016-06-12 Ark. Code R. § 16

Current through Register Vol. 49, No. 6, June, 2024

Rule 016.06.12-016 - Visual Care Update 1-12

Section II Visual Care

215.000Eyeglasses Covered by Medicaid

Brand	Frame	Gender	Size	Colors
Europa	ALT-07	Men's	52 and 54	Brown, Gold and Grey
	Kerry	Unisex	48 and 50	Bronze, Black, Chrome
	Kip	Women's	48	Black and Crystal
	MM-01	Children's	38,40 and 42	Brown, Blue, Violet and Pink
	MM-02	Children's	39, 41 and 43	Bronze, Blue, Gunmetal and Wine
	MM-03	Unisex	46, 48 and 50	Bronze, Black, Gunmetal and Light Copper
	MM-04	Unisex	44, 46 and 48	Brown, Blue, Violet and Red
	MM-05	Women's	45, 47 and 49	Brown, Black, Gunmetal and Blue
	NF-3	Unisex	44 and 46	Matte Black and Matte Silver
	L-Cable	Children's	36,38 and 40	Brown, Gold and Black
	NF-2	Unisex	45 and 47	Matte Black and Matte Blue
	MM-06	Men's	50, 52 and 54	Brown, Black, Gunmetal and Gold
Kenmark	Andrea	Women's	49	Rose, Brown and Wine
	Shannon	Women's	46 and 48	Sand, Black and Lavender
	Sharon	Women's	49	Black Crystal and Brown
	Blaire	Women's	50 and 52	Golden Rose, Nutmeg and Dove
	Gypsy	Women's	55 and 57	Demi, Black and Lavender
	Sam	Men's	49 and 51	Brown, Gunmetal and Black
	Gracy	Women's	52 and 54	Brown, Bleu and Rose
	Henry	Men's	52, 54, 56 and 58	Gold, Gold/Demi Amber and Gunmetal/Tortoise
	Chet	Men's	54 and 56	Brown and Gunmetal
	Aimee	Women's	54 and 56	Brown, Purple and Rose
	Gwen	Women's	51 and 53	Beige, Blush and Mist
	Debbie	Women's	52	Tortoise and Black
	Jim	Men's	53, 55 and 59	Brown, Gunmetal and Gold
	Bryant	Men's	49 and 51	Black, Brown and Gunmetal

	Leya	Women's	45 and 47	Brown, Grape, Black and Plum
United	Destiny	Unisex	47	Coffee, C2 Matte Black and C3 Matte Silver
	Steve	Men's	49 and 51	C1 Brown, and C2 Dark Gray
	Stella	Women's	51	C1 Light Brown C2 Lilac and C3 Matte Silver
	Candy	Unisex	45	C1 Shiny Brown and C2 Matte Black
Modern	Sporty	Kids	44 and 46	Black/Crystal, Blue and Brown
	Gift	Women's	47 and 49	Black/Crystal, Brown/Crystal and Purple/Brown
	Dazzle	Women's	49, 51 and 53	Brown, Gold And Rose
	Judi	Women's	50 and 53	Black/Crystal, Tortoise and Wine/Gray
	Dynamite	Girl's	42, 45 and 47	Antique Brown and Black Silver
	Ralph	Men's	52, 54 and 56	Black, Brown and Gray
	Ninja	Unisex	44 and 46	Blue, Brown and Lilac
Zimco	Attitudes #3	Women's	50	Brown/Crystal and Black
	Retro#1	Women's	48	Gold, Gunmetal Blue and Matte Brown
Hart	Hart-9756	Women's	48	Brown, Gold and Gunmetal Silver
	3766	Women's	52	Brown and Lilac
	Hart-8112	Unisex	48	Matte Black, Matte Burgundy and Matte Coffee
	Reality-Hart	Women's	51	Onyx-Brown and Onyx-Burgundy
	3714	Women's	52	Black-Burgundy and Tortoise
	Hart-3712	Men's	52	Black-Brown and Gunmetal
	7206	Girl's	52	Brown and Graphite
	Hart-9751	Women's	48 and 50	Brown, Silver and Lilac
	Hart-9509	Boy's	38, 41 and 44	Gold Brown, Satin Blue and Shiny Brown
MiraFlex	Mini Baby	Children	Various	Various Colors
	Baby Lux	Children	Various	Various Colors
	New Baby 2	Children	Various	Various Colors
LBI	Woman Day	Women's	55	Gold, Rose and Gray
	LBI--915	Women's	53	Gold/Silver, Silver/Gold and Brown/Gold

016.06.12 Ark. Code R. § 016

10/17/2012