Arkansas secures expanded scope of practice

New Arkansas scope law is safe, ballot issue averted

On Aug. 2, the secretary of state announced that its office of elections had completed its review of a petition filed by Safe Surgery Arkansas seeking a ballot referendum on a new state law expanding optometric scope of practice, including advanced surgical procedures. Safe Surgery Arkansas, the group behind the ballot referendum reportedly spent $150,000 to gather signatures for the petition, failed by a considerable margin in gathering the nearly 53,500 valid signatures from registered voters to put the measure on the ballot.

"We are grateful to be one step closer to providing Arkansas patients with better access to quality eye care."

"This Office has determined that the petition contains 23,953 signatures on its face, thus it is declared insufficient," wrote Director of Elections Leslie Bellamy.

Failure to meet the signature threshold averts a referendum on the November 2020 ballot.

"We are pleased with today's outcome," says Vicki Farmer, chairperson of Arkansans for the Healthy Eyes Ballot Question Committee. "The real winners are Arkansas patients, who will have improved access to eye care under Act 579, and Arkansas voters, who can be assured with today's rejection of more than 60,000 invalid signatures that special interest groups won't be allowed to submit thousands of unlawfully solicited signatures and expect to unwind a duly enacted law in our state.

"We applaud the secretary of state and his staff for their diligence in accurately applying the law and conducting a fair and thorough review," adds Farmer, also executive director of the Arkansas Optometric Association. "We can now focus on the credentialing process. We are grateful to be one step closer to providing Arkansas patients with better access to quality eye care."

Next up are the promulgation of new rules for the new law. Meanwhile, the AOA continues to partner with state affiliates under the Future Practice Initiative and remains vigilant in Arkansas, ready to assist as much as needed.

"We're definitely thrilled that Arkansas has this new law that expands optometric scope for doctors of optometry and access to care to patients," AOA President Barbara L Horn, O.D., says. "It's also a great example of how the AOA and affiliates across the country worked together to support the Arkansas Optometric Association. We need to work as one organization.  

"But we also need to keep our guard up," adds Dr. Horn, noting opposition from ophthalmologists. "We're moving on to other states and they can continue to spend their money to fight patients' access to care. We'll be ready to keep fighting for our patients and their access to the essential care our doctors of optometry provide."  

The well-funded opposition to scope expansion in Arkansas was stiff. Read more in the Arkansas Democrat-Gazette about how one lobbyist alone, for the Arkansas Ophthalmological Society, reported spending more than $111,600 to defeat the measure.  

But, Sen. David Wallace, R-Leachville, who sponsored HB1251 in the Senate, says optometry fought back hard­­-and won.  

"That was a tough fight. The optometrists had them outnumbered on the ground in talking to the representatives and senators. They had boots on the ground, and the ophthalmologists spent the money. I was really impressed with the organization of the optometrists." 

Scope victory in Arkansas

Signed into law March 27 by Gov. Asa Hutchinson, the bipartisan-supported legislation (HB 1251) amends the state's optometric scope of practice act to permit new procedures, including selective laser trabeculoplasty and YAG laser capsulotomy, certain injections (excluding intravenous and intraocular), removal of lid lesions, and chalazion incision and curettage. The bill is a product of the concerted work and perseverance of Arkansas Optometric Association (ArOA) members with support through AOA's Future Practice Initiative.

Belinda Starkey, O.D., ArOA immediate past president, says this progress is a testament to the important primary eye health care that doctors of optometry deliver to patients every day.

"We're very excited that the incredible effort of our ArOA members has been successful in passing our bill through both legislative chambers with overwhelming, bipartisan support," Dr. Starkey says. "The most exciting aspect is that families across the state will have much greater access to comprehensive eye health and vision care with doctors of optometry being authorized to practice near the fullest extent of our training."

Sponsored by Rep. Jon Eubanks, HB 1251 was introduced in January and initially encountered a speed bump in the House Public Health, Welfare and Labor Committee. After amendment, the bill gained bipartisan support and swept through both the House (70 to 19) and Senate (25 to 8) before landing on Gov. Hutchison's desk. Now law, the scope amendments take effect 90 days after the legislative session ends and following a formal rule promulgation process to be approved by committee.

The bill still prohibits doctors of optometry from performing cataract surgery, radial keratotomy surgery and selling prescription drugs; however, it recognizes that doctors of optometry are fully educated, trained and qualified to perform necessary eye health and sight-saving procedures. Additionally, the bill calls on the Arkansas Board of Optometry to establish credentialing requirements for doctors of optometry to perform these laser procedures, as well as require those doctors to report the outcomes of their procedures to the board.

"The ArOA wants to send a huge 'thank you' to all of the legislative members who have supported this critical legislation throughout the process," Dr. Starkey adds. "We would also like to thank the AOA and colleagues across the country for their help and support."

Arkansas becomes the fourth state to permit laser procedures, while Alaska is currently developing regulations for their use. Find more state advocacy updates here (AOA member login required).

AOA, states mobilizing for patient care

As optometry delivers 85 percent of the primary eye health care in America-practicing in counties that make up 99 percent of the U.S. population-AOA and state associations recognize that optometry is well-positioned, trained and qualified to address questions of patient access. Yet, restrictive state laws based on archaic assumptions of optometry's education and abilities have created self-imposed barriers long perpetuated by those seeking a maintenance of the status quo.

However, a recent, agenda-setting report from the U.S. Department of Health and Human Services (HHS) underscores optometry's stance that the status quo is flawed. Released Dec. 3, the report outlaid reforms the government should take to deliver optimal care to Americans, including realizing new health care choices for the public and identifying barriers on federal and state levels to market competition.

Not only did the report specifically note that doctors of optometry can provide the same services as other physicians, it also emphasized that "states should consider changes to their scope of practice statutes to allow all health care providers to practice to the top of their license, utilizing their full skill set." Such high-level validation only emboldens the profession's advocates, already working diligently to bring scope of practice laws into the 21st century.

The AOA's Future Practice Initiative, launched by AOA President Samuel D. Pierce, O.D., and the AOA Board of Trustees in 2018, in close partnership with state affiliates, is poised to fix those outdated state laws that unfairly limit how doctors of optometry practice and provide essential care for their patients, including through fully recognizing new and advanced procedures that reflect optometric education and training.

"On behalf of our patients, optometry is mobilizing to do everything it takes to advance our practices and define our profession for years to come," Dr. Pierce said. "By supporting our AOA and state associations right now, our member doctors and students are answering our profession's most important call to action ever, and we're getting results."

Like any effort to update scope of practice acts to reflect the current, high-level education and training that doctors of optometry receive in accredited schools and colleges of optometry, naysayers redouble their efforts to cast doubt through baseless claims. Yet overwhelmingly, legislators support optometry's accessibility and clinical prowess as primary eye health care providers.

August 7, 2019

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