AOA Seizes Every Opportunity to Shape Pediatric Vision Care Essential Benefit

While the Department of Health and Human Services (HHS) has been hard at work, the AOA has been closely monitoring the federal agency’s moves as top officials seek to implement major provisions of the new health care reform law.

At every step of the way, the AOA has seized the opportunity to convey how important comprehensive eye and vision care is for America’s kids, particularly as health policy staffers work toward defining pediatric vision care within the essential benefits package.

Through all-out advocacy efforts in 2009 and 2010, OD and student volunteers helped make children’s eye and vision care a top national health care priority as health reform legislation was first conceptualized, then drafted, and finally debated on Capitol Hill.

HHS Secretary Kathleen Sebelius and AOA President Dori Carlson, OD at HHS headquarters in Washington, DC

As the Affordable Care Act (ACA) was eventually signed into law after a nearly two-year political and legislative battle, it was clear that the AOA had secured a key patient access victory through the specific designation of children’s vision care as an “essential health benefit.”

As outlined under the ACA, all health plans participating within the new state-based health insurance exchanges, those operating in the individual and small group markets, as well as Medicaid benchmark and benchmark-equivalent plans will be required to provide essential health benefits, starting in 2014.

Listed among the 10 statutory categories, Congress specifically recognized the importance of comprehensive eye and vision care for kids when it included pediatric vision care as an essential health insurance benefit. However, how “pediatric vision care” will ultimately be defined has yet to be determined.

Charged with implementing much of the ACA, the law gives HHS Secretary Sebelius broad authority to define precisely what types of treatments and other services will be included within specific categories of the essential benefits.

Knowing that anti-optometry lobbying groups want to limit any children’s vision benefit to a basic screening, the AOA launched an immediate and sustained advocacy push to ensure that the new children’s vision benefit is defined as an annual comprehensive eye exam coupled with coverage for vision correction treatment, including eyeglasses.

Jason Ortman, OD; Steven Loomis, OD; Walter Morton, OD and Chris Eddy, OD at the HHS essential benefits listening session in Denver

From the very start, OD and student volunteers helped spread the AOA’s pro-access, pro-patient message throughout the nation’s capital and across the country.

Starting shortly after the ACA was signed into law, AOA President Dori Carlson, O.D., held a series of meetings with HHS Secretary Sebelius as well as top White House officials. In fact, at a recent White House meeting, Dr. Carlson delivered the joint statement of the 2011 School Readiness Summit: Focus on Vision.

To help bolster the efforts of AOA volunteer leaders, ODs and students joined the fight by helping to secure a number of key letters from pro-optometry leaders in Congress urging Secretary Sebelius to define the pediatric vision care benefit as an annual comprehensive eye exam.

Among others, Sen. Daniel Inouye, (D-HI.), Sen. Robert Menendez (D-N.J.), Sen. Mary Landrieu (D-La.) and Rep. James Clyburn (D-S.C.) delivered letters to Secretary Sebelius in support of the AOA’s position on the children’s vision care essential benefit.

And in the past number of weeks, as the HHS launched an essential benefits listening tour, AOA staffers and OD volunteers made sure that optometry’s voice was heard loud and clear at each and every session.

Starting with the first listening session in the nation’s capital, AOA staffers spoke directly with HHS staff and urged that the new pediatric benefit be based on direct access to and coverage for an annual comprehensive eye exam.

Rodolfo Rodriguez, OD and Andrea Thau, OD at the HHS essential benefits listening session in New York

Responding to a number of questions, AOA staff made clear that cursory vision screenings can never be considered a substitute for comprehensive eye exams.

Following up on the initial session in the nation’s capital, HHS proceeded to take its listening tour across the country. The AOA quickly contacted state affiliates in the necessary states and volunteer ODs almost immediately responded with their willingness to speak in favor of comprehensive eye exams for America’s children.

In all, the HHS held separate listening sessions in Chicago, Boston, Philadelphia, Dallas, New York, Kansas City, Atlanta, Seattle, Denver, and San Francisco. Optometry was represented at every single listening session.

In testimony before the HHS officials, AOA and Association of Schools and Colleges of Optometry (ASCO) representatives spoke of the importance of early and periodic comprehensive eye exams for children of all ages.

Many reinforced the fact that doctors of optometry understand the asymptomatic nature of many eye and vision disorders and recognize that most childhood vision problems can be prevented or treated effectively through early detection and follow-up care.

Conversely, they said, delayed diagnosis and treatment of vision problems in children can lead to vision loss, additional costly treatments, and missed learning and developmental opportunities.

Scott Daly, OD and Hilary Hawthorne, OD at the HHS essential benefits listening session in San Francisco

In the end, the OD representatives concluded that this nation simply can’t afford to exacerbate existing problems by denying children direct access to comprehensive exams and care.

As a result, they urged that the new pediatric vision care essential benefit be based on direct access to and coverage for an annual comprehensive eye exam provided by an eye doctor and including follow-up care.

Participating in the HHS listening sessions were many ODs, including but not limited to: Sandy Bury, O.D.; Valerie Kattouf, O.D.; Cliff Scott, O.D.; Paul Levine, O.D.; Linda Casser, O.D.; Carey Patrick, O.D.; Andrea Thau, O.D.; Rodolfo Rodriguez, O.D.; Rich Wilson, O.D.; Tom Spetalnick, O.D.; Alan Homestead, O.D.; Steven Loomis, O.D.; Walter Morton, O.D.; Jason Ortman, O.D.; Chris Eddy, O.D.; Hilary Hawthorne, O.D.; and Scott Daly, O.D.

With a tentative deadline of May 2012, the AOA anticipates that HHS will be releasing its first-round essential benefits proposal in the coming weeks.

With an eye on ensuring that American’s children receive the comprehensive eye and vision care that they need, the AOA will continue to fully engage HHS and Capitol Hill leaders on this critical topic.

AOA members with questions or concerns and those interested in becoming more involved in federal advocacy should contact the AOA Washington office at 800-365-2219 or by e-mail at ImpactwashingtonDC@aoa.org.