Oklahoma secures optometry’s latest win over vision plan abuses

The bill’s passage means a more level playing field for doctors of optometry in the competition for vision care services in Oklahoma. That leveling maintains a high quality of care and ensures better options for patients, says Jeff Edwards, O.D., president of the Oklahoma Association Optometric Physicians (OAOP).

Most significantly, it preserves the doctor-patient relationship by limiting intrusion by vision plans.

“This bill helps us maximize our scope and minimizes interference from vision benefit managers,” Dr. Edwards says. “HB 1979 ultimately introduces reasonable, responsible regulations that correct a power imbalance and make sure health care decisions are being made by optometrists and their patients, not vision plans.”

Victories by state affiliate associations over vision plan abuses continue to stack up. With increasing vision plan abuses, more affiliates such as Texas, Nevada, Georgia, Illinois and Oklahoma are stepping up to curb vision benefit managers’ (VBMs’) unfair and harmful policies. Practices by VBMs, especially considering consolidation.

At the same time, the AOA continues to push for a federal regulatory crackdown on VBMs and bipartisan legislation is ongoing to deliver relief to doctors. Legislation backed by the AOA and the American Dental Association (ADA), the Dental and Optometric Care (DOC) Access Act, H.R. 1385/S. 1424, remains a priority for optometry on the federal level. Read more about the AOA and affiliates’ fight against VBM abuses.

Says Johndra McNeely, O.D, chair of the AOA State Government Relations Committee: “This is a great win for patients and patient care in Oklahoma. It's also great that our elected officials are understanding and now pushing for reform against the abuses by vision benefit managers that intrude into the doctor-patient relationship."

Leveling the playing field

Among components of Oklahoma’s HB 1979 are:

• Prohibiting a requirement by prepaid vision plans that optometrists provide services or materials at a fee set by the plans, except for those covered in the contract between plans and doctors of optometry.
• Prohibiting prepaid vision plans from using extrapolation to complete an audit of a vision care provider.
• Ensuring parity in payment across different types of professionals, such as optometrists, physicians or osteopaths.
• Disallowing insurers’ requirement for additional terms for network participation for optometrists, compared to physicians or osteopaths, for services within the optometrist’s scope of practice.
• Providing for unrestricted use of labs and suppliers without facing reduced reimbursement for not using specific labs or suppliers preferred by prepaid vision plans.
• Requiring insurers provide notification of contract changes. If the changes are not agreed upon within 90 days, the agreement will terminate.
• Preventing prepaid vision plans from incentivizing patients to receive vision care services at an entity owned wholly or in part by the plans or their subsidiaries.

Prepaid vision plan organizations must apply for a certificate of authority from the insurance commissioner on or before Feb. 1, 2025.

Oklahoma bill beats the clock

HB 1979’s passage marked two years of full-court advocacy by the OAOP.

Members had taken notice of the growing influence of large, monopolistic vision plans gobbling up practices in the state, in a bid to dominate local markets and use the power of vertical integration to force costly mandates on practices. Last year, OAOP collaborated with members of the legislature to put forth a bill establishing responsible guardrails for the anti-competitive vision plans. But the clock ran out on that initiative.

OAOP took another run at passage in 2024—this time with various factors working in its favor.

First, it leans heavily on its “amazing” grassroots—77% of the state’s doctors of optometry are members of the OAOP—and leadership there uses software to quickly mobilize them to reach out to their legislators. Second, other stakeholders supporting the bill included the state insurance commissioner, the chairman of the Board of Examiners, two Oklahoma-based VBMs, and doctors and students at Northeastern State University Oklahoma College of Optometry.

Further, the OAOP has built long and strong relationships with legislators (for instance with Rep. Carl Newton, R-District 58, an optometrist), compared to lobbyists for the out-of-state vision plans.

An amended 2024 version of the bill was easing its way through the legislative process. But its passage was not assured. And as the session began to wind down last week, they were stunned when the governor vetoed the bill at 3 p.m. May 29.

“It was a blow to the stomach,” though not for long, Dr. Edwards recalls.

Given the overwhelming vote tallies in the senate and house, with the clock running, optometry’s advocates figured they still might have a chance.

“There was no time to dwell or wallow,” Dr. Edwards says. “We immediately went into action.”

Twenty-three hours after the veto, at 2 p.m., May 30, the bill passed. Enough votes to override the governor’s veto had been lined up for separate votes in the house (96-0) and the senate (41-3) with only a few hours to spare.

“We were biting our nails,” Dr. Edwards says of the whirlwind finish to the session. “But, when we started seeing all of the green on the board in the senate chambers, it was overwhelming. Once the vote was finished, it was literally jaw dropping.  A sense of joy came over all of us.

“Sometimes the good guys win,” he adds. “We are one of the best places in the country to practice optometry.”

OAOP is now educating its members on how to leverage the new guidelines in their own practices.

Oklahoma vision plan law good for patients

Oklahoma continues to have one of the broadest scopes of practice in the nation and the OAOP has made protecting and expanding it a priority, Dr. Edwards says.

“As a more rural state that struggles with a shortage of physicians, having a full scope of practice and a healthy number of optometrists has helped to ensure that vision care is a bright spot in Oklahoma’s health care landscape,” he says.

Attend regional advocacy meetings

The AOA’s State Government Relations Committee (SGRC) Regional Advocacy Meetings are pivotal opportunities for grassroots advocates, affiliate leaders and volunteers to compare playbooks for successful statehouse strategies. Registration and housing are now open for the 2024 SGRC Regional Advocacy Meetings:

• SGRC Regional Advocacy Meeting Eastern
  Aug. 9-10 | Charlotte, North Carolina 
   
• SGRC Regional Advocacy Meeting Central
  Sept. 13-14 | Dallas, Texas 
   
• SGRC Regional Advocacy Meeting Western
  Oct. 4-5 | Seattle, Washington

Affiliate advocacy teams are encouraged to join any of the three regional meetings. Visit the event pages above for registration and housing information for these highly interactive meetings.