News from the AOA's Blog

With the enactment of national health care overhaul legislation in March, the AOA is now closely monitoring the “implementation phase” of the new law which will extend over the next several years.  This week, a Federal agency announced that school-based health centers (SBHCs) have until September to begin applying for new Federal funding which they can use to meet the dramatically expanded operating objectives that have been set for them by Congress and the President.  This is important to Optometry and others in the eye health community because – at the urging of AOA – Congress included a provision in the overhaul bill to include vision health services in the care to be provided to tens of millions of school-aged children by SBHCs.  Given the time frame for funding decisions to be made at the local level, the AOA is providing background information and recommended steps that can be taken today by ODs who want to make vision health services more accessible to school-aged children in their communities.   Click here to learn more about SBHCs and to view a map of SBHCs nationwide.

URGENT OUTREACH OBJECTIVE:  It is recommended that affiliates and AOA members to take action now to maximize opportunities for ODs to further improve the vision health and learning potential for school-aged children in their communities.  These recommended actions, which follow-up on successful AOA advocacy efforts to ensure inclusion of vision health services in school-based health clinics,  are needed to further solidify the role of optometrists as leading community-based resources on eye health and vision care and to help children with undiagnosed and untreated vision problems overcome a broken system that has had no accountability for tracking children into care.  By strengthening contacts with local officials now, ODs can help ensure that SBHCs across the country will be able to offer OD-provided comprehensive eye exams to children who need them.   

 I.                  AOA TELLS CONGRESS AND PRESIDENT:  MAKE VISION A HEALTH CARE PRIORITY

A key objective for President Obama and many in Congress throughout the health care overhaul debate in Washington, D.C. was to expand children’s health care programs.   From the start however, it was not clear that healthy vision would be included in any proposals.   The AOA – which has fought hard to make children’s vision a top health care priority at the national level – successfully pushed for a specific designation of children’s vision as an “essential health benefit” in the final bill approved by Congress and signed by the President in March.  Optometry is now working with the Department of Health and Human Services (HHS) to ensure that this benefit includes a comprehensive eye exam coupled with hardware when needed. Click here to watch a special message from HHS Secretary Sebelius to the AOA House of Delegates and here to view AOA’s policy statement on children’s vision.

Similarly, as a program to authorize hundreds of millions of Federal dollars to support an expansion of SBHCs advanced in 2009, the AOA uncovered that eye health care was not recognized in any way as an accountable  service to be provided through these facilities.  The AOA, with the involvement of affiliate leaders and staff and Federal Keypersons, alerted Senator Chris Dodd (D-CT) and other pro-optometry leaders and developed language to correct this exclusion.  As a result, the last amendment to be added to the health care overhaul bill when it was considered in the U.S. Senate included an AOA-backed provision requiring that school-based health clinics provide vision health services.   

II.               VISION HEALTH IN SCHOOL-BASED HEALTH CENTERS:  CHALLENGES AND OPPORTUNITIES

Although the implementation of the children’s vision benefit will be determined through a defined regulatory process at HHS over the next several months, the battle for ensuring that SBHCs devote appropriate resources to vision care will be shaped through a less defined process well removed from Washington, D.C. and will be entering a key phase very soon.  We want you to be informed about SBHCs and this process so that Optometry will be successful in ensuring that more children than ever before have access to the full range of eye health and vision care services they need.

Today, there are about 1,900 SBHCs across the country providing primary medical care, mental health care, and oral health care screening and treatment; offer physical exams and sports physicals; prescribe and dispense medication; bill public and private insurance for reimbursable services; conduct clinical and lab tests; and treat chronic illnesses.  Click here to learn more and view a map of SBHCs nationwide.  AOA’s view is that all SBHCs (current and future) should offer comprehensive vision and eye health care services.  However, we know very well that other groups that talk about children’s vision have a far different agenda.  Although the last minute AOA-backed legislative change to the health care overhaul bill makes eye exams in SBHCs a possibility, it does not make it a sure thing.  That’s why Optometry must now take this fight for healthy vision to local schools districts across the country.   

The new health care law sets aside $200 million in competitive Federal funds over the next four years for SBHC expansion (including for vision health, thanks to AOA’s successful advocacy), which are limited to facilities expenditures – such as the acquisition or improvement of land, construction costs, equipment, and similar expenditures.  Some guidance for the first round of funding has been issued by HHS and more specifics are being developed.   However, it is likely that as much as $50-$100 million in equipment and facilities grants will be awarded to SBHCs across the country in 2010.   HHS will then issue guidance for the next round of funding which is to be used for facility expansion.  A third and final round will be used to again provide grants allowing the purchase of new or upgraded equipment.  Key decisions as to how the funds will be spent to expand SBHC capacity will be made by school officials on a school-by-school basis. The FY 2010 School-Based Health Center Capital Program funding opportunity is for movable equipment only. This includes medical equipment and equipment to support an electronic health record system (i.e., hardware, servers, licenses). Subsequent funding opportunities will address capital expenditures, such as construction, alteration, and renovation projects. The deadline for SBHCs to apply for this first round of funding will be set for later this year.

AOA has taken steps to become the leading resource for the national organization representing SBHCs – the National Assembly on School-Based Health Care (NASBHC) (click here to visit the NASBC web site) as part of our aggressive nationwide advocacy for on-site comprehensive vision and eye health care wherever that can happen.  NASBHC has already placed on its website information provided by AOA on healthy vision and the new statutory recognition of vision health as an SBHC service (click here to view AOA-NASBHC collaborative efforts).  At the same time, in communities where healthy vision has not been made a priority, Optometry’s efforts are needed to help ensure that local SBHCs begin to do more to protect and enhance children’s vision and eye health.  For those SBHCs that do not yet fully share AOA’s goal of providing direct access to comprehensive vision and eye health care and only plan to provide vision screening services at this time, much can be done to offer the technical assistance needed to put in place appropriate and evidence-based screening methodologies coupled with the very highest sensitivity equipment (to be used by trained personnel) with the assurance of tracking children who fail into care. Additionally, school health officials need to know that children who are symptomatic are NOT candidates for screening as they should be referred and tracked directly into care through assurances of a comprehensive eye examination. 

III.              THREE STEPS TO TAKE TO EXPAND VISION HEALTH CARE IN YOUR LOCAL SCHOOL-BASED HEALTH CENTER

With new funding available for SBHCs and vision health now included in the law as priority, optometrists must  make educating their local SBHC about the need for on-site provision of comprehensive eye health services or, at the very least, a significant upgrade of their vision health capability a top priority.  It is essential for ODs to build links to SBHCS, and AOA urges every doctor to review this information and take these three steps: 

1.  Review the children’s vision data in your state or region and the important vision health information provided by AOA to the National Assembly of School-Based Health Care (NASBHC) – which can be found  here, as well as information about SBHCs and their locations –which can be found  here.  

2.    Call your local school system to identify if there is a SBHC in your area.  If there is, please contact the director of the facility and seek an opportunity to speak with them about the opportunity they now have to secure funding top help provide vision health services.  

       3.  Contact the AOA Washington Office to report on your discussion and help us track successful outreach and areas where follow-up efforts are needed.   The point of contact is Michael R. Duenas, O.D., Associate Director Health Sciences and Policy:  MRDuenas@AOA.ORG / 1-800-365-2219 X 1008.