Clarification on change to MCBM, Section 75, Vision Services

March 21, 2012

This message is a follow up to Thursday’s listserv about MaineCare changes related to the DHHS Supplemental Budget. The information on vision services should have been provided as outlined below, which allows exams from ophthalmologists or optometrists. Thursday’s message had incorrectly been limited to ophthalmologists.

Clarification on change to MCBM, Section 75, Vision Services

Adults on MaineCare will be eligible for one (1) routine eye exam once every three (3) years. Previously, MaineCare had paid for one (1) routine exam every two (2) years.

Members in Intermediate Care Facilities for the Mentally Retarded (ICF-MRs) will continue to be eligible for one (1) routine eye exam per year.

MaineCare will still pay for exams by ophthalmologists or optometrists when medically necessary, for example, to care for specific medical diagnoses (e.g. diabetes) or for high-risk medication use (e.g. Plaquinil).

These changes apply only to members who are age 21 and over.

MIHMS Provider inquiries can be directed to 1-866-690-5585.