SECTION 363.501. Definitions

The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise.

(1) EPSDT--The federally mandated Early and Periodic Screening, Diagnosis, and Treatment program defined in 25 TAC Chapter 33 (relating to Early and Periodic Screening, Diagnosis, and Treatment).

(2) Eyeglass supplier--A person, firm, or institution that has a written agreement with HHSC as an eyeglass supplier and is an eligible provider under the program. The fitting, adjustment, and repairs of the eyewear must be performed by an appropriate and qualified provider under Texas Medicaid. Suppliers accept the payments stipulated by HHSC as payment in full for the service and supplies involved, unless otherwise provided.

(3) Eyeglasses--Lenses and frames, dispensed and delivered, that: are medically necessary; are prescribed by an appropriate and qualified provider; are professionally determined to be necessary and appropriate for the lens, age, and sex of the recipient; and significantly improve visual acuity or impede progression of visual problems. The term eyeglasses does not include artificial eyes or any item of eyewear that is not covered under the EPSDT Eyeglass Program.

(4) HHSC--The Texas Health and Human Services Commission, a Texas Medicaid managed care organization, or another designee.

(5) Prosthetic eyewear--Eyewear that is medically necessary and prescribed by an appropriate and qualified provider under Texas Medicaid for post cataract surgery, congenital absence of the eye lens, or loss of an eye lens because of trauma. Prosthetic eyewear includes contact lenses and eyeglasses that meet state and federal specifications.

(6) Prosthetic eyewear supplier--A person, firm, or institution that has a written agreement with HHSC as an eyewear supplier. The fitting, adjustment, and repair of the eyewear must be performed by an appropriate and qualified provider. The eyewear supplier accepts the payment stipulated by HHSC as payment in full for the services and supplies, unless otherwise provided in this chapter.

Source Note: The provisions of this §363.501 adopted to be effective July 1, 1986, 11 TexReg 2758; transferred effective September 1, 1993, as published in the Texas Register September 7, 1993, 18 TexReg 5978; transferred effective September 1, 2002, as published in the Texas Register December 6, 2002, 27 TexReg 11527; amended to be effective December 10, 2015, 40 TexReg 8754