- DOC Access Act reintroduced amid growing Capitol Hill vigor for VBM reform
- U.S. House, Senate approve VA OD physician-level recognition legislation
- Citing array of concerns and complaints, Congress ramps up scrutiny of vision benefit manager industry
- AOA-PAC Election Report: Optometry Has Outsized Impact on 2024 Elections
- How the AOA and affiliates are fighting for reimbursement and coverage fairness
- Are you ready for the Eyeglass Rule of 2024?
- NIH, NEI consolidation plan ‘jeopardizes’ vision research, draws AOA opposition
- Bill seeks better fix to Medicare Physician Fee Schedule cuts
- How Chevron ruling could impact optometry
- Takeaways from CMS’ proposed 2025 Physician Fee Schedule
- FTC issues 10-year Eyeglass Rule update as AOA renews demand for crackdown on medical device scammers
- AOA joins other groups seeking Supreme Court reversal of decision favoring ERISA authority
- AOA sees positives in federal children’s eye health legislation
- CMS heeds AOA recommendations on Medicare supplemental benefits
- 'All the advocacy firepower’ called up at AOA on Capitol Hill
- What optometry’s advocates are championing at AOA on Capitol Hill
- Capitol Hill inquiries into plan abuses are expanding
- Vision plan abuses top of mind? Register for AOA’s town hall on reimbursement, coverage fairness advocacy
- 15 advocacy highlights of 2023
- CMS takes aim at Medicare Advantage plans misrepresenting vision benefits
- Fighting for veterans, fighting for optometry
- AOA: No letting up on Eyeglass Rule advocacy
- AOA and AFOS: ‘Cut through the noise’ and empower licensed doctors of optometry to provide greater access to care to veterans
- A force to reckon with
- U.S. House investigative committee calls for scrutiny of vision plans
- Retail optical lobbying group name change allays AOA, affiliate concerns
- Doctors of optometry challenge reasoning behind proposed Eyeglass Rule changes at FTC workshop
- Contact lens safety legislation proposes banning robocalls
- Help voice optometry’s priorities at AOA on Capitol Hill: Here’s how
- Part of the solution: Optometry groups join AOA in submitting actionable solutions for workforce shortages
- Hatch Act permits issue advocacy by doctors of optometry
- AOA makes robust rebuttal to FTC over proposed changes to Eyeglass Rule
- DOC Access Act introduced amid growing patient calls for Congress to act
- bill seeks advancement for VA doctors of optometry
- Are you adhering to the Contact Lens Rule
- AOA decries misleading Medicare Advantage advertising
- Gaining access A win for veterans and doctors of optometry
- Congress heeds AOA’s call to stop Medicare pay cuts, but lawmakers’ plan falls short
- Proactive advocacy gets early eyeglass rule gains, notice of potential new burden
- AOA PAC plays outsized role in 2022 midterm elections
- Veterans notch win as VA rescinds restrictive language governing community ODs
- Supporting Medicare Providers Act
- Federal student loan forgiveness: What to know
- Medicare Pay Cuts 2022
- 2022 Capitol Hill Recap
- AOA and South Carolina doctors expose and defeat retail lobby group’s influence scheme
- Medicare Pay Cuts March 2022
- Hold Medicare Advantage plans accountable
- Hubble Contacts slapped with 3.5 million penalties restrictions and supervision
- Medicare pay cuts, once delayed, looming without Congressional action
- Bipartisan AOA-backed bill targeting abusive discount plans gets boost from policy-expert report delivered to Congress
- Advocacy in optometry
- U.S. House, consumer groups mull federal action against DTC contact lens sales schemes
- Medicare Cuts Averted
- Medicare vision efforts fizzle 10 percent pay cuts still loom
- Optometry’s advocates going FAR beyond the call
- Lawmakers host AOA, patient and consumer advocates for VBM abuse briefing as Congress expands probes
- AOA-AFOS make case to Department of Veterans Affairs for access-boosting national practice standards
- Medicare expansion: The long road to here and now
- House pens Medicare vision benefits
- Congress sets deadline to ink Medicare vision expansion language
- White House extends student loan relief, AOA continues push for NHSC inclusion
- AOA, AFOS work to ensure optometry well represented in formation of national practice standards by Veterans Affairs
- Medicare expansion
- Congress urges administration to fully implement provider nondiscrimination law
- Department of Veterans Affairs Optometry Service and doctors of optometry
- Medicare Vision Expansion
- AOA-backed DOC Access Act reintroduced to combat anti-competitive vision plans
- 2021 Virtual AOA on Capitol Hill Wrap-up
- Contact lens prescription verification failings targeted by new legislation
- Advocacy Bootcamp
- Medicare Telehealth Expansion
- 2 percent Medicare sequester delayed
- Doctors of optometry obtain 2.1 billion in federal relief
- CL rule takes effect
