Medicare Reimbursement and Low Vision Devices: Is It Time to Update Medicare Policy?

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A new editorial/opinion piece from the Journal of the American Medical Association (JAMA) Ophthalmology discusses the growing incidence of sensory loss in the aging United States population and forcefully advocates for needed updates in current Medicare policy to improve coverage for hearing and vision rehabilitation services – including low vision devices – for older adults.

From JAMA Ophthalmology

The Viewpoint/Opinion article, entitled Hearing and Vision Care for Older Adults: Sensing a Need to Update Medicare Policy, was published online in the November 5, 2014 edition of JAMA Ophthalmology (formerly Archives of Ophthalmology). JAMA Ophthalmology is an international peer-reviewed journal published monthly by the American Medical Association.

The authors are Heather E. Whitson, MD, MHS and Frank R. Lin, MD, PhD, who represent the following institutions: Duke University, Durham, North Carolina; the Durham VA Geriatrics Research Education and Clinical Center, Durham, North Carolina; and Johns Hopkins University, Baltimore, Maryland.

Medicare, Sensory Loss, and Low Vision Devices

Excerpted from Hearing and Vision Care for Older Adults: Sensing a Need to Update Medicare Policy:

When Medicare became law in 1965, Congress made a justifiable decision to exclude items that were “routinely needed and low in cost,” reasoning that the cost of such items could be borne by the consumer. On that basis, hearing aids and lens-containing visual aids were excluded from coverage, with narrow exceptions, such as intraocular lenses for cataract surgery. Advocacy groups for people living with sensory impairment have long called for broader coverage of sensory aids.

During the past year, the issue has gained new traction from legislative and scientific communities. In December 2013, Representatives Carolyn Maloney (D-NY) and Gus Bilirakis (R-FL) introduced a bill (H.R. 3749) to initiate a 5-year demonstration project to provide “usable and medically necessary” low-vision devices to Medicare beneficiaries.

Given present-day understanding of the health effects of sensory loss and advances in technology, Medicare coverage of hearing and vision rehabilitative services, established a half-century ago, may need reconsideration. A key concern in today’s economy is whether any extension of Medicare’s coverage policy is financially realistic.

The prevalence of hearing loss doubles with every age decade, and nearly two-thirds of Americans older than 70 years have a clinically significant hearing impairment. Likewise, persons older than 70 years account for about 80% of the 2.8 millions of Americans with low vision, defined as vision loss (excluding blindness) not correctable with refraction, medication, or surgery.

The burden and prevalence of sensory impairments will continue to increase as the baby boomer generation ages, and such projections are not new. What has more recently been appreciated are the long-term and public health implications of sensory impairment.

Although sensory impairments diminish quality of life for the affected person, converging evidence suggests that vision and hearing loss have additional, cascading consequences for the patient’s families, caregivers, and society.

Thus, while the costs of extending coverage for sensory rehabilitation need to be carefully considered, equal consideration must be given to the societal and health care costs incurred by not enabling access to assistive devices that may prevent or delay the expensive consequences of sensory impairments.

More about Medicare and Low Vision Devices from the American Foundation for the Blind (AFB) Public Policy Center

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 the 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 containing a lens – such as low vision devices – are excluded from coverage, just as are eyeglasses or contact lenses, except in very narrow circumstances.

New Legislation Introduced: H.R. 3749

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, the Medicare Demonstration of Coverage for Low Vision Devices Act of 2013, was introduced by Representatives Carolyn Maloney (D-NY) and Gus Bilirakis (R-FL). It 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 these 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.

The number of individuals who will receive low vision devices and how many physicians across the country will participate in the demonstration 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.

The Blindness Field Collaborates on H.R. 3749

The work that has led to the introduction of this important legislation should serve as a primer on how our field can effectively influence the policy process through joint labor:

  • American Council of the Blind (ACB) initiated the national effort to refocus our field’s attention on the need to address Medicare coverage for low vision devices. The nationally representative team of consumer, professional, and industry advocates that ACB brought together considered a variety of approaches to tackling the low vision device coverage issue.
  • American Foundation for the Blind, as a participant in the ACB initiative, proposed that our field pursue a national Medicare demonstration project and prepared the legislative text that has been introduced in Congress.
  • VisionServe Alliance made this issue one of its principal legislative priorities at ACB’s request.
  • Lighthouse Guild International, supported by VisionServe leadership and member organizations, was instrumental in securing our congressional supporters and advocates. This field-wide collaboration exemplifies the kind of effort that is best positioned to achieve results.

What You Can Do

Advocates are encouraged to contact their members of the U.S. House of Representatives and urge them to co-sponsor H.R. 3749. For more information, contact Mark Richert, Esq., Director of the AFB Public Policy Center, by email at or phone at 202-469-6833.

The AFB Public Policy Center, in Washington, DC, collaborates with policy makers in Congress and the Executive Branch to ensure that Americans with vision loss have equal rights and opportunities to fully participate in society.

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