The Texas State Capitol, where legislators recently passed three laws that the Texas Optometric Association believes will go a long way toward limiting the abusive powers of some vision plans. Those laws are now being defended.
Latest developments on a key state law.
May 29, 2024
On May 14, the Texas Senate Health and Human Services Committee held an interim hearing to examine the Texas health insurance market, and to identify barriers to accessing care that Texans face when navigating a complex health insurance market, the American Optometric Association reported on its site.
The committee also examined the current state of access to primary health care and ways to improve that access.
Texas Optometric Association (TOA) Board of Trustees member Mary Kate Walters, OD, testified to members of the committee about the challenges Texans continue to face when accessing eyecare due to what TOA describes as the anti-access, anti-competitive business practices of vision benefit managers (VBMs).
“Access to eyecare continues to be threatened by the business practices of vision benefit managers, or VBMs,” Dr. Walters said. “The two largest VBMs have closed their panels to any new optometry practices in Texas, prioritizing their profits over patient care. Last session, H.B. 1696 was unanimously passed into law that addressed some, but not all, of the threats that VBMs pose to Texans. There is more work that must be done on this issue.”
Leveling the Playing Field
Texas’ first-in-the-nation vision plan reform law, H.B. 1696, is noteworthy for its unanimous legislative support in curbing recognized anti-patient, anti-competitive policies and requirements levied on optometrists by major plans and VBMs, according to TOA. Signed into law June 16 and having taken effect Sept. 1, H.B. 1696 has been called “groundbreaking legislation” with “first-in-the-nation” reforms. However, the law met an immediate challenge from VBMs.
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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.
On Jan. 8, the TOA announced it had been granted the right to participate in a 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.
And in April, the State of Texas appealed a federal district court ruling that denied the state’s motion to dismiss plaintiffs’ lawsuit and granted a temporary injunction against the law’s notable anti-steering and anti-tiering provisions. Currently, the law remains in effect, but the state is unable to enforce these two provisions. An appellate timeline has not yet been set.
‘Profits Over Patients Cannot Continue’
During the Texas Senate Health and Human Services Committee interim hearing on May 14, Dr. Walters further addressed problems that VBMs are causing in the Texas Medicaid system.
“Another serious problem exists in the Medicaid system, where VBMs are now acting as middleman subcontractors under Texas Medicaid MCOs (Managed Care Organizations),” Dr. Walters said. “The VBM is reducing provider reimbursements far below the state’s published Medicaid rate and pocketing the difference for themselves. This intrusion by VBMs in the Medicaid system is unsustainable and endangers eyecare access for our most vulnerable Texans.”
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