HB1353
To Regulate A Vision Benefit Manager; To Amend The Vision Care Plan Act Of 2015; To Amend The Healthcare Contracting Simplification Act.
AI-Generated Summary
This bill proposes to amend existing Arkansas laws related to vision care benefits and healthcare contracting. It specifically targets the regulation of "vision benefit managers" (VBMs) and revises provisions within the Vision Care Plan Act of 2015 and the Healthcare Contracting Simplification Act. Key amendments include prohibiting certain reductions in benefits due to other insurance coverage unless compliant with coordination of benefit rules. The bill also redefines terms related to vision care, including "covered materials," "covered services," and "vision benefit manager." It introduces several prohibitions on VBMs and other vision plans, such as preventing them from establishing fees for non-covered services, requiring discounts on non-covered services, or using extrapolation in audits. Furthermore, it mandates that reimbursements for covered services and materials not be nominal or less than current Medicare rates. The bill also addresses provider choice of labs and suppliers, and prohibits steering enrollees to specific providers or affiliated establishments. It aims to prevent modifications of contract terms without provider authorization and prohibits certain payment methods like virtual credit cards for reimbursements.
Potential Impact Analysis
Who Might Benefit?
['Vision care providers, such as optometrists and ophthalmologists, are primary beneficiaries as the bill introduces several protections for them. These include limitations on how VBMs can conduct audits, prohibitions on certain discount requirements for non-covered services, and requirements for adequate reimbursement rates. The bill also aims to ensure providers have more autonomy in choosing optical labs and suppliers, and restricts steering patients to specific providers or affiliated entities, potentially leading to increased patient choice and provider flexibility. Enrollees might also benefit from clearer benefit structures and potentially broader provider choices due to the regulations on VBMs and vision plans.']
Who Might Suffer?
['Vision benefit managers (VBMs) and other entities administering vision benefit plans or discount plans are likely to be negatively impacted by this legislation. The bill introduces a significant number of new regulations and prohibitions on their practices, including restrictions on audit methodologies, fee setting for non-covered services, and requirements for minimum reimbursement rates. The inability to use extrapolation in audits and the mandate to provide adequate reimbursement could reduce operational efficiencies and profit margins for VBMs. Furthermore, limitations on steering enrollees and requirements for provider choice could alter their business models and competitive strategies.']