News from the AOA's Blog

Dr. Carol Lakkis describes the latest research on CLs, especially factors related to contact lens case contamination. 

Following a rare weekend session, the U.S. House approved sweeping health reform legislation (H.R. 3962) late Saturday night by a vote of 220 to 215.

The massive bill included the AOA-backed provisions referenced in Dr. Brooks’ and Dr. Ellis’ update to all AOA members sent last week ( http://www.aoa.org/impactwashingtondc/ ) Including:

- The Ross Access to Care amendment (non-preemption of state provider non-discrimination laws), children’s vision as an essential benefit, the Schakowsky amendment (Medicaid physician status for ODs) and an extension of the Medicare surety bond exemption for eyeglasses.

Thirty-nine Democrats opposed the bill. One Republican voted yes.  Rep. Joseph Cao (R-LA) represents a largely Democratic district, once held by recently convicted Democrat William Jefferson.

The bill would require most individuals to buy health insurance if they don’t get it through their jobs, beginning in 2013. Families with incomes up to 400 percent of the federal poverty level could qualify for financial assistance. Employers with annual payrolls over $500,000 would be required to provide coverage or contribute to a fund for such coverage.

It would also create an “exchange” in each state where individuals and certain small businesses could shop for insurance policies, and it would create a public insurance plan to compete with offerings from private companies. Also…

-Insurance companies could no longer refuse to cover customers with pre-existing medical conditions, impose annual or lifetime benefit limits or cancel a policy when someone files expensive claims.

-The measure also would expand eligibility for Medicaid to individuals and families with incomes up to 150 percent of the poverty level.

-Payments under the Medicare Advantage program would be reduced and the Medicare prescription drug program would be enhanced by phasing out a coverage gap.

-The bill would impose a tax surcharge of 5.4 percent on couples with gross incomes of more than $1 million and individuals with incomes of more than $500,000, and a 2.5 percent excise tax on the sale or lease of medical devices.

The Congressional Budget Office (CBO) estimates that the gross cost of the bill would be almost $1.1 trillion through fiscal 2019, but the net cost, after taxes, fees and penalties are taken into account, would be $894 billion. As a result of tax provisions and spending reductions in the bill, it would actually reduce the deficit by $104 billion, CBO estimates.

Early Saturday morning, Democratic leaders struggled to secure the 218 votes needed for passage. Federal funding of abortion services was a major sticking point. To help clear the way for the bill’s adoption, House leaders agreed to allow Rep. Bart Stupak (D-MI) to offer an amendment to H.R. 3962 that would add, and in the view of some, strengthen, existing prohibitions on federal funding for abortion.

Private insurers selling plans through the new health insurance exchange could not offer policies covering elective abortions to people who receive federal subsidies for their premiums. The so-called “public option” included in the bill would face the same restrictions.

The Stupak amendment was adopted by a vote of 240 to 194. Rep. John Shadegg (R-AZ) voted present. Sixty-four Democrats joined with 176 Republicans in voting for the amendment.

Earlier Saturday, President Obama traveled to Capitol Hill to meet with the House Democratic Caucus. Obama told Democrats: “We have to continue moving forward,” to enact health reform legislation. “Here it is. Here is a moment to make history. That’s why we’re here,” he said.

Republicans offered an alternative health reform plan in the form of a substitute amendment. This substitute would take incremental steps to increase health coverage by limiting medical malpractice lawsuits, expanding the use of tax-sheltered medical savings accounts, and allowing insurance to be sold across state lines.

The CBO calculated that the Republican plan would cost about $61 billion over 10 years and result in coverage for 83 percent of the population. The substitute was defeated by a vote of 258 to 176. Rep. Tim Johnson (R-IL) was the lone Republican to oppose the GOP’s health reform alternative.

Earlier in the day, the House voted 242 to 192 to approve the rule providing the framework for debate of H.R. 3962. Fifteen Democrats voted with all Republicans against the rule. The rule also set up an upcoming debate on a bill (H.R. 3961) to change the way Medicare reimburses physicians.

The bill (H.R. 3961) would block a 21 percent reduction in the Medicare payment rates for physician services scheduled for January 2010 and would restructure the formulas setting payment rates on a long-term basis. The rule for floor debate, which could start the week of Nov. 16, would be closed, meaning no amendments are in order. It also would provide that upon engrossment of the bill, the text of another measure (H.R. 2920), a pay-as-you-go budget rule requiring new mandatory spending or tax cuts to be offset, would be added to it.

The focus now turns exclusively to the Senate, where moderate Democrats, and Republican Senator Olympia Snowe (ME) carry even greater weight to conform a final product to their satisfaction.

