AOA: Nondiscrimination standard is optometry’s biggest victory in reform

The American Optometric Association singled out provider nondiscrimination language in the health care reform law as the most significant gain for optometry.

“The approval of the Harkin Amendment is a tremendous victory for optometry and will likely prove to be one of the most historic advances in patient access to optometric care since the 1986 recognition of optometrists as physicians under Medicare,” AOA President Randolph E. Brooks, OD, said in a statement issued by the AOA.

The provision, sponsored by Tom Harkin (D-Iowa), specifies that any insurer offering group or individual coverage “shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider’s license or certification under applicable state law.”

Dr. Brooks said in the statement, “AOA’s goal was to extend the focus of the debate to the more than 70 million individuals with coverage through ERISA [Employee Retirement Income Security Act] plans” that have discriminated against optometry for 35 years.

He noted that optometry is still not considered a mandatory service under Medicaid and optometrists are still excluded in terms of some federal health programs such as the National Health Service Corps. “Congress has failed to address these issues for now, but AOA will continue working to build support for the Optometric Equity in Medicaid Act (H.R. 2697) and the National Health Service Corps Improvement Act (H.R. 1884),” he said.

The Harkin Amendment specifies that an insurer and the Secretary of the Department of Health and Human Services are not prevented “from establishing varying reimbursement rates based on quality or performance measures.”

Provisions of legislation

In general, H.R. 3590, or the Quality, Affordable Health Care for All Americans Act, extends medical coverage to nearly 32 million uninsured Americans, increases payments to primary care physicians who treat Medicare patients, allows children to stay on their parents’ policies until the age of 26 years and prevents insurance companies from canceling coverage in cases other than fraud.

The follow-up Health Care and Education Reconciliation Act expands health insurance subsidies for lower- and middle-income families, gives employers tax credits to help offset the costs of providing health insurance, prohibits health insurance companies from denying coverage to those with pre-existing conditions or canceling coverage for those who become ill and offers $250 to help seniors who fall in the Medicare “donut hole” pay for prescriptions.

Although the debate in Congress has ended, many are voicing opposition to the new law. At least 19 state attorneys general have filed suit to overturn the bill in federal court, questioning the constitutionality of mandating individual citizens to purchase health insurance from a third party.

‘Routine eye exam’

Primary Care Optometry News Editorial Board member Scott A. Edmonds, OD, FAAO, who practices at Wills Eye Hospital in Philadelphia, shared his interpretations of health care reform in an interview. “This will be the best thing that happened to us since we got parity with Medicare,” he said, echoing the AOA’s sentiments.

“The way I understand it, this law marks the beginning of the routine eye exam becoming part of medical health care and, therefore, it will soon be included in all health care programs,” Dr. Edmonds said. “Many health plans already include routine eye exams as a required part of coverage. Starting with children, it will be mainstreamed into routine health care and, as it evolves, will be a covered benefit. It will change the paradigm for optometric care.”

Dr. Edmonds said the existence of traditional vision plans has “confused the public about the role of the optometrist. These plans, however, will not go away; I believe they will recraft their product to provide ‘ophthalmic hardware’ (glasses and contacts) as an optional rider for the medical plans that include the routine vision exam. For those of us who do a lot of medical care, these eyeglass plans will then have a more appropriate role. These changes will end the confusion about what’s health care and what’s eye care.

“Critics refer to the new health care law as ‘socialized medicine,’” he continued. “However, this is ‘socialized medical insurance,’ which is consistent with any type of insurance: the money to pay your claim comes from others paying premiums. The new law will spread the premiums out over a wider base and, therefore, everyone will be covered with basic health insurance.”

VSP weighs in

Al Schubert, VSP’s vice president of managed care and health policy, told PCON in an interview that VSP is committed to increasing access to eye care and supports health care reform.

“The Harkin Amendment was a historic step forward in establishing a federal standard of provider nondiscrimination,” Mr. Schubert said. “While it does include anti-discrimination language, it also specifies some limitations.”

He said that not every provider will be guaranteed panel participation. “It also doesn’t require reimbursement parity,” he said.

Mr. Schubert said that insurance exchanges and the pediatric vision benefit are other areas of concern. “As structured, the majority of vision plans are not allowed to participate in the insurance exchanges unless they work through major medical plans, which could disrupt patient flow,” he said. “While the new legislation calls for children to receive eye care coverage, that benefit has yet to be defined, and there’s no vision coverage for adults. A fully covered eye exam could be good news, but an eye chart test in any licensed clinician’s office could be cause for concern.

“We’re pleased to see the current legislation has a major focus on prevention and wellness, which VSP has long been an advocate for,” Mr. Schubert said. “It’s also good to see that eyeglasses and contacts will be exempted from the medical device excise tax, and vision care was excluded from the ‘Cadillac’ excise tax.”

These last two issues were also addressed in the AOA’s lobbying efforts, Dr. Brooks told PCON.

Devices, small businesses

The proposed tax on medical devices was a priorioty of the Vision Council.

According to Robert Schelling, Vision Council policy analyst and government relations coordinator, in a conference call with reporters, different versions of the bill had Class 1, 2 and 3 medical devices receiving different taxation levels.

“We worked to ensure Class 1 and parts of Class 2 had been cut out,” Mr. Schelling said. “At the end of the process, language was tweaked to be a blanket 2.3% for all medical devices starting in 2014. Fortunately, in the last version of the reconciliation bill signed by the president, eyeglasses were exempt.

“We have spoken with the authors of the language and anticipate this carve out will remain at the time of implementation in 2014,” he continued.

Eve Zartman Ball, senior director of public affairs and advocacy for the Vision Council, addressed the effect on small businesses. She said some changes will take place within 6 months and others not until 2014 or beyond. She said that small business owners who begin offering health insurance to employees will receive a tax credit of 25%.

“By 2014 a new vernacular will come, SHOP [Small Business Health Options Program] exchanges,” Ms. Zartman Ball continued. “This will allow states to set up small businesses into a collective pool so they can bid on health care benefits as if a larger company. If you use this to provide health care to your employees who make $25,000 or less, you’ll be given up to a 50% tax credit.”

Board certification

The American Board of Optometry released a statement saying that H.R. 3590 includes language related to board certification and Maintenance of Certification (MOC), referring to Sec. 10327, Improvements to the Physician Quality Reporting Initiative (PQRI). To qualify for PQRI incentive payments, doctors have to meet certain requirements, including submitting data on quality measures and successfully completing an MOC program. The legislation specifies that an MOC program must require maintainenance of a valid unrestricted U.S. license, participation in an educational and self-assessment program and demonstration through a formalized exam that the physician acquired the appropriate skills.

For the complete text of H.R. 3590, go to http://democrats.senate.gov/reform/patient-protection-affordable-care-act-as-passed.pdf.

For more information:

• Scott A. Edmonds, OD, FAAO, can be reached at Edmonds and Associates, Wills Eye Hospital, (215) 928-3450; e-mail: scottaed@aol.com.
• The American Board of Optometry can be reached at (314) 983-4244; www.abopt.org.
• The American Optometric Association can be reached at (800) 365-2219; www.AOA.org.
• The Vision Council can be reached at (703) 584-4560; www.thevisioncouncil.org.
• VSP can be reached at (800) 877-795; www.vsp.com.