Following the Georgia Supreme Court’s decision affirming the state’s 2010 Patient Access to Eye Care Act, as reported by VMail Dec. 18, 2013, two other states, Kansas and Vermont, have passed legislation with similar language restricting the latitude managed vision care plans have when contracting with optometrists, primarily disallowing insurance companies from requiring providers to give covered members discounts on non-covered materials and services. With Missouri, North Carolina and Rhode Island considering similar bills in the current legislative session, additional statutes may soon be written into law elsewhere. Similar legislation passed in Maryland and Texas last year and in Kentucky in 2012.
While the Kansas statute, signed into law April 17, 2014, is more comprehensive than Vermont Bill S.281, which was passed by the House and the Senate last week on May 7, 2014 and is pending the Governor’s signature in early June 2014, both include language preventing vision insurance plans from requiring optometrists to offer discounts to patients on non-covered services and materials.
Kansas Senate Bill No. 285 goes further, also preventing insurance plans from requiring optometrists to use certain labs, allowing patients to buy materials such as contact lenses from any supplier, not just those specified by the plan, and preventing insurance companies from requiring optometrists to participate in a specific vision plan in order to also participate in any other health benefit plan or vision care plan. In addition, the Kansas law also requires managed vision care plans to obtain written approval from participating optometrists when changing vision plan terms or rates.
In its legislation summary, the Kansas Legislative Research Department states, “SB 285 creates the Vision Care Services Act to prohibit certain limitations in contracts between insurers and vision care providers.” Section 1 of the bill provides that vision care insurance or vision care discount plans cannot require the vision care provider to “provide services or materials to an insured…unless the services or materials are reimbursed as covered services.” Section 2 states: “No vision care provider shall charge more for services and materials that are not covered services under either vision care insurance or a vision care discount plan than such vision care provider’s usual and customary rate for those services and materials.” Section 3 prevents insurance plans from changing “the terms, discounts or rates…without…agreement…by the vision care provider.”
The new Vermont legislation, in addition to also disallowing vision insurance plans from requiring optometrists to offer discounts to patients on non-covered services and materials, also includes language that prevents health plans from discriminating against optometrists: “A health insurer shall permit a licensed optometrist to participate in plans or contracts providing for vision care or medical eyecare to the same extent as it does an ophthalmologist.”
