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2015 SESSION

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HB 1444 Vision care plans; reimbursement for services.

Introduced by: R. Lee Ware | all patrons    ...    notes | add to my profiles

SUMMARY AS ENACTED WITH GOVERNOR'S RECOMMENDATION: (all summaries)

Vision care plans; reimbursement for services. Prohibits a participating provider agreement between a vision care plan carrier and an optometrist or ophthalmologist that is entered into, amended, extended or renewed on or after January 1, 2016, from establishing the fee or rate that the optometrist or ophthalmologist is required to accept for the provision of health care materials or services, or from requiring that an optometrist or ophthalmologist accept the reimbursement paid by the vision care plan carrier as payment in full, unless the services or materials are covered services or covered materials under the applicable vision care plan. Reimbursements by a vision care plan carrier are required to be reasonable, which is defined as the negotiated fee or rate that is set forth in the participating provider agreement and is acceptable to the provider. Vision care plans shall not require an optometrist or ophthalmologist to use a particular optical laboratory, manufacturer of eyeglass frames or contact lenses, or third-party supplier as a condition of participation in a vision care plan. Changes to a participating provider agreement shall be submitted in writing to the optometrist or ophthalmologist at least 30 days prior to their effective date. Provisions of this measure that relate to covered materials also apply to licensed opticians practicing in the Commonwealth. The State Corporation Commission does not have jurisdiction to adjudicate individual controversies arising out of this measure. The bill has a delayed effective date of January 1, 2016.


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