Last week, the White House made public an official response in which Principal Deputy Administrator for the Centers for Medicare & Medicaid Services (CMS), Jonathan Blum, essentially mirrored the interpretation of the landmark provider non-discrimination (Harkin) law shared by the AOA and the provision's lead champion in Congress - Sen. Tom Harkin of Iowa.
A significant development, the White House reading of the Harkin Law stands in direct contrast to the flawed guidance issued by the Obama Administration's own Center for Insurance Information and Oversight (CCIIO). AOA representatives, led by Chairman of the AOA Federal Relations Committee, Roger Jordan, OD and Col. Rich Jacobson, OD, met recently with Blum on a related matter of discrimination in Medicare.
As the AOA has previously reported, CCIIO issued sub-regulatory guidance last year which the AOA and pro-optometry leaders in Congress found to be misleading, inaccurate and threatening to the foundation of the entire provision. Based on that flawed guidance, some states have been limited in their implementation and enforcement of the Harkin Law in a way that would allow insurers to continue to discriminate against ODs and their patients
Congress has grown increasingly frustrated with CCIIO's handling of the Harkin Law implementation and remains concerned that the agency's mistakes could lead to the very type of discrimination targeted by the law. At the urging of the AOA and over the objections of organized medicine and the health insurance industry, Congress approved language earlier this year which directs CCIIO to scrap the flawed guidance.
Additionally, in a public hearing held by the U.S. House Energy and Commerce Committee's Subcommittee on Oversight and Investigations, Rep. Peter Welch (D-VT) told CCIIO's top official that "the guidance could lead to discrimination against some providers by allowing health insurers to continue the very abuses that the statute aims to stop."
Though, only days after the White House issuing the clear-cut Harkin Law interpretation, the Obama Administration issued an extension and expansion of an earlier ACA compliance delay, which the AOA believes will likely impact the Harkin Law implementation timeline for certain health plans in certain states.
This week, CMS informed State Insurance Commissioners that the agency would, if permitted by applicable State authorities, allow health insurance issuers to continue certain coverage that otherwise would have been cancelled for failing to meet certain ACA requirements, including the Harkin Law and other consumer protections.
Overall, the proposal would permit states to allow individual and small group plans in their respective states to remain non-compliant with the consumer protections through policy years beginning October 1, 2016. As a result, the Harkin Law and other similar patient safeguards would not be in full effect in those markets - in those states that choose to allow the delay - until October 1, 2017.
Although this decision represents a significant change to the President's timetable and approach toward implementation, the AOA is reporting that there has been no change in the law's full recognition of optometrists as providers of essential care or in how eye health care will be integrated into comprehensive health insurance coverage for children. Additionally, in spite of the erratic rollout of the new law, the Harkin Law's ban on discrimination against ODs is in effect for a growing number of health plans.
Optometrists supporting and opposing the health care law know that they can rely on the AOA as the source for the best, most accurate, and timely information on how OD practices will be impacted by it. For more information, AOA members can contact the AOA Washington Office at 1-800-365-2219 or ImpactWashingtonDC@aoa.org