Committee amends optometry scope bill after hours of debate over credentialing and insurance costs

A State Public Health and Welfare committee on Monday spent its allotted time reviewing competing amendments to a bill that would expand the scope of optometry to allow certain laser, lid and minor surgical procedures and would subject credentialed optometrists to the Healthcare Stabilization Fund.

Senator Thomas, the bill sponsor, and committee staff presented a sponsor amendment that would add optometrists to KSA 40-34-2's Health Care Stabilization Fund rules only if those optometrists are credentialed to perform specified procedures. The amendment delays full fund participation until Jan. 1, 2028, and caps the first‑year surcharge at 15% of the optometrist's primary layer premium. "This amendment does not satisfy everyone's opposition," Thomas said, but she described it as capturing concessions made by proponents and opponents.

The nut of the debate centered on two technical issues: who would be credentialed to perform the procedures and how including optometrists in the stabilization fund would affect per‑provider surcharges. Jenna, committee staff, explained the amendment would require those licensed before July 1, 2020, to complete a board‑approved 32‑hour certification (didactic and clinical), while more recent graduates would already have required training. The amendment also adds a Kansas Optometric Association nominee to the Healthcare Stabilization Fund Board.

Senator Clifford, a board‑certified ophthalmic surgeon who identified patient safety as his primary concern, warned the structure of the stabilization fund could lead to large per‑provider surcharges if only a small subset of optometrists participate. "Insurance is shared risk," Clifford said, noting that if only a few providers enter a lane, the per‑provider cost rises. Rochelle Colombo, executive director of the Kansas Medical Society, said KMS requested the fund provision, that preliminary actuarial work has been done, and that the 2028 effective date provides time for more detailed analysis. Colombo said optometrists "currently are carrying around $2,000,000 in coverage" and described a primary/secondary structure for coverage layers.

The committee adopted the sponsor amendment after a motion by Senator Thomas and a second by Senator Murphy. The chair announced, "The amendment has passed."

After the sponsor amendment, Senator Clifford offered five opponent amendments aimed at narrowing the bill's scope and strengthening patient safeguards. His first amendment would have struck injections, incision and curettage of a chalazion, and biopsy/removal of certain periocular skin lesions from the proposed scope; it would have preserved the ability to remove skin tags and retained a provision on light‑adjustable lenses. Clifford argued those procedures require surgical experience and suturing skills and so pose patient safety risks. The committee divided on that amendment; after a counted division the motion failed (in favor 4, opposed 5).

Clifford's second amendment sought to remove laser peripheral iridotomy from the bill, arguing that cataract surgery is the worldwide standard of care for narrow‑angle glaucoma and that peripheral iridotomy is an infrequent, technically demanding, and potentially blind procedure. The amendment passed on a voice vote.

A third Clifford amendment that would have broadened the standard‑of‑care language to hold licensees to the standard of care for the eye diseases described in the section failed on a counted vote (in favor 4, opposed 6). Throughout the debate members questioned the completeness and reliability of incident and malpractice data from other states; proponents pointed to a study that reported 146,000 procedures by optometrists with two adverse events, while opponents described potential underreporting and long lags in malpractice litigation.

The chair announced the committee had run out of time and will resume consideration at the start of the next day's session. Members were asked to submit additional amendments to staff (Patrick Orr).

Authorities and relevant statutory citations discussed in committee include KSA 40-34-2 (Healthcare Stabilization Fund) and KSA 74-15-05 (Interprofessional Advisory Committee). The committee recorded three formal amendment actions during the session (the sponsor amendment was adopted; Clifford's first and third amendments failed; his second amendment passed). No final passage of the underlying bill occurred; further consideration is scheduled for the committee's next meeting.