- Medicare Sequester
- Expanded COVID-19 vaccinator workforce includes doctors and students of optometry
- NBEO decisions provoke AOA-AOSA response
- Congress’ COVID-19 relief package HHS funds-ERC extension
- Why staff involvement is critical
- 2021 Virtual AOA on Capitol Hill
- Ohio activates eligible doctors for COVID-19 vaccine administration AOA focuses new relief efforts
- Congress President Biden asked to activate optometry for COVID-19 vaccination response
- AOA- AOSA-backed federal student loan relief extended through September
- AOA takes on anti-optometry lobbying group’s deceptions
- Contact Lens Rule implications key tax and Medicare pay fixes among AOA wins
- AOA and AOSA make appeal to extend suspension of student loan payments
- AOA-backed DOC Access Act gains U.S. Senate companion
- Contact Lens Rule bill gains backing
- Contact Lens Rule changes take effect Oct 16
- 1-800 Contacts notifies patients not to wear AquaSoft lenses due to lens defect
- Contact Lens Rule Modernization Act introduced in the U.S. Senate
- Virtual AOA on Capitol Hill Recap
- Championing paraoptometrics
- Virtual AOA on Capitol Hill 2020
- AOA doctors warn FTC of potential adverse impact of new amendment
- Concerns as optometry students prepare for boards
- Elevating optometry through media advocacy
- AOA finds allies in fight against new FTC contact lens prescription paperwork mandate
- Proposed payment model would have put burden solely on shoulders of doctors of optometry
- Optometry help divert emergent eye cases from ER COVID-19
- Medicaid CHIP relief funds
- AOA address increased cost personal protective equipment
- AOA and state affiliates put optometry's concerns front and center in Washington
- AOA petitions NAVCP member plans temporary relief during emergency
- Pandemic relief bill will help optometry practices nationwide
- AOA mobilizes for doctors in national response to pandemic
- AOA assembles industry leaders set future guidance telehealth services
- AOA secures legislative win provides direction Medicare telehealth services
- AOA calls for FDA investigation into retailers remote vision test
- How and why you should get involved in advocacy
- AOA ensures Medicare legislation recognizes eye exams
- reauthorization of higher education act
- Legislation targets contact lens prescription verification shortcomings
- DOC Access Act fights harmful vision plan abuses
- AOA on Capitol Hill 2019
- The big picture
- AOAs advocacy at top of their game
- Tusculum denied optometry program by institutional accreditor
- Remembering John McCain
- Tusculum media campaign prompts AOA insistence on accreditation standards
- FTC offers revised Contact Lens Rule
- 2018 AOA on Capitol Hill makes history
- AOA on Capitol Hill 2018
- FTC contact lens paperwork proposal update
- FTC workshop wrapup
- Californias congressional delegation joins bi-partisan call to stop FTC paperwork proposal
- Every doc has their day—on the Hill
- FTC Contact Lens Workshop
- DOCACCESS
- FTC Contact Lens Rule Workshop
- Tax Reform Passes
- Scam Alerts
- Better Care Reconciliation Act
- AOAs 247 advocacy is shaping news coverage
- AOA and GOA backed bill take aim at antipatient anticompetitive abuses
- AOA launches Health Policy Institute
- AOA alerts states to NAVCP backed noncovered services bill
- Senate VA chairman deals blow to TECS program
- AOAs patient safeguards reflected in final Cures Bill
- Fullcourt press AOAs 2016 advocacy highlights
- Proposed Contact Lens Rule misguided
- 3 ways to be an all star advocate
- AOA-PAC chair talks importance of contributions
- FTC proposes Contact Lens Rule changes
- AOAs privacy appeal prompts change
- AOA calls for federal investigation
- Bill seeks 90 day EHR reporting period
- Advocates urge federal action against contact lens resellers
- FTC issues warning letters related to Contact Lens Rule
- Recess over Congress considers AOA backed bills
- AOA president stands up for ODs and patients at Senate hearing
- Truth in Healthcare Marketing
- Vision Quest
- AOA provides model legislation to fight forced discounts
- Day of action Grow support for DOC Access Act
- letter from the president prioritizing optometry
- Rumors of meaningful uses demise have been greatly exaggerated
- Year end legislation advances AOA priorities
- Contact lens care guides scrutinized by FDA panel
- AOA-backed legislation aims to boost eye exams among seniors with diabetes
- 3 tips for becoming an AOA keyperson
- Lobbyists hired to oppose AOA ADA backed DOC Access Act
- AOA calls for antitrust protection before Supreme Court case
- New legislation would provide more flexibility in EHR incentive programs
- AOA defends doctors against new attack on Harkin law
- doctors of optometry score win on prescribing law
- AOA submits comments on FTC Contact Lens Eyeglasses rules
- FTC seeks feedback on Contact Lens and Eyeglasses rules
