March 6, 2014

Medicare Coverage of Low Vision Devices Pending Legislation

Posted in: Latest News

by Mark Richert, Esq.
Director, Public Policy
The American Foundation for the Blind

For decades, the vision loss community has been advocating for Medicare’s coverage of assistive technologies, particularly low vision devices. Currently, Medicare will not pay for any device that happens to use a lens, regardless of whether such device incorporates any other features. The Centers for Medicare and Medicaid Services (CMS), the federal agency responsible for the management of Medicare, has ruled that devices, such as low vision devices, that use a lens are excluded from coverage just as are eye glasses or contact lenses except in very narrow circumstances.

Now, for the first time, federal legislation would begin to change this unacceptable national policy by establishing a nationwide Medicare demonstration project to evaluate the fiscal impact of a permanent change in Medicare coverage to pay for low vision devices. The legislation, H.R. 3749, introduced by Reps. Carolyn Maloney (D-NY) and Gus Bilirakis (R-FL), would initiate a five-year demonstration project that would put low vision devices in the hands of Medicare beneficiaries who, after a clinical evaluation by an ophthalmologist or optometrist, can benefit from a low vision device and for whom such devices are medically necessary.

The legislation is careful to require that the demonstration project be genuinely national in scope and is explicitly designed to yield reliable data and meaningful results. Once the legislation is enacted and the demonstration project is successfully completed, Congress will have significantly richer data upon which to consider changes to the Medicare program to make coverage of low vision devices, especially the most costly devices, a permanent feature of the program. Precisely how many individuals will receive low vision devices and how many physicians across the country will participate in the demo project will need to be determined by CMS, working in consultation with stakeholder groups, as it develops and implements the project. The legislation makes $12.5 million available for the project over five years.

Advocates are encouraged to contact their members of the U.S. House of Representatives and urge them to co-sponsor H.R. 3749.

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