By now, you have likely heard the hubbub about the new updates to the Eyeglass Rule regulation from the Federal Trade Commission (FTC). The updates align the Eyeglass Rule more closely with the Contact Lens Rule requirements. Practices are currently working through the updates to ensure their workflows remain compliant and meet the Sept. 24, 2024 deadline for compliance with the Eyeglass Rule. Let’s review the key tenets of the rule and changes that require attention, potential workflow changes, and early concerns addressed.

Patients’ eyeglass prescription

The basic requirement applying to all practices is to provide the patient with their eyeglass prescription immediately following the visit, during which a refraction was finalized for their use without additional charge to provide the prescription. Diagnostic-only refractions not finalized for eyeglasses do not require release.

1. Whether a refraction is finalized for eyeglass prescription release remains a physician's decision.
2. The patient must be provided with a finalized eyeglass prescription even if the prescription does not change.
3. The finalized prescription must be released even if the patient does not request it.

Tip: Ensure any diagnostic-only refractions are discernable in visit documentation to distinguish them from finalized refractions.

Optical shop rules

The signature updates to the Eyeglass Rule apply to practices with optical shops and/or ownership in optical shops. The FTC is working to ensure patients can obtain and take their prescriptions wherever they choose without being coerced into using any particular optical shop.

1. Practices without a direct or indirect financial interest in the sale of eyeglasses are exempt from the patient signature requirement.
2. Physicians not associated, affiliated, and without co-locations with optical shops are exempt from Eyeglass Rule requirements. 

Patient signatures

Patients must now sign for their eyeglass prescriptions when they receive them at the time of their examination.

Patients may elect to receive their eyeglass prescriptions electronically by signing an agreement to receive them through the patient portal. You may not require a patient to receive their prescription electronically. The Final Rule states, “For a prescription copy provided in a digital format, the prescriber shall:

a. identify to the patient the specific method or methods of electronic delivery that will be used, such as text message, electronic mail, or an online patient portal; 
b. obtain, on paper or in a digital format, the patient’s verifiable affirmative consent to receive a digital copy through the identified method or methods; and 
c. maintain records or evidence of a patient’s affirmative consent for a period of not less than three years. Such records or evidence shall be available for inspection by the Federal Trade Commission, its employees, and its representatives.

Must also retain evidence that such prescription was sent, received, or made accessible, downloadable, and printable for three years.”

Tip: Consider reformatting eyeglass prescription forms or templates to include a statement and signature line for the patient to attest to receipt of their prescription. Electronic signatures are acceptable if that capability is available.

Also, you do not have to update the patient’s delivery modality consent at every visit. The Final Rule states, “… if the prescriber identifies the digital method that will be used for prescription delivery and allows the patient to choose whether to consent to that delivery method (rather than making it the default), then allowing patients to sign an authorization just once would satisfy the Rule’s requirements.”

Charging for services

The Eyeglass Rule updates do not change the ability to charge for services when performing diagnostic-only and finalized refractions.

1. If the physician normally charges for an eye exam refraction, the physician may withhold the patient’s prescription until the patient has paid for the refractive eye exam (eg, refraction). All patients must be treated equally per the Eyeglass Rule: “a prescriber may refuse to give the patient a copy of the patient’s prescription until the patient has paid for the eye examination, but only if that prescriber would have required immediate payment from that patient had the eye examination revealed that no ophthalmic goods were required.”
2. Also of note, the Eyeglass Rule states that “Presentation of insurance coverage of a refractive eye exam equals payment.”

Summary

The updates to the Eyeglass Rule require some analysis and workflow updates for practices to remain fully compliant. With the current deadline for compliance, it makes sense for practices to consult their teams to develop and implement the most efficient workflow for compliance. OP 

Laurie Brown, MBA, COMT, COE, CPC, CPMA, LSSYB, is a senior consultant with BSM Consulting in Tucson, AZ. She has experience in the ophthalmic industry holding managerial, clinical, and surgical roles for more than 35 years.