Overview of Managed Care Reform in Nevada
AB436, the NOA's Bill, passed during the 2021 Nevada Legislative Session and covered three main provisions:
- An insurer that does not provide reimbursement for specific vision care shall not claim in any advertisement or other material that the insurer covers that vision care if such vision care is available at a discount or with a copayment or coinsurance in an amount that is in addition to the copayment or coinsurance that a covered person is typically required to pay for covered services. Simply stated, vision plans cannot advertise discounts on materials and services for which they offer no funded benefit. (NRS 686A.135)
- An insurer shall disclose in any policy of insurance that covers vision care or any description of benefits by such a policy, whether written or electronic, any ownership or other pecuniary interest of the insurer in a supplier of ophthalmic devices or materials or a provider of vision care. The disclosure must appear conspicuously and clearly. As most of us know, the largest vision plan carriers have financial interests in many of the materials they force providers to sell. (NRS 686A.135)
- Amends NRS686A.160 to read: If the Commissioner has cause to believe that any person has been engaged or is engaging, in this state, in any unfair method of competition or any unfair or deceptive act or practice prohibited by NRS 686A.010 to 686A.310, inclusive and that a proceeding by the Commissioner in respect thereto would be in the interest of the public, the Commissioner may issue and serve upon such person a statement of the charges and a notice of the hearing to be held thereon. This revision places the actions of vision plans under the jurisdiction of the Insurance Commission.
The NOA and AOA have reason to believe that vision plans have failed to abide by AB436 and are determining the following steps to ensure compliance.
In our most recent legislative session (2023), SB134, as signed by Governor Lombardo, amended NRS 686A.135 further so that it now does the following:
An insurer shall not enter into a contract with a provider of vision care that:
- Authorizes the insurer to set or limit the amount that the provider of vision care may charge for vision care that is not reimbursed under the contract.
- Requires the provider of vision care to use a specific laboratory as the manufacturer of ophthalmic devices or materials provided to covered persons.
- Conditions any rate of reimbursement for vision care on the provider of vision care prescribing ophthalmic devices or materials in which the insurer has an ownership or other pecuniary interest or increases the reimbursement rate if the provider of vision care prescribes such ophthalmic devices or materials.
Through these two legislative wins, the NOA preserves the doctor-patient relationship and improves the quality of care Nevadans receive from their optometrists. Other benefits include expanded choice and lower consumer costs.
Spectera, Davis, and other vision plans have revised provider agreements to comply with the law. However, early indications from VSP Vision Care may counter the law. While VSP Vision Care indicates they comply with the new legislation, they have communicated that doctors will be required to "opt-out of providing discounts (on unreimbursed and non-covered services- ed.) … If a provider chooses to opt-out of providing discounts, they must notify VSP in writing." The NOA and AOA can think of no valid reason for this request because SB134 makes such discounts illegal. Through the AOA counsel, we notified Insurance Commissioner Kipper and Attorney General Ford of these concerns and await further comment.
We ask our membership to forward any communication from insurers who are not obeying the law to the NOA to ensure compliance.
As we look into the future, the NOA will continue to work closely with the AOA. Topics such as anti-trust and monopsony concerns with vertically integrated optical organizations further erode the doctor-patient relationship and will be closely monitored.