Scope of practice – PASSED! COA’s scope of practice legislation, AB 407, has passed. TPA certified OD’s can now prescribe any medication to treat conditions of the anterior segment (with some limitations and exclusions) instead of following a list of “allowed” drugs. OD’s can also use intense pulsed light (IPL) and low-level light therapy. There are also new rules for optometric assistants, including a prohibition of subjective refraction being done by assistants via telemedicine. A summary of the bill is available here. This bill will take effect 1/1/2022.
Provisional license – PASSED! Optometry school graduates can temporarily practice optometry under supervision if they are unable to take Part III of the NBEO because of COVID-19. Effective immediately!
COVID-19 immunizations and testing – PASSED! AB 691 authorizes optometrists to administer COVID-19 vaccines permanently and perform CLIA waived COVID-19 testing. Effective immediately!
State Board of Optometry sunset review – COA protected language in AB 1534, the board’s sunset bill, that requires physicians to be subject to the protections in B&P Code 655 (prohibiting interference in professional judgement). This is intended to make all companies follow the same rules and not allow corporations to use a physician group to get around the law. The lobbyists for some retail chains fought hard to oppose this provision. This bill also significantly increases fines for large companies that continue to break the law. Thank you Assembly Member Evan Low!
PIA update - COA has been working to address long turn-around times for eyeglasses under the Medi-Cal program caused by the pandemic. The governor’s office claims that the PIA is outsourcing the eyeglasses and that wait times have been reduced dramatically. If you are still experiencing long turn-around times, please Kristine Shultz at firstname.lastname@example.org or (916) 752-1671.
New federal vaccine mandate - President Joe Biden ordered all federal workers and contractors, as well as health workers in facilities that receive federal payments from Medicare and Medicaid, to get vaccinated. This is a hard mandate with no option for being regularly tested as an alternative. The Department of Labor and OSHA are expected to issue a rule "in the coming weeks" that will lay out the exact timeframe for the new requirements. Those who do not comply with the OSHA standard could face fines up to $14,000 per violation. More to come!
COVID-19 related requirements for optometry offices
- PPE – The new CDC mask guidelines and the CA Department of Public Health states everyone in a healthcare setting must wear masks (even fully vaccinated). The State of California is providing a one-month supply of N95 respirators to businesses for unvaccinated employees who need to continue wearing a mask while at work. Please contact one of these distribution partners for more information.
- Workplace safety – Employers must establish, implement, and maintain an effective written COVID-19 Prevention Program. Employers must also provide specified training and information to employees regarding COVID-19. Click here for more information.
- Required office posting – Make sure you have this required sign posted in your office (signs in other languages available).
- COVID positive reporting requirements – There are several reporting requirements California employers must follow:
- California employers must report to Cal/OSHA any serious illness, serious injury or death of an employee occurring at work within eight hours. Serious illness occurs if a worker becomes ill while at work and is admitted as in-patient at a hospital.
- State law requires that when an employer knows or reasonably should know that an employee has tested positive for COVID-19, the employer must report certain information to its claims administrator within three business days.
- State law requires employers to notify all employees of a positive case within one business day of learning of a positive case in the workplace. This report must include COVID-19-related benefits and protections, and disinfection and safety measures that will be taken at the worksite in response to the potential exposure. This law also requires employers to notify local public health agencies of any outbreaks, which are defined as three or more cases in different households within a two-week period.
- Sick leave rules
- Small businesses – Employers are required to provide paid sick leave to workers in California under the Healthy Workplace Healthy Family Act of 2014. Covered employees must accrue at least one hour of sick leave for every 30 hours worked. Small and midsize employers can claim refundable tax credits for leave granted between April 1, 2021, through September 30, 2021 that reimburses them for the cost of providing paid sick and family leave to their employees due to COVID-19. Certain municipalities also have paid sick leave laws. In this case, the employer must provide the leave amount that is most generous to the worker.
- Large businesses – SB 95 states employers with 26 or more employees must provide two weeks of COVID-related paid sick leave.
MEMBER BENEFIT! As a COA member, you are entitled to 30 minutes of free legal advice from COA’s attorney, Wilke Fleury. Call them at (916) 441-2430 and give them your COA member number.
