AOA alerts states to NAVCP-backed noncovered services bill

March 10, 2017
Legislation dictates how doctors practice, limits patient choice.

Proposed legislation would empower vision plans to dictate business decisions made by doctors of optometry, thereby limiting patient choice, the AOA cautions, as insurers' lobbying arm engages state legislatures.

The National Association of Vision Care Plans (NAVCP), representing entities such as VSP and EyeMed, is actively backing legislation in Minnesota (HF 1817 and SF 1609) that would not only require doctors to accept vision plans' payment for noncovered services, but also mandate how doctors inform their patients of noncovered services and treatment options that attempt to steer patients in-network.

This bill language requires doctors to visibly post notice that covered patients electing noncovered services are ineligible for a discounted rate, and would require doctors to provide a treatment plan that includes each anticipated service, estimated cost for each anticipated service and furnish a patient's complete evidence of coverage document upon request. Additionally, doctors recommending an out-of-network lab or supplier must notify the patient of any ownership or financial interest the doctor has with such lab or supplier.

Finally, the bill requires that doctors receive a written confirmation of understanding from the patient before continuing to provide services not covered by the vision plan.

The AOA and state affiliates contend such legislation represents a gross overreach by vision plans to dictate how doctors can conduct their business concerning services and products that the plan does not cover. Small businesses providing crucial patient care should not have damaging regulations mandated by the government only to satisfy the wishes of big insurance companies, and the AOA stands ready to help defend states against such intrusion.

Steven Eiss, O.D., AOA Third Party Center Executive Committee chair, says requiring doctors to use plan-owned labs or products does little more than increase profits for vision plans, while limiting patient choice and available product. These policy changes have forced states to enact legislation to curb such behavior.

"As a response to that legislation, the NAVCP has come up with a bill of their own, in which we feel they are trying to speak for optometry," Dr. Eiss notes. "Although, at first, the legislation may appear to include some of the language that we support from earlier bills, it includes subversive language that could further interfere with the doctor-patient relationship."

He adds, "State associations need to be on the lookout for these bills and realize that they are not the same consumer protection legislation that we have seen passed up to this point."

Although only one state, to date, has had such language introduced, the AOA believes it's possible that more state legislatures could follow. State affiliates and AOA members are urged to be wary of bills related to vision plans and noncovered services, as well as pay close attention to the registers of contract lobbyists. The AOA's State Government Relations Center and Third Party Center stand ready to assist should members have concerns.

Already in this current legislative session, eight states have had 13 bills regarding vision plans and/or noncovered services introduced. In 2016, three states—Florida, Missouri and West Virginia—passed some form of vision plan and/or noncovered services legislation, bringing the total number of states with such protections to 20.

AOA engages Congress for federal legislation

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. That's why the AOA again heavily champions the Dental and Optometric Care Access Act (DOC Access Act) in this new Congressional Session.

The DOC Access Act seeks to help level the playing field for doctors and patients by targeting some of the most offensive vision and health plan abuses. The legislation is aimed at outlawing such detrimental policies by ERISA and other federally regulated plans such as:

  • Restrictions on medical plan participation.
  • Limits on doctors' choice of labs.
  • Mandates on noncovered services and materials.

The legislation garnered 65 bipartisan co-sponsors on Capitol Hill in the previous Congressional Session, indicating a measure that will likely continue resonating as the DOC Access Act is expected to be reintroduced in the immediate future.

The AOA remains committed to removing unnecessary barriers that disrupt doctors' ability to provide seamless, quality patient care, and continues to emphasize the importance of legislation that puts patients and their doctors back in control of important health care decisions.  

Read more about the DOC Access Act in an Avalon Health Economics study presented on Capitol Hill last year, and find more information about the DOC Access Act.

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