Illinois enacts new protections against abusive vision benefit practices

Momentum for vision benefit middleman (VBM) reform continues to build, with Illinois becoming the latest state to enact new protections for patients and doctors of optometry.

Gov. JB Pritzker signed S.B. 3707 into law, strengthening oversight of VBMs and addressing contracting and business practices that can interfere with patient choice and care. The Illinois victory follows Louisiana's comprehensive VBM reforms earlier this year, adding to a growing nationwide push for greater transparency and accountability.

"Two years after the Vision Care Plan Regulation Act took effect, Illinois eye doctors encountered issues with vision plans that revealed gaps in transparency and accountability," says Leigh Ann Vanausdoll, CEO of the Illinois Optometric Association (IOA). "SB 3707 builds on the original law by addressing those concerns, strengthening oversight, improving transparency, and delivering meaningful protections for both patients and eye care providers."

Adds AOA President Teri K. Geist, O.D.: "Illinois' action sends another clear message that policymakers recognize the need to protect patients and doctors from practices that restrict choice and undermine a competitive vision care marketplace. This law adds to growing momentum for commonsense VBM reforms that put patients first."

New protections for Illinois patients and doctors

The new law establishes protections designed to increase transparency, strengthen provider rights and give patients greater flexibility in using their vision benefits.

Among the law's provisions:

• Greater contract transparency: Vision plans must provide notice of contract changes and access to provider manuals, policies and fee schedules. Provider contracts are generally limited to two years unless otherwise agreed.
  
• Protection from fee-based reimbursement: VBMs cannot require reimbursement methods that impose transaction fees on providers, including virtual credit cards.
  
• Cash-pay choice for patients: Providers may offer patients a lower-cost cash-pay option when paying directly is less expensive than using their vision benefit.
  
• Benefit transparency: Plans must clearly disclose copays, cost-sharing and patient financial responsibility, while clarifying that services and materials remain covered benefits when deductibles, copays or coinsurance apply.
  
• Protection from forced discount-plan participation: Vision plans cannot make participation in a discount plan a condition of network participation.
  
• Non-retaliation protections: Providers are protected when reporting potential violations, filing complaints or communicating with regulators, legislators or professional associations.
  
• Stronger oversight: The law expands unfair and deceptive practices protections to affiliates and other entities acting on behalf of vision plans.
  
• Protection of practice assets: Vision plans cannot require providers to grant a security interest in their practice or business assets.

Illinois adds to growing national momentum

The Illinois victory builds on comprehensive VBM reforms enacted in several states, where lawmakers addressed reimbursement, contracting, patient steering and other practices affecting patients and providers. 

The AOA worked alongside the IOA and its advocates to support efforts to strengthen VBM accountability, Dr. Geist notes.

"This victory reflects what is possible when optometry speaks with a unified voice," Dr. Geist says. "The IOA and its advocates stayed engaged throughout the legislative process to secure meaningful protections for patients and practices."

With Illinois’ hard won victory, AOA and its affiliates will continue advancing reforms that protect patient choice, support access to high-quality eye care and hold VBMs accountable.