EYECARE: Managed Care Pediatric Vision Care Is ‘Essential’ By Staff Monday, December 2, 2013 9:00 AM RELATED CONTENT What’s in the Cards? Independent ODs Voice Concerns About Managed Care's New Rules Stand-Alone Plans: The Battle Is Now Waged at the State Level Mergers, Partnerships, Multiple Plans Define MVC Companies’ Long-Term Strategies Public and Private Exchanges to Bring More Patients Medicaid and Medicare Adding More Vision Patients ACA Basics: What You Should Know...But Still Might Not No Longer a Choice, Incentives Effectively Mandate Electronic Communication for ODs Some ACA initiatives of the Affordable Care Act clearly point toward an increase in the number of patients seeking eyecare. The first and most direct impact will most likely result from pediatric vision care being among the 10 essential benefits required by the ACA. Starting Jan. 1, 2014, an estimated 7 million to 8 million previously uninsured children (according to the American Optometric Association) throughout the country are expected to have coverage for comprehensive eye exams and materials. “Unfortunately, the ‘vision benefit’ did not receive much more clarity than those two words,” said Bob Stein, chief professional development officer, National Vision, referring to how the pediatric vision benefit is being defined. “However, our industry has responded admirably and has interpreted that to mean a full scope exam and the correction of refractive error when called for.” “The benefit covers vision exams, eyeglasses and other materials. It was deemed essential not only to screen for refractive problems in children, but also for the early detection of eye disease and other systemic disease and thus facilitate early intervention of medical services,” said Daniel B. Levy, OD, CPHM, chief optometric officer of Avesis, explaining that the benefit is viewed as a comprehensive examination and not just a screening. The American Optometric Association (AOA) agrees with this. In its interpretation of a Dec. 16, 2011 U.S. Department of Health and Human Services (HHS) bulletin proposing that states should consider having pediatric vision care cover “routine eye examinations with refraction, corrective lenses and contact lenses,” the AOA announced, “HHS essentially acknowledged that ‘pediatric vision care’ in the new health care law is centered on a comprehensive eye examination, not a screening offered alone or as part of a ‘well child’ office visit.” However, the AOA “believes significant ongoing federal and state advocacy is necessary to ensure that ‘pediatric vision care’ will not be downgraded to less than a comprehensive eye examination for the millions of newly insured Americans under these plans starting in 2014.” Most industry leaders view pediatric vision being an essential health benefit as a boon to optometrists that will bring more patients through their doors. “Greater awareness and coverage for pediatric vision benefits combined with coverage for previously uninsured children will increase the number of individuals using managed vision care and seeking vision care services,” said Richard Hom, OD, MPA, FAAO, national optometric director of WellPoint. ■