The US Department of Health and Human Service (HHS) announced on February 20 its final rule on essential health benefits covered under the Affordable Care Act. The good news for children, parents and eye doctors: The pediatric vision essential health benefit is going to include an annual comprehensive eye exam and treatment, including medical eye care and materials.
Prepare for an influx of newly insured pediatric patients, starting in January 2014. Just don’t schedule them all at the same time.
In addition, all new small group and individual health plans must offer pediatric eye health care as a distinct benefit from well child care. And, according to the AOA, all such plans must recognize optometrists as medical eye care providers.
“Millions of children [through age 18] will gain health insurance coverage … that includes direct access to their local optometrist for a comprehensive eye exam and treatment, including medical eye care,” the AOA stated.
Opponents of this measure—including the American Academy of Ophthalmology, America’s Health Insurance Plans, Blue Cross and Blue Shield Association and others—pushed for HHS to require that children should have to fail a vision screening before getting necessary eye care. “Instead, all optometrists should prepare for an influx of newly insured patients starting January 1, 2014,” the AOA said.
“After nearly a decade of determined advocacy by countless AOA members and staff, federal policymakers officially recognized what America’s doctors of optometry and our patients have known all along: that early and periodic comprehensive eye exams and follow-up care are ‘essential’ to better ensuring the overall health, development, and academic success of our nation’s children” said AOA President Ron Hopping, OD, MPH.