Bill prohibits unnecessary vision plan mandates on doctors.

New Jersey finalizes hard-fought patient access measure

Advocates' determination secured a successful legislative effort in New Jersey to remove the unnecessary barriers that disrupt doctors' ability to provide seamless, quality patient care.

"The bill will make a defined difference on how optometry is able to deliver care and services, opening access for many more New Jersians to optometric health care."

Signed into law January 8 by Gov. Chris Christie, the bipartisan legislation (A-2336) prohibits some of the more egregious third party hurdles that doctors often encounter, while restoring patients' control of important health care decisions and access to timely medical eye care.

The bill's provisions include prohibitions on requirements that doctors participate in a vision plan as a condition for contracting with a health plan; restrictions or limitations on doctors' choice of materials, services or optical labs provided to a patient; and requirements on noncovered services and materials.

"The passage of this bill makes a difference in the delivery of quality health care in New Jersey," says Kenneth Daniels, O.D., New Jersey Society of Optometric Physicians (NJSOP) president. "It will make a defined difference on how optometry is able to deliver care and services, opening access for many more New Jersians to optometric health care."

Tireless advocacy

With the governor's signature comes not only a significant patient access law but also validation on the part of NJSOP's sheer perseverance and grassroots advocacy. Originally introduced in the 2014-15 Regular Session, an early version of the bill cleared both chambers with bipartisan support before a pocket veto struck the bill in January 2016. Although initially discouraging, that action fatefully proved beneficial as NJSOP took the opportunity to bolster its legislation along the lines of AOA's federal Dental and Optometric Care Access Act, says Michael Veliky, O.D., NJSOP Legislative Committee chair and past president.

Reintroduced in the 2016-17 Regular Session, the bill quickly gained bipartisan backing with key support from Assemblymen Daniel R. Benson (D-14th Dist.), Jon Bramnick (R-21st Dist.) and Pam Lampitt (D-6th Dist.), and Senators Nick Scutari (D-22nd Dist.) and Gerald Cardinale (R-39th Dist.), who championed the legislation. Coupled with the NJSOP's strong grassroots effort, advocates ensured legislators were crucially educated on the importance of the legislation.

"Legislators said they were avalanched with information from our members, and when it came time for those votes, we had great support," Dr. Veliky says. "This is landmark legislation from New Jersey that has leveled the playing field for our patients to get a fair shake with their insurance."

Charlie Fitzpatrick, NJSOP Third Party Center Committee chair, says this education bolstered legislators' understanding of the patient perspective, equipping bill sponsors to articulate even the fine details of how the eye care marketplace works today. So, too, those grassroots connections and personal relationships helped push the bill forward, despite strong, last-minute opposition.

"I have no doubt that every state has the talent, passion and resources to make this happen," Dr. Fitzpatrick says.

This win demonstrates that elected officials respect optometry's essential and expanding role in the health care system and they are fed up with anti-doctor, anti-patient abuses by plans, says AOA President Christopher J. Quinn, O.D., who lives and practices in New Jersey and is a past president of the NJSOP. Based on recent meetings with state and federal lawmakers, Dr. Quinn believes that AOA and State Associations are being heard and will continue to see progress.

"On the road to enactment, NJSOP doctors overcame all obstacles and all opposition, a testament to strong grassroots advocacy and teamwork," Dr. Quinn says. "Now, in addition to helping practices across the state, this win provides a real boost to AOA efforts to advance our profession by locking in new support in Washington, D.C., for H.R. 1606." 

AOA renews federal push against vision, health plan abuses

To ensure doctors and patients reap the full benefits of states' patient access laws and other efforts aimed at reforming health and vision plan abuses, federal action is necessary to complement-not supersede-state legislation. The AOA continues to champion H.R. 1606, the Dental and Optometric Care Access Act (DOC Access Act), into 2018, and with more Congressional support than ever.

Thanks to AOA-member advocacy, H.R. 1606 concluded 2017 with its highest level of bipartisan support to-date, gaining 67 co-sponsors despite persistent health and vision plan lobbying efforts to derail it. Introduced by Reps. Earl L. "Buddy" Carter (R-Ga.) and Dave Loebsack (D-Iowa), H.R. 1606 would prohibit these same unnecessary barriers among ERISA and other federally regulated plans.

Since H.R. 1606's introduction, AOA and its members have worked nonstop to build support and understanding of this legislation on Capitol Hill. But more can be done to capitalize on this momentum.

"Now, more than ever, it is important for AOA members to be engaged with their congressional leaders to educate them about the importance of this bill and the positive results it will have for patients," Dr. Quinn says.

Contact your U.S. House members to explain how current health and vision plan policies negatively impact your patients and practice. Visit AOA's Online Legislative Action Center for more information about H.R. 1606, or to send a letter to your U.S. House members. So, too, consider investing in AOA-PAC, the only federal political action committee dedicated to fighting and winning for optometry.

Click here to read more about AOA's 2017 advocacy efforts in the November/December 2017 edition of AOA Focus.

January 10, 2018

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