NEW LAW A new section of law to be codified
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14 in the Oklahoma Statutes as Section 4005 of Title 56, unless there
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15 is created a duplication in numbering, reads as follows:
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16 Payment for adult members is made to optometrists through
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17 SoonerCare as set forth in this section.
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18 A. Eye examinations are covered when medically necessary.
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19 Determination of the refractive state is covered when medically
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20 necessary.
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21 B. Payment can be made for medical services that are reasonable
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22 and necessary for the diagnosis and treatment of illness or injury
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23 up to the patient's maximum number of allowed office visits per
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24 month.
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 1 1. Payment is made for treatment of medical or surgical
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2 conditions which affect the eyes;
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3 2. The global surgery fee allowance includes preoperative
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4 evaluation and management services rendered the day before or the
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5 day of surgery, the surgical procedure, and routine postoperative
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6 period. Co-management for cataract surgery is filed using
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7 appropriate CPT codes, modifiers, and guidelines. If an optometrist
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8 has agreed to provide postoperative care, the surgeon's information
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9 must be in the referring provider's section of the claim; and
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10 3. Payment for laser surgery to optometrist is limited to those
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11 optometrists certified by the Board of Optometry as eligible to
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12 perform laser surgery; and
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13 C. When medically necessary, payment will be made for lenses,
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14 frames, low vision aids, and certain tints for adults. Coverage
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15 includes lenses and frames to protect adults with monocular vision.
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16 Coverage includes two sets of non-high-index polycarbonate lenses
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17 and frames per year. Any lenses and frames beyond this limit must
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18 be prior authorized and determined to be medically necessary. All
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19 non-high-index lenses must be polycarbonate.
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20 D. Corrective lenses must be based on medical need. Medical
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21 need includes a significant change in prescription or replacement
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22 due to normal lens wear.
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 1 E. SoonerCare provides frames when medically necessary. Frames
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2 are expected to last at least one year and must be reusable. If a
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3 lens prescription changes, the same frame must be used if possible.
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4 F. Providers must accept SoonerCare reimbursement as payment in
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5 full for services rendered, except when authorized by SoonerCare,
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6 including but not limited to, copayments or other cost sharing
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7 arrangements authorized by the state:
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8 1. Providers must be able to dispense standard lenses and
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9 frames which SoonerCare would fully reimburse with no cost to the
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10 eligible member; and
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11 2. If the member wishes to select lenses and frames with
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12 special features which exceed the SoonerCare allowable fee, and are
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13 not medically necessary, the member may be billed the excess cost.
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14 The provider must obtain signed consent from the member
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15 acknowledging that they are selecting lenses and/or frames that will
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16 not be covered in full by SoonerCare and that they will be
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17 responsible to pay the excess cost. The signed consent must be
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18 included in the member's medical record;
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19 G. Replacement of or additional lenses and frames are allowed
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20 when medically necessary. The Oklahoma Health Care Authority does
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21 not cover lenses or frames meant as a backup for the initial
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22 lenses/frames. Prior authorization is not required unless the
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23 number of glasses exceeds two per year. The provider must always
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24 document in the member's record the reason for the replacement or
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 1 additional lenses and frames. The OHCA or its designated agent will
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2 conduct ongoing monitoring of replacement frequencies to ensure OHCA
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3 policy is followed. Payment adjustments will be made on claims not
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4 meeting these requirements;
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5 H. A fitting fee will be paid if there is documentation in the
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6 record that the provider or technician took measurements of the
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7 member's anatomical facial characteristics, recorded lab
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8 specifications and made final adjustment of the spectacles to the
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9 visual axes and anatomical topography. A fitting fee can only be
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10 paid in conjunction with a pair of covered lenses and frames.
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11 I. Bifocal lenses for the treatment of accommodative esotropia
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12 are a covered benefit. Progressive lenses, trifocals, photochromic
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13 lenses, and tints for adults require prior authorization and must
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14 satisfy the medical necessity standard. Payment is limited to two
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15 glasses per year. Any glasses beyond this limit must be prior
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16 authorized and determined to be medically necessary.
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17 J. Replacement of lenses and frames due to abuse and neglect by
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18 the member is not covered.
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19 K. Bandage contact lenses are a covered benefit for adults.
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20 Contact lenses for medically necessary treatment of conditions such
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21 as aphakia, keratoconus, following keratoplasty,
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22 aniseikonia/anisometropia or albinism are a covered benefit for
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23 adults. Other contact lenses for children require prior
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24 authorization and must satisfy the medical necessity standard.
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 1 SECTION 2. This act shall become effective November 1, 2024.
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3 59-2-9681 TJ 01/10/24
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