TITLE 7 HEALTH
CHAPTER 30 FAMILY AND CHILDREN HEALTH CARE SERVICES
PART 10 AWARD OF FUNDS FROM SAVE OUR CHILDREN’S SIGHT FUND
7.30.10.1 ISSUING
AGENCY: New Mexico Department of Health.
[7.30.10.1 NMAC - N,
10/29/2010]
7.30.10.2 SCOPE: This
rule applies to any parent (guardian) notified by the school that the
results of vision screening of his/her
child indicate the need for further evaluation, and it establishes criteria for
applying for financial support from the save our children’s sight fund and award
of these funds.
[7.30.10.2 NMAC - N,
10/29/2010]
7.30.10.3 STATUTORY
AUTHORITY: This rule is promulgated pursuant to Sections
9-7-6, 24-1-31, 24-1-32 and 22-13-30 NMSA 1978.
[7.30.10.3 NMAC - N,
10/29/2010]
7.30.10.4 DURATION:
Permanent.
[7.30.10.4 NMAC - N, 10/29/2010]
7.30.10.5 EFFECTIVE
DATE: October 29, 2010 unless a later date is cited
in the history at the end of a section.
[7.30.10.5 NMAC - N,
10/29/2010]
7.30.10.6 OBJECTIVE: To establish a mechanism by which a parent (guardian) of eligible New Mexico students can apply to the save our children’s sight fund.
[7.30.10.6 NMAC - N,
10/29/2010]
7.30.10.7 DEFINITIONS:
A. “Administering agent”
means the office of school and adolescent health of the New Mexico department
of health or its successor.
B. “Eligible student”
means a student whose parent (guardian) may apply to the save our children’s
sight fund because the student’s vision screening indicates the need for
further evaluation and the student is not already covered by health insurance
for a comprehensive eye examination.
C. “Eyewear” means equipment prescribed
for the treatment of vision limitations including but not limited to
polycarbonate lenses and frames and contact lenses.
D. “Funds” means
money from save our children’s sight fund.
E. “Participating
provider” means any optometrist, ophthalmologist or optician with a provider
agreement to supply comprehensive eye examinations, prescribed treatment
eyewear, or both for students awarded funds.
[7.30.10.7 NMAC - N,
10/29/2010]
7.30.10.8 ELIGIBILITY FOR FUNDS: Regardless of family income, any parent (guardian) of an eligible student as defined by Subsection B of 7.30.10.7 NMAC may apply for funds for the following expenses:
A. cost of a
comprehensive eye examination by a participating optometrist or
ophthalmologist through referral;
B. cost of
polycarbonate lenses and frames for eyeglasses or for contact lenses; and
C. cost of replacement
insurance for lost or broken lenses.
[7.30.10.8
NMAC - N, 10/29/2010]
7.30.10.9 APPLICATION FOR FUNDS:
A. Application
for funds shall be made by parent (guardian) of an eligible student to the
administering agent via mail, email, fax or hard copy using the application and
referral forms approved by the administering agent.
B. Applicants shall provide the
administering agent with proof of lack of insurance coverage for a
comprehensive eye examination when applying for funds. A copy of insurance benefits which
demonstrate the insurance does not include a comprehensive eye examination or a
sworn affidavit attesting to lack of coverage shall be acceptable.
[7.30.10.9 NMAC - N, 10/29/2010]
7.30.10.10 REVIEW OF APPLICATIONS:
A. The
administering agent or its designee shall review applications for referral
criteria and verification of insurance status to establish client
eligibility for award of funds.
B. The administering agent shall approve award of funds on the basis of client eligibility and availability of funds according to the agent’s established program guidelines for distribution of the funds.
[7.30.10.10 NMAC - N, 10/29//2010]
7.30.10.11 DISTRIBUTION OF FUNDS:
A. Distribution of funds shall follow
the reimbursement schedule for costs designated in participating provider
agreements established with the administering agent.
B. Reimbursement costs for polycarbonate lenses and contact lenses as described in 7.30.10.8 NMAC shall follow criteria as defined by medicaid services rules (Subsection G of 8.310.6.12 NMAC and Subsection C of 8.310.6.14 NMAC).
C. If funds become exhausted,
the administering agent shall maintain a waiting list of
eligible applicants.
D. Services purchased with awarded funds shall be purchased within the state of New Mexico unless the need to purchase services elsewhere is documented and approved by the administering agent.
E. Funds shall be distributed by the
administering agent in voucher form for direct payment to the participating
provider for services delivered to approved applicants in accordance with
participating provider agreements.
F. The award of funds shall be limited to one-time use per student per school year.
[7.30.10.11 NMAC - N, 10/29/2010]
HISTORY of 7.30.10 NMAC:
[RESERVED]