New legislation signed into Arkansas law late last month seeks to regulate and balance eyecare providers’ (ECPs) interactions with vision benefit managers (VBMs) and protect patient rights.
The legislation follows nearly 6 years after the state passed major scope of practice legislation for optometrists in 2019 (despite ophthalmologist-led efforts to squash it).
Now the basics of this act.
Initially filed at the end of January, House Bill (H.B.) 1353 (Act 142 of 2025) is referred to by the American Optometric Association (AOA)as representing a “groundbreaking step toward” change for the better among the optometric community.
Among other purposes, this act targets:
- Regulation of VBMs
- Amending the Vision Care Plan Act of 2015
- Rundown: This regulates the practices of vision care plans and ensures fair treatment for ECPs via the establishment of standards for reimbursements rates; prohibition of discriminatory practices of ECPs; and restrictions on optical labs / suppliers in vision plans
- Amending the Healthcare Contracting Simplification Act
- Rundown: This governs healthcare contracts between providers and contracting entities
Now into specifics.
As the AOA noted, eight main points of action are targeted:
- Fair reimbursements
- Coordination of benefits
- Ban of unfair audits
- Payment protection
- Reimbursement guarantee
- Elimination of virtual credit card requirements
- Transparent provider and service listings
- Increased oversight
Break each of these down for us.
Looking at fair reimbursements, the new act mandates that all rates must be (at the very least) Medicare-covered services and materials (such as contact lenses, artificial intraocular lenses [IOLs], prisms, low-vision and vision therapy devices, and ophthalmic frames).
With coordination of benefits, patients could maximize their coverage by combining both vision and medical benefits.
Moving on to … banning of unfair audits essentially prohibits VBMs from using “batch” or “extrapolation” of audits (in other words: projecting and estimating an unknown value) of participating ECPs.
- Instead: Any additional payments required are required to be based on the actual over / under payment.
Next up: Payment protection, which prevents VBMs from restricting cash payments to ECPs—particularly when this may be the lowest-cost option for their patients.
And the remaining four changes?
Reimbursement certainty. This prevents VBMs from reimbursing patients at a different amount based on their ECPs’ choice of optical lab, health record software, or equipment.
Removal of virtual credit card requirements translates to preventing VBMs from mandating ECPs accept forms of payment that require a processing fee to be reimbursed.
The last two:
- Transparent provider and service listings prevent VBMs from:
- Misleading enrollees about what services are fully covered
- Stopping “steering” of enrollees and “tiering” of ECPs based on noncovered service discounts or brands of products carried
- Also: Prevents “steering” of enrolled to:
- One ECP over another
- Any VBM-affiliated retail establishment
- Any VBM-affiliated Internet or virtual provider
- Also: Prevents “steering” of enrolled to:
- Increased oversight, which expands the regulatory authority of the state Insurance Department by adding VBMs to the definition of a health benefit plan.
So what does all of this mean moving forward?
The AOA noted that this legislation ensures “VBMs offer contracts that are fair to providers and benefits that are appealing for consumers (patients), thereby improving relations with providers and expanding access for patients with these products.”
And Arkansas Optometric Association (ArOA) Legislative Co-Chair Joseph Sugg, OD, stated: "This law removes influence from insurance companies on where patients receive their eye care. It promotes competition in the vision care market, increases patient choice and access to care by the doctors they prefer to see, and allows patients to use their benefits in combination with their medical insurance.
And when does the act take effect?
Technically: August 2025.
Take note: “Additional provisions” will follow (based on plan renewals and contract changes) by Jan. 1, 2026.
Talk about the significance of this.
We’ll look at this from the legal scope of VBMs, which has long been a hot topic in the optometric community—particularly in the last few years.
In 2023, the U.S. House of Representatives Oversight Committee launched an investigation into the Federal Trade Commission’s (FTC) oversight of the vision market.
- At the time, the chair of the committee panel called for the FTC to investigate the agency’s role in preventing unfair and unharmful marketplace practices—with a specific focus pertaining to the consolidation of the vision insurance market and its impact on consumers.
To note: This was preceded by similar probing into VBMs that had already been the focus of bipartisan legislation seeking to “crack down on anti-doctor and anti-patient policies.”
Go on …
Also in 2023, vision plan reform-specific state legislation was met with some success for states such as Texas, Nevada, Georgia, and Illinois. See here for details on those.
And in terms of coverage on Glance: We previously reported on a January 2024 town hall the AOA held to address vision plan policy concerns and ongoing advocacy initiatives across the country.
At the time, participant polling from the town hall found:
- 93% believed vision plan policies create a barrier to delivering quality care
- 94% believed vision plan policies do not support doctor-patient relationships
And ECPs reported the following vision plan-based burdens faced by clinical practices:
- Valuation of care (55%)
- Linking vision plan participation to medical plan participation (27%)
- Lacking lab choice (9%)
- Exclusion from certain networks (7%)
Interesting … and what should we keep an eye out for in the future?
Continued advocacy, for one. That goes for efforts by the AOA as well as by optometrists across the country.
See here for details on the latest federal developments, as well as how to join national advocacy efforts.
*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.