Panel reviews S.64 to create advanced therapeutic specialty for optometrists; Medicaid coverage would require state-plan change

The Ways & Means committee reviewed S.64, a bill that would expand the statutory definition of the practice of optometry to add ‘administering’ therapeutic pharmaceutical agents and to create an advanced therapeutic procedures specialty allowing certain additional procedures, including defined forms of surgery, laser treatments and injections, Jen Harvey of the Office of Legislative Council told the panel.

Harvey said the bill begins by amending definitions in the optometry chapter of Title 26 and then lists both authorized advanced procedures and a separate list of prohibited practices. "This bill would slightly expand that as it relates to prescribing ... and to clarify therapeutic pharmaceutical agents," she said, summarizing the measure’s structure and limits. The draft includes a list of 23 procedures that would remain off-limits to optometrists.

The bill sets new qualifications for a specialty designation: candidates must meet education and demonstrated-competency requirements, complete a preceptorship with an optometrist with similar scope or an ophthalmologist, pass written and clinical examinations specific to injections, lasers and surgical procedures, and demonstrate hands-on proficiency (the bill requires at least two occurrences of each of six different procedures in live clinical settings). License renewal provisions would keep the existing 40 hours of continuing education every two years and add five board-approved hours specific to the specialty.

Harvey also described a reporting requirement: licensees must notify the board of any adverse event related to an advanced procedure within 30 days. She said she borrowed the adverse-event definition from hospital safety and surveillance reporting systems and that those systems are designed to encourage confidential reporting; disciplinary actions, she added, remain publicly accessible on OPR’s website.

Committee members pressed the administration and counsel on payment and access. One member said Medicaid currently covers these services when provided by ophthalmologists but not when provided by optometrists and called that discrepancy problematic for lower-income Vermonters. Harvey said Medicaid will not reimburse these services when provided by optometrists unless the state amends its Medicaid state plan — a process that requires legislative direction, a fiscal analysis and a federal request. "Medicaid would require an appropriation to have the coverage," she said, and the administration would typically pursue a state-plan amendment only when prompted by legislation and an associated budget request.

A fiscal-office analyst told the committee the specialty designation would typically carry a one-time administrative fee (statutory default of $100 unless otherwise specified). Based on OPR’s estimate that roughly 50 professionals might seek the specialty when the law takes effect on July 1, 2028, the fiscal office estimated about $5,000 in one-time revenue. The specialty itself does not entail a recurring specialty renewal fee, though holders remain subject to continuing-education requirements.

The committee debated procedural options for handling the Medicaid-payment issue. Members discussed sending S.64 to Appropriations so that committee could consider an amendment directing the administration to seek a Medicaid state-plan amendment and to include any appropriation needed for coverage. The chair said the committee had possession of the bill and could vote, or it could pause and return after floor activity; members agreed to take a short break and return to vote later.

Next steps: committee members planned to continue with floor business and return to Ways & Means later to cast a vote on S.64 after additional consultation and, if desired, an Appropriations amendment.

Sources: Transcript of the Ways & Means committee meeting; Jen Harvey, Office of Legislative Council (presentation and responses).