October 01, 2007
3 min read
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Bill seeking to expand optometrists’ ‘scope of practice’ sparks debate

Federal action is needless because the states determine scope of practice, ophthalmology advocates say. The bill would increase access to eye care, optometric group contends.

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Ophthalmology advocates have voiced concerns over a House bill that they said would boost optometrists’ efforts to get state licensing for surgical procedures covered by Medicaid.

Rep. Janice Schakowsky, D-Ill., introduced the Optometric Equity in Medicaid Act of 2007 in April, and it is currently under House subcommittee review.

The bill would amend Title XIX of the Social Security Act to “require Medicaid coverage of professional services of optometrists that are otherwise covered when furnished by a physician,” according to the Library of Congress Web site.


Catherine Cohen

The American Society of Cataract and Refractive Surgery and the American Academy of Ophthalmology called the legislation a strategy to expand optometrists’ “scope of practice,” rather than provide “equity” between optometrists and ophthalmologists, as the bill purports to do. The American Medical Association and American College of Surgeons also oppose the measure and have joined the coalition led by the AAO.

The American Optometric Association supports the bill and said it would “confirm” optometrists’ ability to provide medical eye care for Medicaid beneficiaries.

“It’s not necessary,” Catherine Cohen, AAO vice president for governmental affairs, said in a telephone interview with Ocular Surgery News. “It would be precedent-setting. There are no other practitioners in that section that describes physicians and dentists. If you let optometry in, then the psychologists will want to be listed and then podiatrists. … They’re all going to pile on.”

‘No need’ for federal action

Optometrists’ real battle is at the state level, Ms. Cohen said.

“This is really a state fight,” she said. “It’s not a federal fight. If they are having trouble getting paid, it’s because there’s a dispute between the medical board and the optometric board over what they’re really allowed, what is in their scope. The battle is at the state level, and there’s no need for federal action at all.”

Optometry groups have long tried to add surgical procedures to their scope of practice, Nancey McCann, ASCRS director of government relations, said.

“They have been on the move in the state legislatures for several years now, trying to get surgical privileges and being able to do laser surgery and the like,” Ms. McCann said. “It’s not really a federal issue, but they are trying to get a definition in the Medicaid law to include surgery. They can then turn that around in the state legislatures and say, ‘See, this is what the federal law says, now we should be able to do this.’ That’s the concern.”

Optometry is not the only specialty lobbying to expand its scope of practice, Ms. McCann said.

“When you broaden your scope of practice, that allows you to do more procedures,” she said. “It’s not unique to ophthalmology and optometry. It happens in all different sectors of health care.”

Scope of practice, access to care

The ASCRS and the AAO have said they think that the bill is precedent-setting in that it seeks to amend a section of the federal Medicaid statute describing services provided by physicians and dentists. No nonphysician practitioners are included in that section.

A statement posted on the American Optometric Association Web site said the bill “specifically recognizes” that optometrists are able to provide the same medical eye care services to Medicaid patients as for Medicare and privately insured patients.

“H.R. 1983 seeks to close forever a loophole in federal law that can be used by state bureaucrats and Medicaid third-party payers to restrict access to eye care services,” the American Optometric Association said. “As confirmed by a recent study provided to Congress, H.R. 1983 would efficiently eliminate significant barriers to care without creating any new costs for the federal government. Most importantly, though, the bill will result in increased access to eye care for school-aged children and working adults who need it most.”

For more information:
  • Catherine Cohen can be reached at American Academy of Ophthalmology, Governmental Affairs Division, 1101 Vermont Ave. NW, Suite 700, Washington, DC 20005; 202-737-6662; fax: 202-737-7061; e-mail: cgcohen@aaodc.org.
  • Nancey McCann can be reached at ASCRS-ASOA, 400 Legato Road, Suite 700, Fairfax, VA 22033; 703-591-2220; fax: 703-591-0614; e-mail: nmccann@ascrs.org.
  • Matt Hasson is an OSN Staff Writer who covers all aspects of ophthalmology. He focuses on regulatory, legislative and practice management topics.