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Joe E. Ellis, O.D. 

President 243 N. Lindbergh Blvd  St. Louis, MO 63141 Blvd  (314) 991-410

91-4101

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FAX: (314) 9 

August 16, 2010 

Kathleen Sebelius 

Secretary 

Department of Health and Human Services 

Hubert H. Humphrey Building 

200 Independence Avenue SW 

Washington, DC 20201 

Submitted electronically at Regulations.gov 

Subject: Group Health Plans and Health Insurance Coverage Relating to Status as a Grandfathered 

Health Plan Under the Patient Protection and Affordable Care Act (75 Fed. Reg. 34538 (June 17, 2010).) 

Dear Secretary Sebelius, 

The American Optometric Association (AOA) submits these timely comments in response to the 

Department of Health and Human Services (HHS) interim final rule to implement provisions set forth in 

the Patient Protection and Affordable Care Act (Affordable Care Act) regarding “grandfathered” health 

plans. 

The AOA represents approximately 36,000 doctors of optometry, optometry students and paraoptometric 

assistants and technicians. Optometrists serve patients in nearly 6,500 communities across the country, 

and in 3,500 of those communities are the only eye doctors. Doctors of optometry provide more than 

two-thirds of all primary eye and vision health care in the United States. Without optometrists, the eye 

care needs of the American public cannot be met. Therefore, HHS should not only preserve and protect 

access to optometrists in group health plans and health insurance coverage, but should also take this 

unprecedented opportunity to provide and promote access to optometrists for those Americans whose eye 

and vision care needs are not yet addressed. 

The Affordable Care Act, walking a thin line between President Obama’s promise that “If you like your 

health care, you can keep it,” and the need to improve health care delivery for everyone else, establishes 

important requirements for new health plans and existing health plans. The existing plans are called 

“grandfathered” plans. The interim final rule published in the Federal Register on June 17 establishes 

what circumstances will cause an existing plan to lose its grandfathered status and be subject to additional 

new (and higher) standards. The AOA believes important new patient protections are included in the 

Affordable Care Act and that it is in the interest of all patients to have these rights. Therefore, final 

regulations should be more restrictive than the interim final rule to prevent existing plans from eluding the 

improvements in health care delivery included in the Affordable Care Act by merely maintaining the 

status quo as a grandfathered plan. 

The AOA proposes an additional event that should cause a grandfathered health plan to lose its protected 

status. Section 2706 of the Affordable Care Act creates an important patient protection by prohibiting 
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plans from discriminating against participation or coverage against health care professionals acting within 

their applicable state scopes of practice. The AOA has seen such discrimination have a negative effect on 

patient care in the past, and is concerned that grandfathered health plans will attempt to use their protected 

status as a temporary opportunity to expand discriminatory practices even though they do not improve 

health care delivery, quality, or efficiency. Grandfathered plans should be required to maintain or expand 

their networks of providers rather than narrow their networks based on arbitrary discriminatory or other 

anti-patient and anti-provider policies. This would ensure that patients in group health plans and health 

insurance coverage would, at a minimum, not lose appropriate access to health professionals in their 

plans. This would allow patients to keep their plans as they know them or have them improved by 

provisions in the Affordable Care Act. Thus, HHS should prohibit grandfathered health plans from 

making their networks of participating professionals more restrictive or more discriminatory merely on 

the basis of the degree of the professional without losing their grandfathered status. 

The AOA also proposes a modification of one of the delineated events that cause a grandfathered health 

plan to lose its protected status. The interim final regulations stipulate that an elimination of benefits 

would cause a grandfathered health plan to become subject to additional provisions in the Affordable 

Care Act. Since some plans offer benefits through a supplemental plan or rider, the final regulations 

should make clear that non-renewal or discontinuance of the supplemental plan or rider would be 

considered an elimination of benefits. This additional stipulation would prevent grandfathered health 

plans from eluding the intent of the interim final regulations by tinkering outside a core policy. 

The AOA strongly recommends HHS not loosen other provisions in the interim final regulations that 

would allow more grandfathered plans to slip through the reforms granted by the Affordable Care Act. 

The AOA also agrees with HHS that modifications by grandfathered plans to abide by the additional 

requirements of the Affordable Care Act should be encouraged and not necessarily cause a plan to lose its 

protected status. A grandfathered plan should be required to list the consumer protections that it does not 

follow so patients will better understand the rights they are not receiving as a result of being in a 

grandfathered plan. It’s important that patients realize that the Affordable Care Act introduces many 

benefits that patients might not realize they are missing. Congress and the President supported the law to 

improve health care in the United States. HHS should be careful not to allow existing plans to retain 

antiquated, out-of-date policies from the past, particularly discrimination that artificially boosted their 

bottom lines at the expense of their beneficiaries. 

On behalf of our membership and the tens of millions of Americans that our members serve, we thank 

HHS for considering these comments and using the feedback to help improve the interim final regulations 

on grandfathered group health plans and health insurance. Please contact Rodney Peele, Esq., Assistant 

Director for Regulatory Policy and Outreach at rpeele@aoa.org or (703) 837-1348 if you have questions 

or need additional information about these comments. 

Sincerely, 

Joe E. Ellis, O.D. 

President, American Optometric Association