(a) “Prescribed drugs” means simple or compound substances or mixtures of substances prescribed for the cure, mitigation, or prevention of disease, or for health maintenance that are—
(1) Prescribed by a physician or other licensed practitioner of the healing arts within the scope of this professional practice as defined and limited by Federal and State law;
(2) Dispensed by licensed pharmacists and licensed authorized practitioners in accordance with the State Medical Practice Act; and
(3) Dispensed by the licensed pharmacist or practitioner on a written prescription that is recorded and maintained in the pharmacist's or practitioner's records.
(b) “Dentures” are artificial structures made by or under the direction of a dentist to replace a full or partial set of teeth.
(c) “Prosthetic devices” means replacement, corrective, or supportive devices prescribed by a physician or other licensed practitioner of the healing arts within the scope of his practice as defined by State law to—
(1) Artificially replace a missing portion of the body;
(2) Prevent or correct physical deformity or malfunction; or
(3) Support a weak or deformed portion of the body.
(d) “Eyeglasses” means lenses, including frames, and other aids to vision prescribed by a physician skilled in diseases of the eye or an optometrist.
Notes of Decisions
Cited in
18
cases (
2 in the last 5 years), 1979–2023 · leading case:
Davis v. Shah, 821 F.3d 231 (2d Cir. 2016).
Davis v. Shah, 821 F.3d 231 (2d Cir. 2016).
· cites it 5× “42 C.F.R. § 440.120 (c). As purely elective features in a state Medicaid plan, prosthetic devices are exempt from the requirements of § 1396a(a)(10)(D), See Rodriguez, 197 F.”
Simpson v. Wilson, 480 F. Supp. 97 (D. Vt. 1979).
· cites it 3× “” 42 C.F.R. § 440.120 (d) (1978). The prior regulation had one additional phrase at the end: “to aid or improve vision,” 42 C.”
Ledet v. Fischer, 548 F. Supp. 775 (M.D. La. 1982).
· cites it 4× “” 42 C.F.R. 440.120. Plaintiffs claim of conflict with federal law and regulations, in sum, is that Louisiana’s policy of limiting eyeglasses to post cataract patients amounts to a reduction in the amount, duration or scope of a required service solely because of diagnosis,…”
United States ex rel. Dickson v. Bristol-Meyers Squibb Co., 123 F. Supp. 3d 584 (D.N.J. 2015).
“” 42 C.F.R. § 440.120 (a). . Notably, Defendants do not, however, claim that the state requirements are preempted; rather, Defendants maintain that the states' requirements compliment the federal standard under Medicaid.”
Ohlson v. Weil, 953 P.2d 939 (Colo. Ct. App. 1997).
“See 42 C.F.R. § 440.120 (c) (1996). The fact that Ohlson’s brace fits both the state definition of durable medical equipment and the federal definition of a prosthetic device does not create an irreconcilable conflict.”
Doe v. Pickett, 480 F. Supp. 1218 (S.D.W. Va 1979).
“Moreover, “the Medicaid agency may not deny or reduce the amount, duration, or scope of a required service under §§ 440.210 (for the categorically needy) and 440.”
Ledet v. Fischer, 638 F. Supp. 1288 (M.D. La. 1986).
“” 42 CFR § 440.120 (d) (1985). The tension presented by this case then is between Louisiana’s limitation of its service and the federal requirement that the service, including optional services, “must be sufficient in amount, duration, and scope to reasonably achieve its purpose.”
Visser v. Taylor, 756 F. Supp. 501 (D. Kan. 1990).
“42 C.F.R. § 440.120 (a). Prescription drugs covered by the Kansas Medicaid plan are limited to drugs which are included on a formulary listing adopted and distributed by SRS.”
Fred C. v. Texas Health & Human Servs. Com'n, 988 F. Supp. 1032 (W.D. Tex. 1997).
“42 C.F.R. § 440.120 (c) (1996). Texas Medicaid has chosen to cover two devices as prosthetic devices under its Medicaid program: tube feeding equipment and hearing aids.”
— 42 C.F.R. § 440.120(c) — 2 cases
Davis v. Shah, 821 F.3d 231 (2d Cir. 2016).
“42 C.F.R. § 440.120 (c). As purely elective features in a state Medicaid plan, prosthetic devices are exempt from the requirements of § 1396a(a)(10)(D), See Rodriguez, 197 F.”
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