New laws restrict MVC plan contracts with ODs in Kansas and Vermont

May 20, 2014

Kansas and Vermont’s legislatures have both recently passed bills, which restrict the leeway managed vision care plans have in contracts with optometrists.

Kansas and Vermont’s legislatures have both recently passed bills, which restrict the leeway managed vision care plans have in contracts with optometrists.

Kansas Governor Sam Brownback recently signed a bill that created the Vision Services Act, which prohibits certain limitations between insurers and the vision care providers.

According to the Kansas Legislature, the bill “applies to contracts between an insurer, health insurer, or another entity writing vision care insurance or a vision care discount plan and a vision care provider.”

Related: AZ, NE, TN see see legislative changes

The act prohibits any provision that would require a vision care provider to:

• “Provide services or materials to an insured under vision care insurance or a health benefit plan, or to a subscriber of a vision care discount plan at a fee limited or set by the plan unless the services or materials are reimbursed as cover services under the contract.”

• “Participate in a vision care insurance or vision care discount plan as a condition to participate in any other health benefit plan or vision care plan, regardless of whether such plan is a plan of insurance or a vision care discount program which is not an insurance plan.”

The bill states that vision care providers can’t charge more for services or materials that aren’t covered under either vision care insurance or discount plans than the provider’s usual rate for those services and materials. Also, the bill prohibits any entity that offers vision care insurance policies or discount plan contracts from changing the terms, discounts, or rates without the agreement of the vision care provider.

 

Related: Role of optometrists expanded in Alberta, Canada

This month, a bill in Vermont was passed by the state’s legislature that requires vision care insurance to:

• Cover eye care services, whether provided by an optometrist or an ophthalmologist “provided the health care professional is acting within his or her authorized scope of practice and participates in the plan’s network.”

• Provide comparable reimbursement for comparable services.

• Not impose a greater “co-payment, coinsurance, or cost-sharing amount for services when provided by an optometrist than for the same service when provided by an ophthalmologist."

Vermont Governor Peter Shumlin is expected to sign the bill next month.

Next: New York ODs seek expanded scope of practice

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