Proposal Meets Minimum Insurance Coverage Mandate Set in Health-Care Law
WASHINGTON, D.C. AND SAN FRANCISCO – A coalition of medical doctors is recommending regular eye screenings for children and young adults as an evidence-based, cost-effective plan for providing vision benefits mandated by the Affordable Care Act. The American Academy of Ophthalmology, along with the American Academy of Pediatrics and the American Association for Pediatric Ophthalmology and Strabismus, outlines specific eye-related services in Children and Vision Care, presented to the Department of Health and Human Services (HHS). The agency is in the process of defining an essential health-benefits package – including pediatric vision care – that must be included in qualified health plans available through state insurance plan exchanges, called for in the Affordable Care Act.
Adopting the recommendation of the medical associations provides a strategic means to significantly and positively impact the lives of children. The associations recommend essential vision benefits:
- Begin with regular eye screenings in the doctor's office, the community and the schools.
- Cover a comprehensive eye exam – including refraction – for children or adolescents who fail a screening, have an unfavorable risk assessment, report a visual problem, or who cannot complete a screening due to such factors as a developmental delay.
- Include glasses, contact lenses, or low vision aids, determined to be necessary by a licensed ophthalmologist or optometrist.
Instituting regular screenings for all children provides multiple opportunities throughout a child's preschool and school-age years to effectively identify disease or detect problems. This is a national health goal under Healthy People 2020, the science-based, 10-year national objective for improving the health of all Americans.
"Congress' mandate to include children's vision in the health care reform law greatly expands the potential for identifying eye-related issues in children and adolescents from birth to 21-years old," said Michael X. Repka, MD, medical director for governmental affairs for the American Academy of Ophthalmology. "States consistently have recognized that screenings are the most effective, practical method for identifying children with eye problems, and it is logical that the federal government be consistent in establishing pediatric vision-care benefits."
The joint medicine recommendation differs from a more complex and expensive proposal by optometrists and eye-glass frame manufacturers, which calls for annual comprehensive eye exams as the identification mechanism. Medicine's recommendation is consistent with Bright Futures guidelines developed by the HHS Health Resources and Services Administration and the American Academy of Pediatrics that has wide support among children advocates; guidelines of the United States Preventative Services Task Force, an independent panel of non-federal experts in prevention and evidence-based medicine; and Medicaid Early Periodic Screening, Diagnosis and Treatment guidelines used by the Centers for Medicare and Medicaid Services and the states.
HHS likely will release its determination of essential health benefits – including children's vision – this fall. Health plans participating in the state insurance exchanges will be required to include these benefits beginning on Jan. 1, 2014.
Note to media: Full text of Children and Vision Care is available from the Academy's media relations department.
About the American Academy of Ophthalmology
The American Academy of Ophthalmology is the world's largest association of eye physicians and surgeons—Eye M.D.s—with more than 30,000 members worldwide. Eye health care is provided by the three "O's" – ophthalmologists, optometrists and opticians. It is the ophthalmologist, or Eye M.D., who can treat it all: eye diseases and injuries, and perform eye surgery. To find an Eye M.D. in your area, visit the Academy's Web site at www.aao.org. The Academy's EyeSmart® public education program works to educate the public about the importance of eye health and to empower people to preserve their healthy vision, by providing the most trusted and medically accurate information about eye diseases, conditions and injuries. Visit www.geteyesmart.org to learn more.