Appeals Court decision spotlights expanded opportunities for optometrists in federally backed health centers

August 20, 2013

Mandatory services in rural clinics and federally qualified health centers (FQHC) must include physician services provided by optometrists that must be covered by the state Medicaid program, the 9th U.S. Circuit Court of Appeals ruled July 5, 2013.

The clinics and health centers sued the state of California after it eliminated coverage of so-called “optional services” in Medicaid (i.e., adult optometric, podiatric, chiropractic and adult dental services). Previously, the AOA and the California Optometric Association worked together to successfully reverse that attempt by the state to eliminate adult medical eye care provided by optometrists in the state’s Medicaid program, but the clinics and health centers pursued the case to ensure coverage of the eliminated services at their sites.

In the latest ruling, the federal appellate court determined that all Medicare-covered physician services provided by optometrists must also be covered by state Medicaid programs when those services are provided in rural health clinics and federally qualified health centers.

This decision does not mean that optometrists in California or other states can be considered as “physicians in the Medicaid program.” The Medicaid law requires coverage of physician services provided by a medical doctor or doctor of osteopathic medicine and, if AOA-backed legislation advances in Congress, doctors of optometry. Moreover, federal law prevents states from eliminating coverage of medical eye care already provided by optometrists.

The AOA Health Center Committee analyzed the federal appeals court ruling and believes it presents an enhanced opportunity for optometrists across the country who want to serve patients in rural clinics and FQHCs. Medical eye care for adults and children will now be covered under Medicaid, unless the U.S. Supreme Court is eventually persuaded to intervene and overturn the decision.

As of now, the courts have boosted the AOA’s efforts to persuade these facilities to contract with or hire more ODs, if they can be convinced on a facility-by-facility basis to begin or expand the offering of covered eye health care services. With only 134 full-time equivalent optometrists at FQHCs nationwide currently providing optometric care and coverage set to expand under the new health care law, the time to take action is now.

The AOA, through the Health Center Committee, is working with federal agencies and other national health care groups to increase opportunities for ODs at the nation’s FQHCs and rural health clinics and allow expansion funding to go toward eye health care.

ODs are urged to review these AOA resources aimed at helping state affiliates and doctors target and approach local facilities about making eye health care access a priority by adding optometry to their scope of services. Visit http://bit.ly/13xLxxN for more information.

AOA members with questions and those seeking more information from the AOA Health Center Committee should contact Kelli White of the AOA Washington office at 800-365-2219 or kwhite@aoa.org.

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