WASHINGTON, D.C.—The U.S. Department of Health and Human Services’ Essential Health Benefits Bulletin of Dec. 16, 2011 proposed to give each state its own say in how it would implement the Patient Protection and Affordable Care Act (see HHS Gives States More Flexibility to Set Essential Health Benefits). However, because the bulletin did not specifically authorize the use of stand-alone vision insurance plans to provide the pediatric vision care required by the law, a number of industry organizations have initiated efforts to encourage each state to allow for this.

For example, the House of Delegates of the California Optometric Association will vote this weekend on a policy resolution that “strongly advocates the inclusion of stand-alone vision plans in the California Health Benefit Exchange.” This provision is sponsored by three Bay Area optometric societies—the Santa Clara County Optometric Society, the San Francisco County Optometric Society and the San Mateo County Optometric Society.

This provision is also supported by the Primary Eyecare Network (PEN), an ECP alliance based in San Ramon, Calif, which sent a letter to its members stating that the majority of PEN members “derive more than 50 percent of their revenues from patients who are seen in their office as a result of a stand-alone vision plan,” and of the “PEN members who are currently seeing members under a health-plan based model, many are limited in their access to patients, are locked out of seeing patients, or are reimbursed poorly.” The letter concludes, “We feel that the inclusion of stand-alone vision plans in the California Health Benefit Exchange will help to maintain the quality of care received by our patients and the health of the independent practitioner’s practice.”

Broader support comes from the National Association of Vision Care Plans (NAVCP), a trade association representing the managed vision care industry, which stated in a press release this week, “The NAVCP firmly supports the inclusion of stand-alone vision plans in insurance exchanges as part of the Affordable Care Act.” In addition to the press release, the NAVCP has also developed an advertising campaign that compares the pros and cons of excluding stand-alone vision plans from insurance exchanges and invites optometrists to sign an online petition that supports the inclusion of stand-alone vision plans. “The fact that stand-alone vision plans have been excluded from the insurance exchanges is an issue that impacts our members and our industry. The ad campaign was launched to raise awareness with doctors about this issue,” Julian Roberts, executive director of the NAVCP told VMail. “We’re trying to get the message out to the provider community to help them make an educated decision.”