- Rethinking eye health and vision care
- Optometrys advocates mobilize during Congressional recess
- AOA steps up efforts to guide NAM vision study
- AOA advocacy helps avert Medicare cuts in trade bill
- Supreme Court dismisses ACA challenge AOA backed provisions remain in full effect
- AOA lobbies for changes in EHR Incentive Programs
- HHS reverses course on Harkin Law guidance
- AOA advocacy helps shape Cures Act
- Medicare seniors deserve better coverage for eye care
- Optometry takes Capitol Hill
- CMS proposes shorter meaningful use reporting periods
- What you need to know about MACRA the new Medicare pay reform law
- AOA continues fight to improve meaningful use in 2015
- CMS to ease meaningful use reporting periods
- AOA Contact Lens watchdog group to track report illegal contact lens sales
- How to engage with local elected officials
- Medicare payments increase by 75 percent in 10 years
- AOA urges members to lobby for loan repayment bill at CAC
- Congress spending bill addresses optometrys priorities
- Doctors of optometry step up as pandemic sets in
- Medicare pay cuts loom without Congress action
'One of the most impactful legislations for decades to come'
August 5, 2021
Is it happening? How will it work? What can you expect? The AOA fielded members’ questions about Congress’ efforts to create a Medicare vision benefit, providing the latest updates on a fluid situation.
Tag(s): Advocacy, Federal Advocacy
Growing momentum behind Congressional infrastructure plans brings Medicare expansion efforts closer into focus, while the AOA actively advocates for a workable vision benefit that stays within traditional Medicare and safeguards beneficiaries’ care.
Days before the U.S. Senate unveiled a $1 trillion, bipartisan “hard” infrastructure bill, possibly clearing the way for a much larger “soft” infrastructure bill that includes a Medicare vision, hearing and dental coverage expansion, the AOA’s Special Advisory Committee on Medicare Expansion convened to inform and guide the AOA’s advocacy. Such on-the-ground feedback from doctors is critical into a potentially historic Medicare expansion that while the AOA did not initiate, the AOA is determined to shape by reinforcing the highest standards and value of primary eye health care delivered by doctors of optometry.
“There is still a tremendous amount that needs to be figured out in legislative language and through the regulatory process to really understand all the elements of how a new Medicare vision benefit would operate in reality,” noted AOA President Robert C. Layman, O.D., before hundreds of AOA members, volunteers and staff during the July 29 videoconference. “There also remains uncertainty regarding whether we will actually see a benefit expansion this year. However, despite uncertainty, it is critical for AOA to make optometry’s voice heard with policymakers.
“If AOA is not there advocating for doctors in the trenches, our place at the table will be taken by those who seek to diminish the role of doctors of optometry and to undervalue the care that we provide,” Dr. Layman added.
Currently, the White House and supportive majorities in Congress are working toward a program expansion that would add a new refraction and materials benefit for the program’s roughly 62 million seniors and younger people with disabilities. As the program operates now, Medicare only provides coverage for a complete, comprehensive eye examination if a medical condition is identified or present and typically requires beneficiaries to pay 100% of the costs for eyeglasses or contact lenses.
Although Medicare Advantage plans may provide some of these benefits, this coverage costs seniors extra and many plans feature practices that are harmful to doctors and patients. Such is the case, beneficiaries’ confusion over coverage or lack thereof may cause seniors to delay or forgo essential, annual eye health care in the same way they forgo dental cleanings or hearing aids.
However, as evidenced by optometry’s increasing role in the delivery of primary, medical eye care under Medicare—growing 28% to $1.3 billion since 2011 as compared to ophthalmology’s 8% growth—optometry stands to play a critical part in seniors’ preventive care and medical management.
“This Medicare expansion has the potential to be one of the most impactful legislations for decades to come,” says Jeffrey Michaels, O.D., moderator of the advisory committee videoconference. “This is an opportunity to increase access to America’s seniors and improve their eye health and vision care, and ultimately prevent blindness.
“This can be a 1986-like moment, when optometry’s role within Medicare was forever changed and our impact on our patients’ lives was fully realized,” Dr. Michaels added, alluding to the year that optometry gained Medicare inclusion—also, notably, via budget reconciliation.
