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Pressure groups launch massive new attack on AOA’s position on essential care for children

February 6, 2013

AOA calls on HHS to reject proposed barrier to kids’ essential care

As the U.S. Department of Health and Human Services (HHS) takes its final steps toward implementing the Affordable Care Act’s essential health benefits (EHB), the American Academy of Ophthalmology (AAO) and groups representing health insurers and business interests are lobbying the agency hard to reverse course on its pediatric vision care EHB proposal by erecting a new barrier between kids and the eye and vision care they need.

The anti-access coalition’s pediatric vision care recommendations stand in direct contrast to what the AOA, Congress, and HHS know the benefit needs to be for America’s families.

In the ongoing legislative and regulatory battles in Washington, D.C., the AOA has successfully advocated to make expanded and direct access to comprehensive eye care a national health care priority and to ensure that coverage for at least an annual comprehensive eye exam and follow-up care is the foundation of the newly created pediatric vision essential benefit. Ophthalmology and insurers have actively opposed the AOA at each step of the process, and are now pursuing a last-ditch effort to roll back eye health and other coverage requirements before they can take effect next year.

The AOA is now calling on the HHS to reject outright the ophthalmology-led group’s vision screening benefit recommendation to place a new and dangerous barrier between kids and the comprehensive eye and vision care that they need to learn and grow.

Essential Health Benefits Coalition recommendations

Consisting of the AAO, the Blue Cross and Blue Shield Association, America’s Health Insurance Plans, the National Association of Manufacturers, and others, the so-called “Essential Health Benefits Coalition” delivered a lengthy letter to the HHS last month pleading for the agency to reduce access to benefits, including essential eye care, by implementing six recommendations for shaping the final EHB rule in a way the group claims will make coverage less costly.

One of the key items on the anti-access EHB coalition’s wish list is a demand that the HHS eviscerate requirements for pediatric vision benefits by giving medical doctors, employers, and insurance companies the means to keep patients from seeing optometrists. Overall, the proposal calls for the HHS to allow participating health insurance plans to downgrade HHS’ benchmark vision benefit to one that “follows the American Academy of Pediatrics’ Bright Futures’ recommendations for preventive dental and vision screenings, with referral for necessary vision, medical and surgical care for potential problems as needed.”

For pediatric vision services, Bright Futures’ recommendations call for risk assessments up to age 3, a vision screening at ages 3, 4, 5, and 6 with a risk assessment at age 7, and, in general, alternating a screening and risk assessment beginning at age 8 and continuing through childhood and into adolescence.

The group assures that “if a risk assessment indicates a potential issue, an eye examination including refraction would occur.” However, acknowledged research and OD experience shows vision screenings miss most eye and vision problems and even those identified by a screening often remain unresolved because, tragically, the appropriate transitions into care do not usually occur.

The anti-access group’s letter also offers a dangerous alternative should HHS officials again reject a screening-based benefit. It contains a final and desperate plea for the HHS to create a gaping loophole in the final EHB rule by including a special provision through which “insurers may require a referral from a primary care provider, school or health department prior to receiving vision benefits.” The coalition adds that “the referral should identify the need for additional care following a screening/risk assessment consistent with Bright Futures guidelines.” In an apparent effort to create a new gatekeeper system, the group’s recommendation would universally require that kids first fail a vision screening before gaining access to any other eye and vision care service.

AOA efforts

Through grassroots advocacy efforts over the last three years, AOA doctors and staff have worked alongside key members of Congress to press for a pediatric vision benefit based on direct access to optometry and covering comprehensive eye exams and follow-up care. On behalf of America’s children, the AOA has consistently and repeatedly delivered this message directly to HHS leadership and the agency’s staff experts who have agreed, at each step of the process, that the pediatric vision care benefit should be centered on a comprehensive eye exam, not a screening offered alone or as part of a well-child visit.

With state-based health insurance exchanges expected to be up and running later this year and enforcement of EHB requirements at the start of next year, the AOA expects the HHS to release its final EHB determination in the coming months.

For the latest coverage on the AOA’s children’s vision advocacy, visit http://newsfromaoa.org/2013/01/04/aoas-patient-access-message-key-as-hhs-releases-plan-for-pediatric-essential-eye-health-benefit/.

AOA members with questions on this important topic and those seeking to get more involved in federal advocacy should contact the AOA Washington office at 800-365-2219 or ImpactwashingtonDC@aoa.org.

7 comments

  1. It’s because of pediatric screenings at an early age I noticed my baby was blind in one eye. They are essential and a necessary part of all baby and pediatric exams and ongoing well checks.


    • Ongoing well-child checks do serve an important role in helping to keep our kids healthy. They can and do identify some eye and vision problem, as evidenced by your story, Nancy. The problem is that many types of vision screenings actually miss more eye and vision problems than they detect. Pediatricians need to assess the entire child and consequently have only a few moments to do any sort of visual screenings. An exam from an eye care provider is much more thorough and does a better job of detecting vision problems. You can read more about the limitations of vision screenings at http://www.aoa.org/x9650.xml.


      • Thank you Dr. Carlson. I have found out last year there is some vision loss in her eye that was 20/20. This was found at a Pediatric Ophthalmologist’s office however. I’m thankful to my daughter’s PCP Pediatrician and her Pediatric Opthamilogist. At a very early age she was diagnosed with Optic Nerve Hypoplasia. Without their help, understanding and guidance I would not have understood the importance of early vision testing.

        My story is on a tangent of the original idea behind the article. I do however agree that better and accessible healthcare which includes psychiatric, neurological as well as vision screenings should be readily available.


  2. Research shows that visioning screenings have horrible or non-existent outcomes. Go to MainoMemos.com type in “vision screening” in the search box and you will see the research on this.


  3. Higher premiums mean fewer will ENROLL in the Exchange; comphrehensive eye exams for children covered by every QHP is NOT NECESSARY for those who do not have children. Both CHIP & FEDVIP include very comprehensive benefits that results in significantly higher premiums. FEDVIP is designed as a supplemental, voluntary benefit & will thus significantly increase the cost of coverage…which could lead fo fewer small employers & individuals purchasing coverage. First a screening – then a comprehensive exam by OD or MD for those who fail the screening – this is SENSIBLE & PRACTICAL & AFFORDABLE;


  4. It is my understanding that the HHS has on Feb 20 th, published a Final Rule regarding Essential health Benefits.The pediatric vision benefit that will be included in Qualified Health Plan medical coverage includes a comprehensive exam and materials similar to those covered under the FEDVIP plan used in many states.Your article was issued on Feb 6 th but was received today Feb 28 th.Perhaps an updated bi-line would have been helpful in providing more up to date news.My concern is that the states will dump their present Medicaid patients into the new government exchanges where the fees will be much lower. i would appreciate the AOA’s response to my concern.signed EC.


    • Hello Dr. Dean, please check out our more recent update at http://bit.ly/XU5gDz. The AOA is also developing a members-only pediatric essential benefit FAQ due out very soon that should address your concerns.



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