Kentucky heralds third party triumph in new law

July 23, 2015
Potentially creates new standard business model

Concerted third party and state advocacy efforts ensure Kentucky's doctors of optometry have direct access to health plan members needing medical eye care via a business model that could be a bellwether for other states.

Our hope is that this model will become the new norm in the industry.

At the behest of a new state law—backed by the Kentucky Optometric Association (KOA) and AOA—VSP Vision Care announced on July 15 that their business model in Kentucky would change to allow doctors the opportunity to participate directly with the Cigna medical network sans participation with a vision care plan, and the state's VSP Integrated Primary EyeCare Program (IPEC) would be discontinued, effective Sept. 15, 2015.

This change in posture comes after months of third party advocacy and legislative efforts by the KOA and AOA to roll back these tying arrangements between health and vision care plans for credentialing and contracting doctors of optometry.

"The announcement from VSP clearly delineates the ability of a Kentucky optometrist to choose to participate in either a medical plan from Cigna or the routine vision plan from VSP," says Karoline L. Munson, O.D., KOA president. "There is no longer a forced participation in one plan to gain access to the other."

Last fall, several Kentucky doctors of optometry received notice that despite being on Cigna's medical panel for years, they would be removed unless they joined VSP. The KOA notified the Department of Insurance, and an effort was initiated to educate legislators on the importance of separating these tied medical and vision service plans.

The result was Kentucky HB 465 that not only prohibits insurers from requiring a doctor's participation in a vision care plan in order to become a network provider for a health plan, but also prohibits an insurer from requiring additional terms and conditions for an optometrist that are not required of any other doctor in the provider network for services within the scope of practice.

Darlene Eakin, KOA executive director, says Kentucky has an excellent set of access laws—going back to the "any willing provider" (AWP) laws—and this is just another piece of the access puzzle. "Our philosophy is that there's nothing like a law," Eakin says.

New standard moving forward?

This action in Kentucky represents a major change in the industry, and one that could be applied in other states, says Stephen M. Montaquila, O.D., AOA Third Party Center (TPC) chair. When health plans choose to contract with vision care plans for the provision of routine eye care, Dr. Montaquila says this arrangement in Kentucky is the preferred model.

"We want to see this model become the new norm in the industry, and will be citing this change as an example of the progress that's needed elsewhere," Dr. Montaquila says.

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Going further

The practice of optometry cannot move forward without expanding advocacy efforts and educational and professional development efforts. Are you ready to take your practice—and your profession—to the next level?