Now is the time to do more than ever before in support of AOA-PAC ( http://www.aoa.org/x4827.xml ) and the AOA Federal Keyperson program ( http://www.aoa.org/x4826.xml), and to make a difference at this critical moment.

As always, members with questions or concerns may contact the AOA Washington office directly at 1-800-365-2219 or by email at advocacy@aoa.org.

At the urging of the AOA, the U.S. Centers for Medicare and Medicaid Services (CMS) is now finalizing its plans to more accurately recognize the value of eye care and the practice expenses of ODs as part of a major overhaul of the Medicare physician payment system.  The result will be a $288 million in additional Medicare payments to optometrists between 2010 and 2013 and new recognition for the role of ODs as providers of primary care.   

In 2007, AOA agreed to participate in, design and fund a portion of a survey of physician practice expenses nationwide.  The objective was to be able to provide CMS with the actual data to calculate expenses incurred by ODs serving Medicare beneficiaries and to then allow for a comparison of expense data from the range of other Medicare providers.  With the data from AOA and national medical groups in hand this year, CMS calculated payment changes aimed at correcting inequities in the current system and placing a new focus on the delivery of primary care services.     

More than 100 AOA members – selected at random – completed the detailed survey questions, a very time consuming endeavor.  After the results were submitted, the AOA Washington office’s federal regulatory team and state optometric associations joined together to urge CMS officials to begin using the new data beginning in 2010, which the agency now plans to do through a four-year, phased-in increase in the relative value codes billed by eye doctors.  According to an analysis by the AOA Third Party Center, the Medicare increases could also affect third party payers who rely on the Medicare resource-based relative value scale (RBRVS).

Some medical specialty groups – notably cardiologists and oncologists – face reductions in Medicare payments over the same four-year period.  They’re complaining to CMS and to Congress, and want to overturn the results of the survey.  The AOA is closely monitoring their efforts, and is providing agency officials and key Members of Congress with accurate information in support for the survey and the new payment system.

The Federal Trade Commission (FTC) has announced an additional enforcement delay of the ‘Red Flags’ identity theft rule. At the request of pro-optometry Members of Congress, the agency has extended the enforcement deadline until June 1, 2010. The AOA is now working to advance a measure in Congress that would exempt small business optometry practices from having to comply with the new requirements.

Originally, the Red Flags rule was due to take effect in October 2008. However, objections raised by Rep. Nydia Velazquez (D-NY), the Chair of the Small Business Committee, the AOA and other organizations have resulted in FTC officials announcing four separate delays in their plan to begin enforcement of the rule. 

Under legislation passed in 2003, businesses determined to be “creditors” would be required to implement appropriate programs to prevent and detect identity theft.  The regulation is targeted primarily at banks and other financial institutions which over recent years have reported growing numbers of serious identify theft incidents.

However, the FTC has indicated that health care practices fit within the legislative definition of “creditors” and would be required to comply with the new regulation. While the FTC has not disputed AOA concerns that the new requirement is applied too broadly, the agency has indicated that it does not believe that it has the flexibility to interpret a more narrow definition without a legislative fix from Congress.

On October 18, the U.S. House of Representatives overwhelmingly approved AOA-backed legislation to exempt small business optometry practices with 20 employees or fewer from having to comply with the far-reaching rule. Sponsored by Rep. John Adler (D-NJ), the bill (HR 3763) would provide an exemption for ODs and other health care providers as well as a mechanism for those over the 20-employee threshold. The AOA is now working to advance similar legislation in the U.S. Senate.  

Rep. Adler’s bill would specifically exempt optometry practices with 20 or fewer employees and also provide the FTC with an option of excluding larger health care practices other small businesses if they submit an application which meets the following criteria: the business knows all of its customers or clients individually, only performs services in or around the residences of its customers or has not experienced incidents of identity theft and identity theft is rare for businesses of that type. 

The AOA has also been successful in winning inclusion of favorable report language within the FY 2010 Financial Services and General Government appropriations bill requesting the FTC to further delay implementation of the Red Flags rule as it continues to work with the small business community to minimize the resulting burdens. Since then, the FTC has expressed a desire to delay enforcement to provide Congress with the opportunity to legislatively fix the statute.

HR 3763 will need to be cleared by the U.S. Senate and sent to President Barack Obama’s desk to be signed into law before ODs are released from the requirements of the new regulation. However, the latest enforcement delay provides additional time to press for needed changes and secure a legislative fix.

Identify theft prevention measures that may be appropriate for optometric practices can be found in the Red Flags rule compliance guide, which can be accessed on the AOA Web site at www.aoa.org/FTCRedFlags.xml