Louisiana unanimously approves comprehensive VBM regulations - American Optometric Association (AOA)

[ODwire.org NewsBot]

Louisiana unanimously approves comprehensive VBM regulations American Optometric Association (AOA)

Continue reading...


From the story:

New law regulates VBM reimbursements and contracting, promotes transparency and oversight​

• Fair reimbursements: Fee schedules must be transparent and at least equal to the current Medicare or Medicaid rates. If not listed, compensation must be reasonable.
• Contracting: VBMs must provide all contract details, procedures and fee schedules to providers prior to contracting and after contracting through electronic means. The law provides specific contracting timelines and allows providers to appeal if the provider is not credentialed.
• Multiple plans: VBMs that offer multiple health, vision or vision discount plans cannot require a provider to participate in more than one plan as a condition of participating in a single plan.
• Noncovered services: VBMs cannot require providers to give discounts on noncovered services and materials.
• Audit protections: VBMs are prohibited from using “extrapolation” audits of participating providers. Any additional payments due must be based on actual overpayments or underpayments.
• Reimbursement consistency: VBMs are prohibited from reimbursing at a different amount based on providers’ choice of optical lab, health record software, or equipment.
• Choice of reimbursement method: VBMs cannot require providers to accept forms of payment in which a processing fee is assessed to get reimbursed.
• Transparent provider and service listings: VBMs are prohibited from misleading enrollees about what services are fully covered. They are also prevented from “steering” enrollees to particular providers, retail establishments, or internet or virtual providers affiliated with the VBM.
• Withholding reimbursement: VBMs are prohibited from withholding current or future reimbursement if, at the time the service or material was provided, the provider used the VBMs’ process to verify the patient’s coverage credentials.
• Increased oversight: The law expands the regulatory authority of Louisiana’s Department of Insurance by adding VBMs to the definition of a health benefit plan.

This is a great step...I wonder if other states will follow...
—Gretchyn

 

[Stephen McDaniel]

Louisiana unanimously approves comprehensive VBM regulations American Optometric Association (AOA)

Continue reading...


From the story:

New law regulates VBM reimbursements and contracting, promotes transparency and oversight​

• Fair reimbursements: Fee schedules must be transparent and at least equal to the current Medicare or Medicaid rates. If not listed, compensation must be reasonable.
• Contracting: VBMs must provide all contract details, procedures and fee schedules to providers prior to contracting and after contracting through electronic means. The law provides specific contracting timelines and allows providers to appeal if the provider is not credentialed.
• Multiple plans: VBMs that offer multiple health, vision or vision discount plans cannot require a provider to participate in more than one plan as a condition of participating in a single plan.
• Noncovered services: VBMs cannot require providers to give discounts on noncovered services and materials.
• Audit protections: VBMs are prohibited from using “extrapolation” audits of participating providers. Any additional payments due must be based on actual overpayments or underpayments.
• Reimbursement consistency: VBMs are prohibited from reimbursing at a different amount based on providers’ choice of optical lab, health record software, or equipment.
• Choice of reimbursement method: VBMs cannot require providers to accept forms of payment in which a processing fee is assessed to get reimbursed.
• Transparent provider and service listings: VBMs are prohibited from misleading enrollees about what services are fully covered. They are also prevented from “steering” enrollees to particular providers, retail establishments, or internet or virtual providers affiliated with the VBM.
• Withholding reimbursement: VBMs are prohibited from withholding current or future reimbursement if, at the time the service or material was provided, the provider used the VBMs’ process to verify the patient’s coverage credentials.
• Increased oversight: The law expands the regulatory authority of Louisiana’s Department of Insurance by adding VBMs to the definition of a health benefit plan.

This is a great step...I wonder if other states will follow...
—Gretchyn

They tried something similiar in Texas but was removed after appeal I believe.

 

[Michael I. Davis]

That’s very nice. Let’s revisit this next quarter and see what loopholes the VBM found. First will be that it does not apply to current contracts I bet

 

[Mike Ware OD]

Does anyone know if the states that have passed similar laws are actually getting paid Medicare rates by vision plans? I know Arkansas passed a similar law but have not heard how it is going there.

 

[Mike Alvarez]

That’s very nice. Let’s revisit this next quarter and see what loopholes the VBM found. First will be that it does not apply to current contracts I bet

Yes, that was a giant loophole in the Texas law. These laws need to take effect immediately.

 

[Dr Mark Cohen]

Yes, that was a giant loophole in the Texas law. These laws need to take effect immediately.

 

[Dr Mark Cohen]

We’ll only be able to bill exams as “S” codes and we’ll get whatever is considered “reasonable compensation” by the VCP.

 

[Mike Alvarez]

This might be a model law to try to pass in every state. They even closed the Texas loophole. It takes effect upon:

• Renewal of the patient’s current benefit plan or issuance of a new plan.
• A new provider contract or any modification of an existing provider contract.
• January 1, 2027, regardless.

 

[Bill Keating]

Does anyone know if the states that have passed similar laws are actually getting paid Medicare rates by vision plans? I know Arkansas passed a similar law but have not heard how it is going there.

Spectera is the only one for me so far.
However,
"On Friday, August 28, the ArOA became aware of communications from Vision Service Plan (VSP) to Arkansas providers announcing reimbursement changes that VSP states are being made “in compliance with Arkansas Act 142,” effective August 31, 2026."
It's unclear which providers will be affected.

 

[Stephen McDaniel]

All of Texas surrounding states: Arkansas, Louisiana, Oklahoma and New Mexico have better laws than Texas.

 

[Jonathan Warner]

You can count on EyeMed fighting this.

 

[Bill Keating]

You can count on EyeMed fighting this.

They have already said it doesn't apply to them.

 

[Jonathan Warner]

They have already said it doesn't apply to them.

The law doesn't apply to them????