AOA’s push for eye care for children continues

The AOA and affiliates spoke up to make healthy vision a top national health care priority, especially for children. The federal government listened.

The result is its implementation plan for the Affordable Care Act's pediatric vision essential health benefit.

Pediatric eye health care is confirmed as an “essential health benefit” and must be offered by all new health plans as a distinct benefit from well child care.

Here's an overview of the benefit and its expected impact on optometry:

  • Millions of children will gain health insurance coverage through age 18. Coverage includes direct access to their local optometrist for a comprehensive eye exam and treatment, including medical eye care.
  • Pediatric eye health care is confirmed as an "essential health benefit" and must be offered by all new health plans as a distinct benefit from well child care.
  • Pediatric eye health care is defined as an annual comprehensive eye exam and treatment, including medical eye care.
  • All new health plans-both inside and outside of state exchanges-are required to provide fully integrated coverage for pediatric eye health care and must recognize optometrists as providers of medical eye care.
  • Vision plans are permitted to partner with health plans to offer fully integrated eye health care coverage inside and outside of state exchanges.

In taking this action, the Obama administration accepted the AOA's long-standing position on healthy vision for America's children. It also rejected lobbying by ophthalmologists, pediatricians and their organized medicine allies who wanted pediatric vision care to be based on a screening or limited to an element of well child care. The administration also said "NO" to a plan that would have segregated a full pediatric eye health benefit, downgraded it from mandatory to optional status and imposed new barriers to OD-provided medical eye care.

State officials will continue to make important implementation decisions. Continued advocacy by optometry will help lock in the increased patient access envisioned under federal law.

June 24, 2013

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