Overwhelmingly, doctors of optometry participating in the special advisory committee agreed that a benefit expansion would greatly improve seniors’ access to comprehensive eye care that can help prevent eye disease, vision loss and other systemic diseases. Yet, doctors still had many questions.
4 questions about Congress’ Medicare expansion and AOA’s advocacy
Members of the AOA’s Federal Relations and Third Party Center committees, as well as AOA advocacy staff, fielded those queries about what, when and how any new vision benefit would take shape, considering a budget framework is not finalized and specific proposals are likely to change. Below are the questions and answers.
1. Legislatively, where does Medicare expansion currently stand? Will it happen?
Congressional efforts to expand Medicare coverage are as serious as ever; however, there is still uncertainty over the current proposal. The Senate’s 2,700-page Infrastructure Investment and Jobs Act, which includes $550 billion in new federal spending on “hard” infrastructure projects, such as roads and bridges, currently has bipartisan support. Should the bill pass the Senate, the Budget Committee would approve a resolution directing Congressional committees to start developing parts of a reconciliation package that includes Medicare coverage expansion. Leaders have indicated that a budget resolution to formally begin the reconciliation process may take place before senators’ mid-August recess. Public polling shows overwhelming majorities of both self-identified Republicans and Democrats support adding benefits to Medicare, which could lead to bipartisan work in Congress.
Unfortunately, as part of the “hard” infrastructure bill recently put forth in the Senate, Congress proposes a one-year extension of mandatory Medicare sequestration cuts to offset some of the $1 trillion agreement. This isn’t the first time that Congress has targeted Medicare payments, and the AOA continues to remind lawmakers that such funds shouldn’t be used for roads and bridges.
2. How is the AOA advocating for optometry in the current Medicare expansion discussion?
Based on the special advisory committee feedback received and evaluation of the current landscape, the AOA believes that if an expanded vision benefit is to be developed, it must have several foundational requirements to work well for both patients and doctors.
First, a new refraction and materials benefit must be administered directly by Medicare and not subcontracted or supplemented through other parties or discount plans. The AOA volunteer leaders are adamant that doctors be able to retain their independence and preserve their doctor-patient relationships by relying on the current, traditional Medicare benefits administration systems available.
Second, safeguards must exist to help ensure that unscrupulous, online eyeglasses and contact lens sellers, as well as disreputable, low-vision device makers, cannot take advantage of the Medicare program or its beneficiaries. Toward that end, AOA volunteer leaders suggest supporting leveraging the Durable Medical Equipment (DME) program for its robust safety requirements.
Third, the care that doctors of optometry provide is a key part of keeping seniors healthy and independent, and fair and appropriate reimbursement will be critical if the Medicare benefit is expanded. The AOA will advocate for any new benefit to be administered in such a way as to ensure that Medicare physicians are appropriately reimbursed for their time and patient care.
3. Why does the AOA currently advocate for utilizing the DME program?
The AOA is well aware of issues with the DME program and advocated against changes to the program that the Centers for Medicare & Medicaid Services (CMS) eventually finalized, in addition to advocating for a physician exemption. However, considering rampant fraud in the DME program at the time, the changes that CMS implemented—requirements to enroll in the Medicare program, to obtain a DME accreditation and post a $50,000 surety bond for each National Provider Identifier maintained—did enhance security. The AOA volunteer leaders believe disreputable retailers will not want to or cannot subject themselves to DME requirements, thereby offering an additional level of protection.
4. Should the AOA push for a new G code for this benefit to simplify billing?
The AOA volunteer leaders do not support a new G code for a couple of reasons. First, the AOA is very engaged with valuing Current Procedural Terminology (CPT) codes with representation on and input to the Relative Value Scale Update Committee (RUC). This access permits optometry to weigh-in on discussions regarding the valuation of procedures provided. Second, the CMS has authority with G codes not only to decide how much they will pay but also to define what they believe is required for a comprehensive eye examination and to generate a prescription. The AOA stands by its evidence-based clinical practice guidelines that emphasize a comprehensive eye examination is necessary for assessing a patient to determine a contact lens or spectacle prescription. For these reasons, the AOA is more inclined toward current CPT and ICD codes.
Given the rapidly evolving nature of this Congressional action, the AOA has fully mobilized its advocacy resources, and optometry’s advocates are diligently working to proactively build support for optometry. In turn, the special advisory committee is expected to reconvene in the weeks ahead as more becomes apparent about any coverage expansion.
“America is aging and each of us has the knowledge, skills and training to help every American as they age to protect their precious eyesight, to maximize the vision they have and to help individuals continue to live independent lives,” noted AOA Trustee Teri K. Geist, O.D. “While we clearly have uncertainty before us, we also have tremendous opportunity.”