New E-Prescribing Law - Beginning Jan. 1, 2022, optometrists and other prescribers in California must issue electronic-data prescriptions for both controlled and noncontrolled substances. COA successfully advocated for the exclusion of eyeglass and contact lens prescriptions from AB 2789, which mandates the electronic prescribing. More details about the electronic prescribing requirement and exceptions to the state mandate can be found in our COA Resource Guide.
COA children’s vision directory - MEMBER BENEFIT! COA is creating a directory of COA member optometrists who provide vision care to children. This list will be available to parents and other health care providers. If you would like to be included, please complete the questionnaire.
- Immunization scope expansion - Optometrists and students cleared to administer COVID vaccines by the federal government. The U.S. Department of Health & Human Services will launch a new website to help individuals determine whether they are eligible to sign up to volunteer to administer shots. The Biden administration also increased how much Medicare will pay for administering a COVID-19 vaccine to $40 for each dose. For more information on vaccine administration, visit COA’s COVID webpage. Also, COA has sponsored AB 691 by Assemblymember Ed Chau. This bill would authorize an optometrist to administer COVID-19 vaccines and to perform COVID-19 point-of-care testing. This bill is needed to make the new emergency vaccine authority permanent. Click here to send a letter to your lawmakers in support of this bill.
- Provisional license – Senator Scott Wilk has introduced SB 509 that would create a provisional license that would allow optometry graduates that are unable to take the national board (NBEO) test to practice temporarily under the supervision of another optometrist. The bill is intended to help optometry students who cannot travel because of COVID-19. Keep this in mind if looking for an associate. Click here to send a letter to your lawmakers in support of this bill.
- Scope of practice – COA also has sponsored AB 407 by Assembly Members Rudy Salas and Evan Low. The current version of the bill allows optometrists to prescribe a new drug to treat acquired blepharoptosis. A new ophthalmic solution of oxymetazoline hydrochloride (Upneeq) has been FDA indicated to treat this condition that previously only could be treated with surgery. Click here to send a letter to your lawmakers in support of this bill.
- COVID-19 loan tax deductibility – COA is in support of AB 80 and AB 281 by Assemblymember Burke. These bills would make Paycheck Protection Program (PPP) funds tax deductible. There was a deal announced last month to make up to $150,000 of a PPP loan deductible in California but COA is advocating that the entire PPP loan be deductible. COA is also supporting AB 994 by Assembly Member Jim Patterson to make California’s Small Business COVID-19 Relief Grant tax deductible.
- PPE reimbursement and deductions
- Medi-Cal reimbursement - COA is in support of SB 242 by Senator Josh Newman. This bill would require Medi-Cal plans to reimburse providers for business expenses that are medically necessary to comply with a public health order.
- PPE deductibility – COA is in support of AB 62 by Assembly Member Adam Gray. This bill would allow small businesses to deduct the costs to comply with the regulations adopted by OSHA related to COVID-19 prevention.
- Sick leave – On Friday, Governor Newsom signed AB 84 and SB 95 requiring businesses with more than 25 employees to give workers up to two weeks of paid sick leave. Click here for more information.
- CL Compliance Rule in effect - you MUST do the following:
- Provide a copy of the CLRx to the patient at the end of the visit.
- Have the patient sign a form acknowledging receipt of a copy of CLRx and maintain it for 3 years.
- Respond within 40 business hours to a request for a copy of a CLRx.
- Display the CA required poster in your office (can get on COA website)
- Healthcare consolidation – AB 1132 by Assembly Member Jim Wood has been introduced to address health care consolidation. The bill has three main parts. It would require California Attorney General approval for private practice sales over $3 million. The bill also would require a health plan to get approval from regulators before they acquire or obtain control of a health plan, hospital, health system, provider, or other entity. Lastly, the bill would prohibit certain contracting practices that impede competition and raise prices. COA is seeking amendments to exempt the sale of optometry practices from this bill.
- Utilization review – The California Medical Association has sponsored SB 250 by Senator Richard Pan. The bill would reform the prior authorization and billing processes by relieving health care providers from repetitively submitting prior authorizations for a set period of time, with a review at the end of that period to determine if that provider may continue to be exempt from prior authorization requirements. The bill would also require payors to collect enrollee cost-sharing amounts directly from the patient and not require the providers to collect the money. COA is in support of this bill now that it was amended to apply to all health care providers and not just physicians.
