Congress sets deadline to ink Medicare vision expansion language

Congressional committees circled a Sept. 15 deadline for draft language that would expand Medicare vision benefits, affording optometry’s advocates an opportunity to contribute critical insights learned from the AOA’s special advisory group sessions.

The self-imposed deadline for key committees in the U.S. Senate and House of Representatives—the Finance and Energy and Commerce committees, respectively—to pen legislative language for a historic expansion of Medicare vision, hearing and dental coverage comes as congressional debate plods along on a $3.5 trillion budget reconciliation bill. Although the House approved its budget resolution with reconciliation instructions on Tuesday, such deadline for draft language is anticipated to be followed by committee action and a possible final vote later this fall.

Currently, the White House and supportive majorities in Congress are working toward a Medicare expansion that would add a new refraction and materials benefit for the program’s roughly 62 million seniors and younger people with disabilities. While the AOA did not initiate these efforts, the AOA is determined to shape any legislation by reinforcing the highest standards and value of primary eye health care delivered by doctors of optometry.

“Optometry’s expanding role in the delivery of medical eye care as part of the Medicare program demonstrates just how critical it is to ensure our input shapes the decisions that will impact our practices and patients for years to come,” says Robert C. Layman, O.D., AOA president.

“As Congress begins drafting what could prove very consequential legislation in the weeks ahead, it’s vitally important that our doctors, our staff and students elevate the profession’s voice and reinforce the necessary requirements that would truly make this a workable benefit.”

Given the far-reaching effects that Medicare coverage expansion would have on America’s optometry practices, the AOA continues to work closely with leaders in Congress to proactively build support for optometry and provide essential input in the legislative process. That input is directly informed by AOA-member feedback discussed as part of the AOA-convened Special Advisory Groups on Medicare Expansion.

These townhall-stye #AskAOA webinars return with a three-part format in the weeks preceding the Sept. 15 committee deadline to help provide members relevant information and details, as well as to solicit feedback from doctors, paraoptometric staff and optometry students. Those sessions include: 

What: #AskAOA Special Advisory Group on Medicare Expansion: Vision Care Benefit Design
When: 9 p.m. ET, Wednesday, Sept. 1 

What: #AskAOA Special Advisory Group on Medicare Expansion: Materials Benefit Design and Reimbursement; Vision Rehabilitation and Non-Covered Services and Other Issues
When: 9 p.m. ET, Thursday, Sept. 9

What: #AskAOA Special Advisory Group on Medicare Expansion: Grassroots Advocacy
When: 9 p.m. ET, Monday, Sept. 13

All members are invited to attend these #AskAOA Special Advisory Group on Medicare Expansion webinars. After registering, you will receive a confirmation email containing information about joining the webinar.

Members’ feedback is especially critical as insurers and discount plans look to shape these new benefits and shift the debate away from quality care. Unfortunately, anti-optometry interests and their lobbyists are actively trying to control any new benefit and intrude upon the doctor-patient relationship at the heart of optometry practices. This, combined with the historic nature of such a coverage expansion, is why the AOA has maintained a seat at the table in any congressional efforts to move forward with a Medicare vision benefit.

Member feedback influences 3 points of AOA advocacy

Optometry stands to play a critical part in seniors’ preventive care and medical management in the years ahead as evidenced by the profession’s increasing role in the delivery of primary, medical eye care under Medicare: since 2011, optometry has grown 28% to $1.3 billion as compared to ophthalmology’s 8% growth.

“This Medicare expansion has the potential to be one of the most impactful pieces of legislation for decades to come,” noted Jeff Michaels, O.D., moderator of the first special advisory group videoconference in August. “This is an opportunity to increase access to America’s seniors and improve their eye health and vision care, and ultimately prevent blindness.”

Under the current program, 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. Therefore, beneficiaries’ confusion over coverage or lack thereof may cause seniors to delay or forgo essential, regular eye health care in the same way they forego dental cleanings or hearing aids.

Already, doctors of optometry participating in the AOA’s special advisory group have 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 disease. Understandably, doctors still have questions.

Based on members’ feedback, if a benefit is going to be created, the AOA believes that it must have certain basic guardrails, including:

• Any new benefit must be administered directly by Medicare and not subcontracted to vision discount plans, which continue to implement harmful practices that limit choice, result in higher prices and lead to less patient access to care.
• Safeguards must exist to ensure that dishonest online eyeglasses and contact lens sellers and others who seek to disrupt the doctor-patient relationship cannot take advantage of unsuspecting seniors or the Medicare program.
• Current Procedural Terminology coding should be relied upon for reporting the new benefit components and doctors of optometry must be separately reimbursed for any additional care provided.

Learn more about the rationale behind these guardrails and other comments and questions discussed during the AOA’s first special advisory group videoconference.

3 ways to support the AOA’s Medicare advocacy

To ensure optometry’s physician role is respected and the value of care you provide is understood, the AOA calls on members to bolster the AOA’s advocacy efforts. Here’s how you can take action:

1. Call your U.S. Senators and House members. Lawmakers are currently working on language that would define any new Medicare vision benefit, and hearing input from not only constituents but also subject matter experts—such as AOA members—can help influence this drafting process. Please consider reaching out to your senators or representatives by calling the Capitol Switchboard at 202.224.3121, and share with your legislators these perspectives from our special advisory group.
2. Send a letter to your U.S. Senators and House members. Additionally, sending a follow-up letter can help drive home the importance of getting these details right should any policy advance on Capitol Hill. Send a letter by logging in to the AOA’s Action Center or by texting “MEDICARE” to 855.465.5124.
3. Attend #AskAOA Special Advisory Group on Medicare Expansion webinars. This three-part, interactive #AskAOA webinar series is open to all members and will provide the latest updates and discussion points from Capitol Hill. Register at the above links for this webinar series.

For more information about AOA’s Medicare advocacy or to report on the responses you’ve received from members of Congress, please contact AOA advocacy at advocacy@aoa.org.