Optometrists, Students Set to Educate Legislators Feb. 10

By Executive Director Keith Kerns

Legislators are asked on a daily basis to make decisions on health care policy, yet the majority of elected officials know very little about the delivery of health care, optometry or the challenges facing small business optometric practices.  As a result, they rely on experts to educate them so they can ensure that they are making informed decisions on these critical issues.  This week, dozens of optometrists and students at the OSU College of Optometry will be headed to Columbus to provide information to legislators on issues important to the profession as part of Optometry’s Day at the Statehouse.  Attendees will be meeting with elected officials on a number of issues, including the Ohio Vision Services Act (House Bill 275) and a repeal of sales tax on prescriptive eyewear (Senate Bill 216).

Legislators and other policymakers know that they can look to organized optometry for reliable information on vision care because it speaks with a credible, unified voice with nearly 70% of Ohio optometrists as members.  Additionally, the OOA is member-driven.  As the experts in primary vision care, optometrists establish policy positions for the organization and provide legislators with an accurate and trustworthy source of information.

In the past year alone, patients and the profession have benefited from the advocacy efforts of the OOA and its member optometrists.  These victories include:

  • a 7% increase in reimbursement for Medicaid primary vision care codes, the first increase in 15 years.
  • Reauthorization of Medicaid expansion, providing access to vision services to hundreds of thousands of needy Ohioans, and
  • Prevention of a 24% cut in Medicare reimbursements through advocacy on the federal level with the AOA.

Despite these major victories, much work remains.  In these transformative times, optometrists can’t afford to sit on the sidelines and hope that things work out.  More changes are on the horizon and the best way to control the future and protect your profession, your patients and your ability to practice optometry on your own terms is through membership and involvement with the OOA.  Thank you for your membership in organized optometry and please join me in thanking those members of the OOA and students at the OSU College of Optometry who are taking time away from their practices and studies this week to help support and strengthen this great profession.

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Prior Authorization Standards Bill Passes Ohio Senate

By: Executive Director Keith Kerns, Esq.

Ohio’s healthcare providers and patients scored a victory in the Ohio General Assembly this week before the state legislature broke for its holiday break.  Senate Bill 129, a measure supported by the Ohio Optometric Association, Ohio State Medical Association and other provider groups, passed the Ohio Senate by unanimous vote.  If adopted the bill will establish common standards for health care prior authorization requests, including the establishment of time-frames in which third party payers must respond to requests.

Specifically, SB 129 would:

  • Require insurers to accept electronic submissions of prior authorization requests,
  • Require insurers to respond to prior authorization requests within 5 days and within one day for requests of an urgent nature,
  • Create a streamlined appeal process when a prior authorization request is denied.   The appeals process would first allow the provider to appeal to the individual who made the initial determination and then appeal to a panel that includes a clinical peer.  Finally, the provider may seek an external review if necessary.  The bill also creates expedited time frames which must be followed in the appeals process,
  • Require insurers to provide advance notice of any changes to the prior authorization process including providing detailed instructions should new information be required, and
  • Create a process to handle prior authorizations of new medical procedures and for medications for chronic conditions.

SB 129 was introduced by Sen. Randy Gardner (R-Bowling Green) in March.  The OOA testified in support of the bill last month before the Ohio Senate Insurance Committee.  The bill will now move to the House for consideration.  To learn more about OOA legislative priorities, please visit: OOA Advocacy Page