The U.S. Department of Health and Human Services recently released its implementation plan for the Affordable Care Act’s pediatric eye-health benefit.
The guidance on the ACA’s standard set of benefits reaffirms that:
• Millions of children will gain health insurance coverage that includes comprehensive eye exams and treatment.
• Pediatric eye health care is considered an “essential health benefit” and must be offered by all new health plans as a benefit of well-child care.
• Pediatric eye health care is defined as an annual comprehensive eye exam and treatment, including medical eye care.
• All new health plans — both inside and outside of state exchanges — are required to provide fully integrated coverage for pediatric eye health care and must recognize optometrists as providers of medical eye care.
• Vision plans are permitted to partner with health plans in offering eye health care coverage inside and outside of state exchanges.
“In taking this action, the Obama administration accepted the (American Optometric Association’s) longstanding position on healthy vision for America’s children and rejected lobbying by ophthalmologists, pediatricians and their organized medicine allies who wanted pediatric vision care to be based on a screening or limited to an element of well-child care,” AOA President Dr. Ron Hopping said. “The administration also said no to a stand-alone plan carve-out of vision that would have segregated a full pediatric eye health benefit, downgraded it from mandatory to optional status and imposed new barriers to OD-provided medical eye care.
“In the weeks ahead, state officials will also be making important implementation decisions, and continued advocacy by optometry will be needed to lock in patient access gains envisioned under federal law,” Hopping added. “To make certain that ODs will play a leading role in delivering the full range of eye-health and vision-care services — including medical eye care to the millions more children who will soon gain coverage — the AOA is urging affiliates to advocate for the following directive to be adopted by or included in state exchanges.
“The pediatric vision benefit includes a comprehensive eye evaluation and, if medically indicated, dilation and refraction for prescription glasses as well as other medically indicated vision services,” the AOA president said. “This type of eye care is primarily provided by optometrists. As a result, optometrists must be included in qualified health plan networks in order to meet the requirement to provide pediatric vision care.”
For more information on AOA advocacy or to get involved, contact the AOA Washington office at 800-365-2219 or email ImpactWashingtonDC@aoa.org.