PAO Advocating for You

ADVOCACY LEADS TO $1.655 MILLION INCREASE

Medicaid Reimbursement:

Over 1.5 million children are served by Medicaid in Pennsylvania. The Commonwealth currently has one of the lowest rates for patient visits in the entire country. Advocating to increase the Medicaid reimbursement rate will help to protect our patient’s ability to access quality health care.  In 2024, this legislative session the PAO set out to help ensure Medicaid patients have access to the ophthalmology services they deserve! In order to do this, the PAO  advocated for increases to the Fee for-Service fee schedule for ophthalmic services. Through this advocacy, the PAO met with countless staff in the Governor’s office and the Department of Human Services.  After months of advocacy, we were informed that reimbursements would increase for multiple codes. Below are the links to the specific codes being increased.

Increase #1:  54 Pa.B. 3850 - Saturday, July 6, 2024

Increase #2:  54 Pa.B. 5919 - Saturday, Sept. 14, 2024

The increases are all in effect as of September 15, 2024. A total of 37 CPT codes were updated with an average of 76% increase in reimbursement. These include eye examination, refraction, strabismus surgery, FA, VF, EOG, ERG, EMG, OCT, and color vision testing codes among others. These codes were selected to specifically address the shortages of pediatric and neuro-ophthalmologists in our state. The state estimates a $1.655M yearly increase in payments, most of which will directly benefit PA ophthalmologists. These fee schedule rate increases can be used to negotiate improved or enhanced individual or group Medicaid Contractor Organization rates. 

ADVOCACY WORKS TO PROTECT PATIENT SAFETY

The PAO continue to advocate on behalf of our members and patients daily. This year we are asking our member to meet with their legislators in their districts. Below are some of the important issues that the PAO is advocating for in Harrisburg: 

Educate legislators about the difference between Ophthalmologists and Optometrists: 

Ensuring our elected officials understand the difference between an Ophthalmologist and Optometrist is vital to ensuring our patients receive the safest and highest quality care possible. 

The Importance of Yearly Vision Screenings for Children -

Current Pennsylvania law (Act 122 passed in 2020) dictates that a student is to receive a vision screening before entering school for the first time and then yearly until the 5th grade. From the 5th grade on, students receive vision screenings every other year. Only students who do not pass the screening are then required to have comprehensive eye examinations.  New legislation would alter this and mandate costly, unnecessary full comprehensive eye examinations for all students regardless of need. The PAO opposes any new bills as act 122 vision screenings adequately identify vision issues while this proposed new legislation adds an unnecessary burden to parents and the health care system while adding significant cost. 

New in 2025: Medical Waste Legislation

Currently, legislations has been introduced (HB446)  to address this medical waste by allowing patients to be discharged with the unused portion of these medications when needed for ongoing care. The bill would cover drugs that are both commonly used for procedures and necessary during recovery, such as drops, ointment or nasal sprays prescribed for dilation, glaucoma, infection and inflammation. Delaware, Illinois and Tennessee have passed similar versions of this legislation. Additionally, multiple medical organizations have supported this type of legislation. This simple change will help Pennsylvanians get what they pay for, will reduce increasingly common medication shortages, and will address unnecessary plastic and medical waste.