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Vermont, Kansas pass managed care plan legislation
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Legislatures in both Vermont and Kansas passed bills recently that refine the relationship between vision and health plans and ensure equal treatment for optometry and ophthalmology.
Vermont Gov. Peter Shumlin signed S281, an act that aims to improve provider choices for eye care services as well as vision riders, into law on June 10.
“This act requires health insurance plans to provide a choice of providers for vision and medical eye care services and to reimburse providers the same amount for the same services when provided by either an optometrist or an ophthalmologist,” according to the legislation. “It requires health insurers to permit optometrists to participate in vision and medical eye care plans to the same extent as ophthalmologists and prohibits insurers from placing certain requirements on an optometrist or ophthalmologist as a condition for participation in a health insurance or vision plan. The act also ensures that optometrists and ophthalmologists are compensated for the services and materials they provide.”
“We are very proud of Vermont for passing S281,” Karena Shippee, OD, former president and current legislative chair of the Vermont Optometric Association, told PCON. “Now Act 182, this bill helps ensure patients’ access to their choice of provider for eye health care. It also takes steps towards recognizing the value of optometrists as primary eye care providers.”
The law is scheduled to become effective Jan. 1, 2015.
Kansas Gov. Sam Brownback signed SB 285, an act prohibiting limiting payment for covered insurances to insurance plan amounts, into law on April 17. The act went into effect on April 24 when it was published in the official state newspaper.
Explicitly, the bill deals with contracts between “an insurer, health insurer or another entity writing vision care insurance or a vision care discount plan and a vision care provider.”
“The Kansas Optometric Association was successful in expanding the concept of noncovered service legislation to address some ongoing issues relative to health insurance and vision plans,” Gary L. Robbins, MA, CAE, executive director of the association, told Primary Care Optometry News. “Kansas joins Rhode Island and Texas in prohibiting the practice of requiring participation in a vision plan to get on a health insurance plan panel.”
As of April 24, contracts cannot contain language that would require an eye care provider to “provide services or materials to an insured under vision care insurance or a health benefit plan, or to a subscriber of a vision care discount plan at a fee limited or set by the plan unless the services or materials are reimbursed as covered services under the contract; or participate in a vision care insurance or vision care discount plan as a condition to participate in any other health benefit plan or vision care plan, regardless of whether such plan is a plan of insurance or a vision care discount program which is not an insurance plan,” as detailed by the Kansas legislature.
“There are two groundbreaking features in the Kansas law,” Robbins said. “First, it provides that no vision plan may have the effect of limiting patient choice, directly or indirectly, of sources and suppliers of materials. Second, no vision care insurance policy or vision care discount plan contract shall change the terms, discounts or rates provided therein without the concurrence and agreement of an optometrist or ophthalmologist at the time of such change.” – by Chelsea Frajerman