- COVID-19 Liability – COA is in support of AB 1313 by Assembly Member Frank Bigelow. This bill would exempt a business from liability due on a claim that a person contracted COVID-19 at the business, if that business has substantially complied with all protocols.
- FTC CL paperwork mandate (S. 3559/H.R. 6365) - AOA and COA still fighting. Currently will go into effect on Oct. 16, 2020. Here is a link to the AOA compliance kit.
- Senate Bill 977 by Senator Monning - COA WIN! The bill would require the attorney general (AG) to review and approve the acquisition of health care providers or hospitals by a health care system, private equity group, or hedge fund. COA’s concern was technical in nature, but could have proved costly to optometrists who are planning to sell their practice. Thanks to COA’s efforts, optometrists who planned to fund their retirement from their practice sale will not be subject to a costly, bureaucratic process.
- Student license waiver – COA has been seeking a temporary waiver for 2020 graduates to enable them to practice without having to travel across country during a pandemic to take the clinical skills part of the NBEO.
- Independent contracting – COA WIN! After months of advocacy, AB 2257 (Gonzalez) was amended last week to make it easier for health care providers that form a separate business to independently contract under some circumstances. If this bill passes, COA will provide more detailed legal guidance to our membership on what they need to do to qualify as an independent contractor.
- Scope of practice - AB 1467 (Salas and Low) will not be heard this year. However, negotiations with ophthalmology continue. We are seeking language to expand the services optometrists provide and conditions that optometrists can treat, including COVID-19 testing by optometrists.
- Mobile clinics – COA WIN! AB 896 (Low) would allow Vision to Learn and other nonprofits to operate a mobile optometry clinic. COA has amended the bill to make sure for-profit groups cannot operate mobile clinics in California and that COA’s volunteer work would not be impacted.
- New rules for offering credit to your patients take effect July 1 - Last year, COA fought to maintain the ability of health care providers to offer CareCredit or other loans with deferred interest to patients. The resulting compromise requires providers who offer this credit to follow new rules and make specified disclosures to your patients starting July 1, 2020. Click here for more information.
- PPE mandates – SB 275 (Pan & Leyva) would require an employer of a health care provider to build a stockpile of personal protective equipment for employees. COA recognizes the importance of having sufficient PPE during a public health emergency, however, we share the concerns of other health care providers that some of the proposed timeframes are impractical.
- Unhappy about the new VSP changes? Email AOATPC@aoa.org to voice concerns.
06/09/20 Virtual Legislative Day - first virtual Legislative Day happened June 1st. SJOS is scheduling constituent meetings with our legislators Flora, Eggman, Grey, Caballero, and Galgiani. Topics will be scope expansion, medi-cal optometry coverage, and independent contracting.
06/09/20 CE Waiver - COA successfully advocated for a waiver of the CE requirement. If your license expires between March 31 and June 30, CE requirements are waived till Oct 1, unless further extended.
06/09/20 Interactive online CE to count as in-person - Interactive courses offered live over internet platforms will count towards the 30 hours required of live continuing education course credits.
06/09/20 Medicare telehealth expansion - The AOA successfully advocated to ensure optometrists are included in the temporarily telehealth expansion for Medicare beneficiaries. As a result of these actions, patients can be at home, doctors can waive coinsurance or deductible, non-public facing platforms like Skype, FaceTime, and Zoom are allowed, and phone appointments are reimbursable for new and existing patients.
06/09/20 Telehealth payment parity - COA advocated for early enactment of a law passed last year to mandate telehealth payment parity. The new law requires health plans to pay for telehealth services and plans must reimburse at the same rate as in-person services. Also, COA secured an interpretation on the record so that this new law can not be used to mandate payment for online vision testing.
06/09/20 We have AOA to thank for optometrists inclusion as physician status in CARES Act. PPP relief and US Department of Health and Human Services (HHS) grants thanks to AOA efforts.
06/09/20 Continued advocacy for telehealth services. AOA got us physician status in telehealth legislation. COA has made EyecareLive their recommendation for telehealth giving members 1 month free and a reduced monthly rate afterwards.
