20-1057.18. Contracts; optometrists; covered services; definition
A. Except as provided in subsection C of this section, a contract, entered into or renewed on or after January 1, 2022, between a health care services organization and an optometrist who is licensed to practice in this state shall not:
1. Require the optometrist to provide a service to an individual covered under an evidence of coverage based on a fee set by the health care services organization unless the service for which the fee applies is a covered service under the individual's evidence of coverage.
2. Prohibit an optometrist from offering or providing a vision service that is not a covered service to a covered individual at a fee determined by the optometrist or by the optometrist and the covered individual.
3. Require an optometrist to use one or more specific vendors to replenish the optometrist's inventory of spectacle lenses after the optometrist dispenses the optometrist's inventory to eligible members of the vision plan as a covered vision service.
B. This section applies to an administrator providing third-party administration services or a provider network for a vision plan.
C. This section does not restrict the ability of a health care services organization to enter into a contract for an optometrist to participate in a discount program sponsored by the health care services organization for services that are not covered if:
1. Participation in the health care services organization network is not contingent on participation in the sponsored discount program.
2. The health care services organization offers equal treatment to an optometrist who does not participate in a sponsored discount program, regarding:
(a) Promotional treatment.
(b) Marketing benefits.
(c) Materials.
(d) Contract terms for providing a covered service.
D. Notwithstanding subsection C, paragraph 2, subdivision (d) of this section, a health care services organization, when providing a typically formatted list of optometrists in the health care services organization network, may identify whether an optometrist participates in a discount program for services not covered by the health care services organization if all lists state that other discounts may be available with individual optometrists.
E. All contracts shall be in compliance with this section by the first renewal period on or after January 1, 2022, but not later than December 31, 2022.
F. For the purposes of this section, " covered service" means a service for which any reimbursement is available under an evidence of coverage without regard to contractual limitations by a deductible, copayment, coinsurance, waiting period, annual or lifetime maximum, frequency limitation, alternative benefit payment, exclusion or other limitation.