N.J. Admin. Code § 10:62-1.8

Current through Register Vol. 56, No. 21, November 4, 2024

Section 10:62-1.8 - Vision training program

(a) For purposes of the New Jersey Medicaid/NJ FamilyCare fee-for-service programs, vision training is the use of certain procedures and modalities for the development of and/or increase in the vision capacity of the eye(s) with poor and/or inconsistent or distorted vision localization.

(b) Vision training is limited to orthoptics, with its acceptable procedures and/or modalities, and further limited to the following types of conditions to be treated by private physicians approved for such training by the respective peer group:

1. Strabismus;

2. Amblyopia;

3. Heterophoria; and

4. Accommodative and/or convergence anomalies.

(c) If vision training is required following the initial comprehensive eye examination, the practitioner shall submit a written request (form FD-358) to the Vision Care Unit for prior authorization pursuant to N.J.A.C. 10:62-1.16 for a vision training work-up. This request shall include the preliminary findings, detailed reason(s) why it is believed a further evaluation is needed, and any history of previous vision training with the dates and the results. Upon receiving approval for a vision training work-up, the practitioner shall then submit, within 30 days of receipt of authorization, the work-up report to the Vision Care Unit. The vision training work-up report shall consist of, but not be limited to:

1. Diagnosis;

2. Findings;

3. Interpretation;

4. Recommendations;

5. Outline of training procedures and frequency of sessions with estimated duration of treatment; and

6. Prognosis.

(d) The decision of the Vision Care Unit to approve or deny vision training will be transmitted to the practitioner by the fiscal agent.

(e) Upon completion of an approved training program, the practitioner shall submit a detailed progress report, listing the status of all parameters indicated in the original evaluation. No treatment plan shall exceed a period of 90 days or a total of 30 training visits, commencing with the inception of the treatment plan. An additional prior authorization is required for any extension of treatment and requires submission of a detailed progress report to the Vision Care Unit.

(f) Vision training may be provided by a practitioner when found medically necessary. This service can be performed in the office or in an independent clinic approved by the New Jersey Medicaid/NJ FamilyCare fee-for-service programs.

N.J. Admin. Code § 10:62-1.8

Amended by 49 N.J.R. 2279(b), effective 7/17/2017