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Bill > HB1328

MS HB1328

MS HB1328
Fairness in vision care; establish requirements for contracts between insurers and vision benefit providers and eye care providers.

summary

Introduced
01/19/2026
In Committee
01/19/2026
Crossed Over
Passed
Dead
02/03/2026

Introduced Session

2026 Regular Session

Bill Summary

An Act Establishing Requirements Relating To Contracts And Agreements Between Insurers And Vision Benefit Providers And Eye Care Providers; To Define Certain Terms; To Require Certain Public Disclosures By Insurers And Vision Benefit Managers; To Require Notice To Be Provided To Participating Eye Care Providers Of Amendments To Agreements And Other Documents; To Prescribe Certain Requirements For Contracts Between Eye Care Providers And Insurers And Vision Benefit Managers; To Prohibit Certain Coercive Tactics By Insurers And Vision Benefit Managers In Contracts With Eye Care Providers; To Prohibit Differential Treatment By Insurers And Vision Benefit Managers Toward Optometrists And Ophthalmologists; To Prohibit Insurers And Vision Benefit Managers From Requiring Providers To Participate In Certain Healthcare Networks; To Establish Certain Requirements That Must Be Included In The Process Of Credentialing And Contracting With Eye Care Providers; To Prohibit Insurers And Vision Benefit Managers From Changing The Terms Of An Agreement With A Participating Eye Care Provider Without Clear Written Communication To, And Acceptance Of The Changes By, The Provider; To Prohibit Insurers And Vision Benefit Managers From Restricting Participating Providers From Using Certain Sources And Suppliers; To Prohibit The Use Of Extrapolation In Auditing Participating Eye Care Providers; To Authorize An Aggrieved Participating Provider To Institute An Action Against An Insurer Or Vision Benefit Provider; To Require The Insurance Commissioner And Department Of Insurance, Along With The Attorney General, To Enforce The Provisions Of This Act; To Provide That This Act Applies To An Enrollee's Current Benefit Plan Upon Renewal The Initiation Of New Provider Agreements Or Amendments To Existing Agreements After The Effective Date Of This Act; And For Related Purposes.

AI Summary

This bill establishes requirements for contracts between insurers and vision benefit providers, referred to as "vision benefit managers" (VBMs), and eye care providers, such as optometrists and ophthalmologists, to ensure fairness in vision care. Key provisions include requiring VBMs to publicly disclose their business information, including litigation and complaints, and to provide eye care providers with at least 90 days' notice for any proposed changes to agreements or documents, clearly marking all changes. The bill prohibits VBMs from using deceptive marketing practices, imposing unfair financial burdens on providers, or restricting their choice of suppliers. It also mandates that VBMs use standardized coding systems for services and materials, ensure reimbursements are not nominal or negligible, and prohibits them from altering submitted claim codes in a way that reduces payment. Furthermore, VBMs cannot require providers to participate in multiple plans as a condition for joining one, must have a transparent and timely credentialing process, and cannot change contract terms without explicit provider acceptance. The bill also prohibits the use of "extrapolation" in audits, which is a method of estimating audit findings for a larger group of claims not reviewed, and allows aggrieved providers to sue for violations, with enforcement by the Insurance Commissioner, Department of Insurance, and Attorney General. These provisions will apply to existing benefit plans upon renewal and to new or amended provider agreements after the bill's effective date.

Committee Categories

Business and Industry

Sponsors (1)

Last Action

Died In Committee (on 02/03/2026)

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