Long-awaited final rule enables healthy vision for America’s children

March 12, 2013

The U.S. Department of Health and Human Service (HHS) announced final regulations that require the pediatric vision essential health benefit to be a yearly eye exam with materials for millions of children in this country.

Washington, DC-The U.S. Department of Health and Human Service (HHS) announced on February 20 final regulations that require the pediatric vision essential health benefit to be a yearly eye exam with materials for millions of children in this country. This final decision will help children access the necessary vision care that will contribute to their healthy development.

Following is an overview of the final rules published by HHS and their potential for optometry:

  • Millions of children will gain health insurance coverage through age 18 that includes direct access to their local optometrist for a comprehensive eye exam and treatment, including medical eyecare.

  • Pediatric eyecare is confirmed as an "Essential Health Benefit," and must be offered by all new small group and individual health plans as a distinct benefit from well-child care.

  • Pediatric eye health care is defined as an annual comprehensive eye exam and treatment, including medical eyecare.

  • All new small group and individual health plans-both inside and outside of state exchanges-are required to provide fully integrated coverage for pediatric eye health care and must recognize optometrists as providers of medical eyecare.

  • While adult eyecare cannot be an essential benefit, health plans are free to add the benefit if they choose to or if required by a state insurance marketplace or exchange.