AOA Needs A Fact Check On California Exchange Board Decision

By Daniel L. Mannen, OD, FAAO November 12, 2012

On October 30, the California Health Benefit Exchange Board voted to include stand-alone vision plans in their soon-to-open state insurance exchange. This important decision, endorsed by the California Optometric Association (COA), will allow California optometrists the opportunity for stand-alone vision plans to compete with Qualified Health Plan-affiliated vision plans and expand access to patients.

Shortly thereafter, the American Optometric Association (AOA) came out with an AOA First Look advocacy alert regarding the California decision. Unfortunately, several false statements and assumptions were present in this 'Dear Colleague' letter which must be clarified. The COA has also responded with a letter to its membership regarding the inaccuracies, and I will attempt to summarize below.

AOA statement #1: "California's exchange board voted to eliminate pediatric eye health care from the unified package of essential, federally subsidized benefits for millions of families in the state."

Fact #1: Pediatric eyecare is still included as part of the essential benefits package. In fact, the recommended plan not only includes a comprehensive eye exam, but also includes material coverage.


AOA statement #2: "Under hastily adopted revisions, qualified health plans in California will no longer be required to offer the pediatric eye health essential benefit or to include OD's on their medical panels. Instead, the state chose a more limited vision care-only benefit to be provided by stand alone plans."

Fact #2: The pediatric essential benefit is UNCHANGED and is NOT optional. There is no requirement that Qualified Health Plans (QHPs) include all optometrists on their medical panels. Hence, the need for multiple access channels for optometry including stand-alone vision plan access as we work toward medical inclusion and integration.



AOA statement #3: "California optometrists have been de-linked from coverage for medical eye care and the federal subsidy intended to enable families to pay for it, and pediatric vision care has been downgraded from mandatory to optional status."

Fact #3: The decision to include stand-alone vision plans has NO impact on the requirements for QHPs to contract with optometrists. COA and VSP are continuing to advocate that the optometrist contract requirement be defined to mean that QHPs must contract with doctors of optometry DIRECTLY to ensure fair treatment and opportunity.

So, what is the bottom line? The future has brightened for both patients and the profession of optometry in California. Not only will vital pediatric eyecare be available to millions of children, but optometry will have greater access through BOTH stand-alone vision plans and QHPs as outlined by state mandate.

As I see it, the landmark California decision to include stand-alone vision plans in the California Health Benefit Exchange is a huge victory for both patients and doctors of optometry. The COA-backed decision improves access and opportunity. Much work still must be done to ensure that all optometrists have access to QHP medical panels and can provide medical eyecare services to QHP enrollees. Access must be maintained as these efforts continue.

I call on the AOA to make patient access through all available channels their number one priority as it is fundamental to the accomplishment of medical inclusion and integration for optometry.


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