S1716-119

1. Short title This Act may be cited as the Vision Lab Choice Act of 2025.

2. Improving health care coverage under vision plans Title XXVII of the Public Health Service Act is amended by inserting after section 2719A (42 U.S.C. 300gg–19a) the following new section: With respect to a group health plan or individual or group health insurance coverage that provides benefits for items and services relating to vision care (including such a plan or coverage that offers limited scope vision benefits), the following shall apply: In the case of a doctor of optometry who has an agreement or is the beneficiary of an agreement with respect to a group health plan or health insurance coverage that offers limited scope vision benefits— the term of the initial agreement shall be not longer than 2 years; the agreement may be extended with the prior acceptance by such doctor for each such term extension, and any such extension may be for a term not longer than 2 years; and the agreement may be extended for unlimited terms, subject to subparagraph (B). A group health plan or health insurance issuer offering such coverage may not, directly or indirectly, restrict or limit a doctor of optometry described in paragraph (1) with respect to choice of laboratories, or choice of source or supplier of services or materials provided by the doctor to an individual who is enrolled under the plan or coverage. The Secretary shall on an annual basis notify each State of the State’s authority to enforce the provisions of subsection (a) against a group health plan or a health insurance issuer offering health insurance coverage described in subsection (a) pursuant to section 2723(a)(1) and request confirmation from the State whether or not the State will enforce the provisions of subsection (a). If a State notifies the Secretary that the State will not enforce the provisions of subsection (a) or fails to respond within 90 days of the Secretary’s request, the Secretary shall treat such State as failing to substantially enforce such provisions for purposes of subsections (a)(2) and (b) of section 2723. In this section, the term doctor of optometry means a doctor of optometry who is legally authorized to practice optometry by the State in which the doctor so practices. Section 2722(c)(1) of the Public Health Service Act (42 U.S.C. 300gg–21(c)(1)) is amended by inserting (other than the requirements under section 2719B) after section 2791(c)(2). Notwithstanding any amendment made by this Act, State law that directly affects any standard or requirement relating to health insurance issuers and vision benefit plans, shall have exclusive application and the amendments made by this Act shall not apply to the extent that such State law conflicts with such amendments. The State shall retain exclusive jurisdiction over health insurance issuers and limited scope vision benefit plans that are directly governed by such State. 2719B. Improving coverage under vision plans (a) In general With respect to a group health plan or individual or group health insurance coverage that provides benefits for items and services relating to vision care (including such a plan or coverage that offers limited scope vision benefits), the following shall apply: (1) Duration of limited scope vision plans In the case of a doctor of optometry who has an agreement or is the beneficiary of an agreement with respect to a group health plan or health insurance coverage that offers limited scope vision benefits— (A) the term of the initial agreement shall be not longer than 2 years; (B) the agreement may be extended with the prior acceptance by such doctor for each such term extension, and any such extension may be for a term not longer than 2 years; and (C) the agreement may be extended for unlimited terms, subject to subparagraph (B). (2) No restrictions on choice of laboratories and sources and suppliers A group health plan or health insurance issuer offering such coverage may not, directly or indirectly, restrict or limit a doctor of optometry described in paragraph (1) with respect to choice of laboratories, or choice of source or supplier of services or materials provided by the doctor to an individual who is enrolled under the plan or coverage. (b) Notification The Secretary shall on an annual basis notify each State of the State’s authority to enforce the provisions of subsection (a) against a group health plan or a health insurance issuer offering health insurance coverage described in subsection (a) pursuant to section 2723(a)(1) and request confirmation from the State whether or not the State will enforce the provisions of subsection (a). If a State notifies the Secretary that the State will not enforce the provisions of subsection (a) or fails to respond within 90 days of the Secretary’s request, the Secretary shall treat such State as failing to substantially enforce such provisions for purposes of subsections (a)(2) and (b) of section 2723. (c) Definition In this section, the term doctor of optometry means a doctor of optometry who is legally authorized to practice optometry by the State in which the doctor so practices. .

2719B. Improving coverage under vision plans With respect to a group health plan or individual or group health insurance coverage that provides benefits for items and services relating to vision care (including such a plan or coverage that offers limited scope vision benefits), the following shall apply: In the case of a doctor of optometry who has an agreement or is the beneficiary of an agreement with respect to a group health plan or health insurance coverage that offers limited scope vision benefits— the term of the initial agreement shall be not longer than 2 years; the agreement may be extended with the prior acceptance by such doctor for each such term extension, and any such extension may be for a term not longer than 2 years; and the agreement may be extended for unlimited terms, subject to subparagraph (B). A group health plan or health insurance issuer offering such coverage may not, directly or indirectly, restrict or limit a doctor of optometry described in paragraph (1) with respect to choice of laboratories, or choice of source or supplier of services or materials provided by the doctor to an individual who is enrolled under the plan or coverage. The Secretary shall on an annual basis notify each State of the State’s authority to enforce the provisions of subsection (a) against a group health plan or a health insurance issuer offering health insurance coverage described in subsection (a) pursuant to section 2723(a)(1) and request confirmation from the State whether or not the State will enforce the provisions of subsection (a). If a State notifies the Secretary that the State will not enforce the provisions of subsection (a) or fails to respond within 90 days of the Secretary’s request, the Secretary shall treat such State as failing to substantially enforce such provisions for purposes of subsections (a)(2) and (b) of section 2723. In this section, the term doctor of optometry means a doctor of optometry who is legally authorized to practice optometry by the State in which the doctor so practices.