06/09/20 PPP Flexibility Act: HR 7010 extends covered period for loan forgiveness from 8-weeks to 24-week. Also change to 60/40 payroll/non-payroll split (from 75%). Extended repayment term of 5 years instead of 2 at 1% interest. 10 month deadline to submit forgiveness application. Deferral until lender receives forgiveness amount from SBA. Delay in payment of payroll taxes.
06/09/20 VSP changes
- Free to use any lab now for VSP Choice and Advantage plans.
- New guaranteed member pricing for VSP Choice plan lens enhancements starting 9/1/2020.
- New preferred and non-preferred categories for lens designs and enhancements with lower doctor service fees for products deemed non-preferred.
For more information email email@example.com
5/4/2020 COA advocacy currently focusing on:
- Online CE: pushing for Gov. Newson to grant extensions to complete CE and allow all hours though online CE. Currently, any live online CE that isn’t a recording will qualify as CE.
- Pushing for inclusion for small business relief. AOA has already had success with including optometrists in CARES Act. Currently working on changing AB 5 regarding independent contractors and loosening language so associate doctors can be classified as independent contractors.
- Continued advocacy for telehealth services. COA has made EyecareLive their recommendation for telehealth giving members 1 month free and a reduced monthly rate afterwards.
3/23/20 Inclusion of OD’s in the COVID-19 Relief Package
With leading U.S. senators now deciding which provisions will ultimately make it into the COVID-19 emergency relief package Congress is scheduled to vote on later today, the AOA is urging all doctors and students to call their senators this morning to demand that Congress provide immediate and desperately needed relief for struggling doctors of optometry and other frontline physicians across the nation.
To take action today, doctors and students should call the Capitol Hill switchboard at 202-224-3121, ask to be connected with the offices of your U.S. senators, and urge that your senators:
1) co-sponsor S. 3559 and
2) tell Senate leadership that they support inclusion of S. 3559 within the COVID-19 relief package Congress is now considering.
Please include relevant information about the challenges your office is facing under these crisis conditions and about the increasingly vital health care role doctors of optometry play. Suggested telephone message for doctors and students to use to call their senator(s):
- Thank you for taking my call. I appreciate your service to the public at this difficult time and all that you and the Senator are doing to support our state during this national emergency.
- I am a Doctor of Optometry practicing in ___________________________. I deliver essential, primary eye health and vision care to working men and women, school-aged children and seniors, and my practice employs ____________.
- Right now, our health care practices are getting hit doubly hard during this current crisis as they continue struggling to keep up with patient care needs and the demands of keeping our offices running and workers employed. More and more are closing by the day, likely for good.
- Please let the Senator know that I called to ask for him/her to co-sponsor S. 3559 and support inclusion of S. 3559 in the COVID-19 relief package now being considered. This will help doctors of optometry like me and other physicians now struggling to stay on the health care frontlines caring for our neighbors and keeping them healthy and employed.
- Thank you.
After taking action, doctors and students should contact AOA Advocacy staffer Matt Willette (MWillette@aoa.org) with any important outreach updates and/or needed follow-up with lawmaker offices.
You can also email ASAP using these links below.
03/23/20 - Routine eye exams should be stopped due to stay at home order from our governor.
03/23/20 URGENT NON-ROUTINE CARE
- Red eyes
- New flashes/floaters
- New onset double vision
- Foreign Body
- Ongoing neuro rehab therapy
- Ocular trauma/injury
- Sudden loss of vision
- pre-post Ops
- TBI therapy
03/23/20- All membership dues waived until June 1st. Join now to take advantage of the free 1 hour legal advice and emergen-CE. Lots of resources for COA members on their website for practice owners and associate doctors.
Check out coavision.org for more information.
