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Illinois passes vision plan protection legislation

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Earlier this month, Illinois Gov. J.B. Pritzker signed into law legislation that protects optometrists from vision plan-enforced discounts and outside interference into the patient and doctor relationship.

Let’s start with this bill.

The Vision Care Plan Regulation Act (SB0764) prevents vision care organizations (VCO) from requiring eye care providers (ECPs) to set required fees for vision services that are not covered within the plan.

Further, fees which are covered under a vision plan must be reasonable and clearly outlined.

Other requirements include:

  • Prohibits misrepresentation of vision care benefits
  • Prohibits VCO from restricting a provider’s supplier choice
  • Certain areas (terms, fees, discounts or reimbursement rates) in a vision care plan can only be changed when both the ECP and VCO agree.

See the full text here.

What does the state optometric association have to say about this?

According to Illinois Optometric Association (IOA) President Chelsey Moore, OD, this new legislation targets enhancing doctors’ control and patient communication while promoting accountability.

“(The bill) promotes transparent pricing and out-of-network disclosures,” Moore stated.

Wasn’t similar legislation just passed elsewhere?

Indeed it was. In May 2023, Georgia passed and signed into law SB27, which prohibits VOCs from requiring ECPs to offer patients discounts on noncovered services.

Why was this so important?

It all leads back to an earlier bill passed in 2021 (SB43) that defined proper fair trade practices for VCOs.

Despite this bill, a loophole had permitted VCOs to require ECPs to offer discounts for noncovered services.

And the consequence of that?

Due to that loophole, one vision insurance company—VSP Vision Care—had continued to provide such discounts.

Yikes. What kind of impact does the new bill have?

SB27 prohibits VCOs (like VSP) from requiring an ECP to “extend any discounts on services that are not covered eye care services in order to receive increased payments, better reimbursements, preferential treatment.”

So now what?

As of earlier this month, the AOA reported that VSP had notified the Georgia Optometric Association (GOA) that it would follow the law and notify Georgia optometrists, “that it would no longer require doctors to offer discounts on noncovered services under its Premier Edge program,” the AOA reported.

And the bigger picture?

This is just the latest update regarding legislation updates for vision plan protections

Other recent legislation includes:

  • Nevada: S.B.134
    • Signed June 12, 2023 (effective October 1, 2023)
  • Texas: H.B. 1696 with analysis here
    • Signed June 16, 2023 (effective September 1, 2023)

In other legislative news…

A U.S. House Committee is investigating the Federal Trade Commission (FTC) over its regulation of the vision insurance market.

Beginning Oct. 3, a New Hampshire law will allow optometrists to administer vaccines.

Last month, Iowa legislation granted optometrists access to perform anesthesia injections.

Additional legislation includes:

  • Nebraska: LB 216 (introduced Jan. 10, 2023)
  • Connecticut: Raised SB-899 (introduced Jan. 25, 2023)
  • California: AB-765 (introduced Feb. 13, 2023)
  • Massachusetts: Bill H.3606 (introduced March 9, 2023)
  • Texas: HB 2324 (introduced March 9, 2023)
  • Wisconsin: SB143 (introduced March 23, 2023)
  • North Carolina: H576 (filed April 5, 2023)
  • New Jersey: A-5445 (introduced May 15, 2023)
  • New Jersey: S3841 (introduced May 15, 2023)

*Disclaimer: The information provided in this article does not and is not intended to constitute legal advice; instead, all information, content, materials available herein are for general information purposes only.