Texas vision plan law, now in effect, sees favorable development in federal lawsuit

Texas optometrists will join the state’s defense of its landmark vision plan reform law after a federal judge granted a motion to intervene in the legal challenge brought forth by plans.

On Jan. 8, the Texas Optometric Association (TOA) announced it had been granted the right to participate in the federal lawsuit, advocating alongside the State of Texas and Attorney General’s Office in defense of the important consumer protection provisions ushered in by H.B. 1696. The “first-in-the-nation” vision plan reforms enacted by H.B. 1696 curb many of the anti-competitive, anti-patient policies and requirements that doctors of optometry contend with daily in dealings with major health insurers and vision plans.

“The judge agreed with TOA that its members have a material interest in the outcome of the matter and granted the motion for the TOA to intervene,” says Tommy Lucas, O.D., TOA director of advocacy. “The TOA now officially joins with the state and attorney general to defeat this meritless lawsuit brought by vision plans and their surrogates.”

Signed into law June 16 and taking effect Sept. 1, H.B. 1696 enjoyed unanimous support in the state legislature. The legislation directly counters plan mandates that affect the relationship between patients and doctors. The new provisions rein back plans’ infringement on doctors’ independent judgement and patient choice caused by the lack of competition and untenably low fee schedules precipitated by vertical integration and market consolidation.

In August 2023, several vision plan plaintiffs, including Visionworks of America, Inc., the National Association of Vision Care Plans, Inc., VSP, and Healthy Vision Association, filed a suit in the U.S. District Court for the Northern District of Texas, centered on the anti-steering and anti-tiering provisions prohibited by the law. The judge denied the plaintiff’s request for a temporary restraining order preventing these important provisions from going into law.

In its January announcement, the TOA notes its honor in standing alongside the Attorney General’s office to fight for Texas consumers and their access to patient- and doctor-driven eye care, and echoed the sentiment of the state’s defense of H.B. 1696:

“As is clear from its text and history, the Amendment seeks to promote fair business practices for managed care plans—an area of concern for the Legislature since at least 2015. Indeed, the express purposes of the Amendment are to ‘prevent managed care plans from directly or indirectly controlling or attempting to control the professional judgement, manner of practice, or practice of an optometrist,’ and to prevent ‘steer[ing] patients to doctors at locations where [business] owned products are being sold and financially control[ing] doctors by incentivizing or disincentivizing plan benefits and reimbursements to prefer the products and services [the businesses] own.

“The only thing the Amendment regulates is the level of control a managed care plan has over others in the vision care industry in Texas.”

AOA, affiliates fighting for optometry practices

Tens of millions of Americans rely on their local doctors of optometry for their comprehensive eye  health and vision care needs, and despite historic advancements in optometry’s scope and level of care provided, plans haven’t kept pace. Compounded by increased costs and new challenges to deliver care, plans’ stagnant pay scales have put doctors of optometry in a difficult place. In fact, over the past two decades, inflation alone rose 65% while the cost of running a practice increased by 39%, according to the Centers for Medicare & Medicaid Services.

The AOA and affiliates understand this dynamic, developing a multi-pronged approach for moving toward an equitable system that fairly values optometric care. That approach includes:

• Countering the influence of the vision plan industry’s lobbying group, the National Association of Vision Care Plans.
  
• Taking direct action to resolve doctor complaints against plan-imposed barriers to patient care.
  
• Launching the AOA Health and Vision Plan Action Report, a day-to-day tally of member doctor complaints about plan abuses and the AOA’s response.
  
• Forging advocacy alliances with the American Dental Association and other groups supporting a crackdown on plan abuses.
  
• Working together with affiliates to update state laws, including notable 2023 wins in Nevada, Georgia, Illinois and Texas, as well as seeking stepped-up legal enforcement.

Looking for even more background? Access the reports that AOA references in its health and vision plan advocacy, including:

• The AOA Health Policy Institute Report on stagnation in vision plan fee schedules.
• The Avalon Health Economics Report on how plan mandates result in higher costs, less convenience and worse health outcomes.
• The AOA’s advocacy reading list with the top 15 advocacy-related articles from 2023.

If you or your practice experience difficulties with a health or vision plan, please report these challenges to the AOA Third Party Center at stopplanabuses@aoa.org.