DHS 107.20 NoteNote: For more information on prior authorization, see s. DHS 107.02 (3). DHS 107.20(3)(a)(a) Eyeglass frames, lenses, and replacement parts shall be provided by dispensing opticians, optometrists and ophthalmologists in accordance with the department’s vision care volume purchase plan. The department may purchase from one or more optical laboratories some or all ophthalmic materials for dispensing by opticians, optometrists or ophthalmologists as benefits of the program. DHS 107.20(3)(c)(c) The dispensing provider shall be reimbursed only once for dispensing a final accepted appliance or component part. DHS 107.20(3)(d)(d) The department may define minimal prescription levels for lenses covered by MA. These limitations shall be published by the department in the MA vision care provider handbook. DHS 107.20(4)(4) Non-covered services. The following services and materials are not covered services: DHS 107.20(4)(c)(c) Services provided principally for convenience or cosmetic reasons, including but not limited to gradient focus, custom prosthesis, fashion or cosmetic tints, engraved lenses and anti-scratch coating. DHS 107.20 NoteNote: For more information on non-covered services, see s. DHS 107.03. DHS 107.20 HistoryHistory: Cr. Register, February, 1986, No. 362, eff. 3-1-86; correction in (1) made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636. DHS 107.21(1)(a)(a) General. Covered family planning services are the services included in this subsection when prescribed by a physician and provided to a recipient, including initial physical exam and health history, annual office visits and follow-up office visits, laboratory services, prescribing and supplying contraceptive supplies and devices, counseling services and prescribing medication for specific treatments. All family planning services performed in family planning clinics shall be prescribed by a physician, and furnished, directed or supervised by a physician, registered nurse, nurse practitioner, licensed practical nurse or nurse midwife under s. 441.15 (1) and (2) (b), Stats. DHS 107.21(1)(b)(b) Physical examination. An initial physical examination with health history is a covered service and shall include the following: DHS 107.21(1)(b)1.1. Complete obstetrical history including menarche, menstrual, gravidity, parity, pregnancy outcomes and complications of pregnancy or delivery, and abortion history; DHS 107.21(1)(b)2.2. History of significant illness-morbidity, hospitalization and previous medical care, particularly in relation to thromboembolic disease, any breast or genital neoplasm, any diabetic or prediabetic condition, cephalalgia and migraine, pelvic inflammatory disease, gynecologic disease and venereal disease; DHS 107.21(1)(b)4.4. Family, social, physical health, and mental health history, including chronic illnesses, genetic aberrations and mental depression;