Non-covered services shall include:

1. (a) Replacement of lost eyeglasses, as follows:

   1. (1) For recipients age 21 and over; and
   2. (2) More than once per lifetime for recipients under age 21, except in accordance with He-W 546.06;
2. (b) Photochromatic lenses, including transition lenses, except for recipients diagnosed with ocular albinism or for other recipients with prior authorization;
3. (c) Contact lenses, except as described in He-W 565.05(g), which shall be limited to a 60-day supply at a time;
4. (d) Orthoptics and vision therapy, such as muscle training;
5. (e) Low vision aids, such as magnifying glasses;
6. (f) Sunglasses and eyeglass tinting, except with prior authorization;
7. (g) Polarized lenses and anti-reflective coatings, except with prior authorization;
8. (h) Titanium frames;
9. (i) High-index lenses, except with prior authorization;
10. (j) LASIK surgery;
11. (k) Low vision aids;
12. (l) Items or services for which a less costly alternative is available; and
13. (m) Any other item or service not listed in He-W 565.05.

Source. (See Revision Note at chapter heading He-W 500); ss by #4819, eff 6-1-90, EXPIRED: 6-1-96 New. #6705, eff 3-3-98, EXPIRED: 3-3-06 New. #8603, eff 4-10-06; ss by #10342, eff 6-1-13; ss by #10638, eff 7-12-14; ss by #14080, eff 9-25-24