Pediatric Eye Care Essential Health Benefit Has Now Been Officially Realized

After initial federal government recognition and support, the Pediatric Eye Care Essential Benefit has now been officially finalized by the US Department of Health and Human Service, marking the end of years and years of hard fought advocacy and the beginning of comprehensive eye exams and related medical services for millions of children across the country! Thanks to the dedication and persistence of optometrists, students, the AOA, supporting government officials and many more, the Pediatric Eye Care Essential Benefit is now a true and clear reality. This is yet another fantastic example of the strength of all those who work together within our profession to create positive change for the better of patient care everywhere. – Ben Emer; Director of Organized Optometry at


The section below is an excerpt from the AOA First Look Newsletter

Optometry’s Decade-long Advocacy Effort to Make Healthy Vision for America’s Children a National Priority is Realized with an Historic Regulatory Policy Win

The U.S. Department of Health and Human Service (HHS) announced final regulations Wednesday, February 20, 2013 that require the pediatric vision essential health benefit to be a yearly eye exam with materials for millions of children in this country. This action again rejects the concerted effort by the American Academy of Ophthalmology (AAO) and groups representing health insurers and business interests who continue to lobby the agency hard to reverse course on its pediatric vision care EHB proposal by erecting a new barrier between kids and the eye and vision care they need.

AOA successfully fought to make healthy vision a top national health care priority. The AAO’s anti-access coalition pushed for pediatric vision care restrictions that would stand directly in the way of what the AOA, Congress, and HHS know the benefit needs to be for America’s families. This final decision will help children access necessary the necessary vision care that will contribute to their healthy development. The following is an overview of the final rules published by HHS and its expected impact on optometry:

  • Millions of children will gain health insurance coverage through age 18 that includes direct access to their local optometrist for a comprehensive eye exam and treatment, including medical eye care.
  • Pediatric eye health care is confirmed as an “Essential Health Benefit,” and must be offered by all new small group and individual health plans as a distinct benefit from well child care.
  • Pediatric eye health care is defined as an annual comprehensive eye exam and treatment, including medical eye care.
  • All new small group and individual health plans – both inside and outside of state exchanges – are required to provide fully integrated coverage for pediatric eye health care and must recognize optometrists as providers of medical eye care.
  • While adult eye care cannot be an essential benefit, health plans are free to add the benefit if they choose to or if required by a state insurance marketplace (or exchange).

Once again the Obama Administration agreed with the AOA’s longstanding position on healthy vision for America’s children and rejected lobbying by ophthalmology and their partners consisting of the Blue Cross and Blue Shield Association, America’s Health Insurance Plans, the National Association of Manufacturers and others pushed for the agency to reduce access to essential benefits, including eye care, by calling on HHS to require all children should have to fail a vision screening before getting necessary eye care. Instead, all optometrists should prepare for an influx of newly insured patients starting January 1, 2014.

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