FDA orders “Visibly” (formerly Opternative) to shut down online vision screening! 9/18/19
Medi-cal adult eyeglasses reinstated - Medi-cal coverage for adult eyeglasses are back effective 1/1/2020. The restoration includes services previously offered in 2009 including eyeglasses, low vision devices, and medically necessary CL’s. 9/18/19
Dental and Optometric Care Access Act (DOC Access Act) - HR 3762 disallows detrimental policies by ELISA such as limits on a doctor’s choice of lab and mandates on noncovered service materials. 9/18/19
In-home Care - AB 458 (which is sponsored by the State Board of Optometry) will allow OD’s to provide optometric care at a home residence. A “home residence certificate” will be required. Bill will be heard in the Senate Business and Professions Committee. 9/18/19
CL Rx Verification Modernization Act - HR 3975 prohibits Rx verification made by robocall in favor of direct communication (phone, fax, patient portal, or email) so there is a paper trail to ensure patient’s get what was prescribed. Also requires online sellers to develop HIPAA-compliant methods for patients to electronically transmit Rx. 9/18/19
Medi-cal reimbursement rates - the new budget has $600-$700 million in Prop 56 funding dedicated to medi-cal provider payment increases. COA will aggressively push to increase reimbursement rates for us. 9/18/19
Medi-cal docs must maintain medical records for 10 years (instead of 7). 9/18/19
Independent Contractors - COA is seeking an amendment to AB 5 that would allow OD’s to be independent contractors. A new law (Dynamex decision) went into effect last year that changed how independent contractors were defined and conflicts with OD’s as independent contractors. COA fighting to be excluded along with medicine, dentistry, and psychology. 9/18/19
Scope of Practice - AB 1467 passed Assembly and will next be heard in the Senate Business and Professions Committee. Will allow us to perform minor surgical procedures under physician protocol. 9/18/19
Immunizations and optometry –
In 2017, AB 443 gave OD’s the ability to administer flu, shingles, and pneumonia vaccines to patients over 18 after receiving training and certification. COA’s website has info if you want to be certified. 9/18/19
California law allows optometrists to become certified to perform three immunizations – flu, shingles and pneumonia vaccines – on adults. The training for immunization certification has three requirements: (1) completion of an immunization training program, (2) basic life support certification, and (3) one hour of ongoing CE every 2 years.
Many optometric colleges are currently working on creating a certification training course specifically for optometrists. In the meantime, immunization training courses developed by the pharmacy profession can be taken now. The pharmacy certification course is 20 hours total – 12 hours of self-study with a test and an 8-hour, live seminar component that involves attending the full live seminar, successfully completing the injection technique assessment, and completing the assessment.
For more information about immunizations generally, check out the Immunization Action Coalition (IAC). IAC works to increase immunization rates and prevent disease by creating and distributing educational materials for healthcare professionals and the public that enhance the delivery of safe and effective immunization services. Additionally, the CDC produces a number of resources such as posters and flyers that can be downloaded free of charge. 7/25/19
The Think About Your Eyes national campaign – Most COA members now are eligible for a free basic listing on the Think About Your Eyes doctor locator. COA is paying the cost of this new membership benefit – all you have to do is update your company record in COA’s database. 2.3 million site visits with 4 million eye exams are attributed to the campaign. 7/25/19
VSP bill signed into law – AB 1092 gives VSP authority to continue its existing practice auditing for suspected fraudulent claims. COA had experts review this bill to make sure we are protected. Amendments were made to ensure VSP used independent and verifiable statistical methodology to detect fraud and reduced the time window for fraudulent claims from 3 years to 1 year. 7/25/19
Illegal sales of contact lenses – COA is concerned that Hubble and other companies are allegedly violating state and federal law by selling contact lenses without a prescription. COA has filed a complaint with the State Board of Optometry and we urge you to do the same. Contact COA’s hotline at (916) 266-5027 for information on how to report a complaint. 7/25/19
Online eye testing – COA continues to seek patient examples that we can use in our fight to educate the public about the dangers of online or remote refraction. If you have a patient between 18 and 50 who came to you asymptomatic, but had a life- or sight-threatening condition that you were able to detect during your exam, please report the case to COA or call COA’s “hotline” at (916) 266-5027. We need your help to collect these patient examples to help COA demonstrate the risks to consumers, the media and elected officials. Your patient need not have received an online or remote refraction to submit your example. 7/25/19
Sexual harassment training – SB 1343 requires an employer with five or more employees to provide at least two hours of sexual harassment training to all supervisory employees and at least one hour of sexual harassment training to all nonsupervisory employees by January 1, 2020, and once every two years thereafter. 9/18/19
Office poster requirement for optometrists – California Code of Regulations (CCR) Section 1566 and 1566.1 requires a Consumer Notice be posted in each optometrist’s office in a conspicuous place for consumers to see. The notice must state that patients will be given a copy of their spectacle and contact prescription. The FTC has recently come into California to check offices for this notice. For a sample of the consumer notice requirements, please visit the COA website. 7/25/19