8 Ways the ACA Could Affect Your Ophthalmology Practice

Leigh Page


September 11, 2013

In This Article

More Pediatric Patients

6. Pediatric vision exams become a mandated reimbursement

As part of the ACA, reimbursement for comprehensive eye exams for children will be required for all insurance plans covering individuals and small groups as of January 1, 2014. This new coverage mandate is expected to increase patient traffic for pediatric ophthalmologists, according to Michael Repka, MD, a pediatric ophthalmologist and Medical Director for Governmental Affairs at the AAO.

The comprehensive exam, along with the provision of eyeglasses and other devices, is part of a wide-ranging package of "essential health benefits" mandated by the ACA. Dr. Repka said that reimbursement levels for the exam have not been announced yet. The requirement involves plans both inside and outside the new health insurance exchanges, but not plans for companies with 50 or more insured employees.

Dr. Repka warned, however, that the newly covered exam might be overused and increase healthcare costs. He said that the exam should be limited to "children who have symptoms or a visual impairment, suggesting they need to be examined," rather than for all children every year, as the mandate allows. Federal authorities, he said, might reexamine the mandate in a few years and see if it should be more limited, but he would oppose a change that impedes clinically necessary use of the exam.


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