Appropriations committee backs S64 to create advanced therapeutic specialty for optometrists

The House Appropriations Committee on May 27 supported S64, a bill that would add an "advanced therapeutic procedure specialty" to the state optometry statute and enumerate a narrow list of intraocular laser procedures, injections and limited surgical steps that certified optometrists could perform.

Jen KBY of the Office of Legislative Counsel told the committee the bill, as passed by the Senate, amends Title 26 to create a new subchapter and specifies both permitted advanced procedures and an explicit list of prohibited practices (including treatment of macular degeneration and certain retinal surgeries). "This allows an optometrist who holds this specialty to apply for authority to provide the advanced therapeutic procedures set forth," she said while walking members through definitions, continuing-education requirements and the prohibited list.

Jennifer Coen, director of the Office of Professional Regulation, said OPR has studied the proposal since 2018 and revised its Sunrise assessment in 2023 after reviewing U.S. optometry curricula and interstate practice. Coen said the office concluded the baseline education in U.S. optometry schools provides a foundation for the specialty when combined with additional hands-on training, national board examinations and a preceptorship. "Our mission is public protection always," Coen said, describing OPR's work to set what it called more-stringent requirements than some peer states.

Key implementation details in S64 include a preceptorship requiring at least eight hours of direct, in-person supervised clinical training with minimum procedure counts; an additional five hours of continuing education for certificate holders every two years (on top of the existing 40-hour requirement); written and clinical national board exams; endorsement pathways for practitioners with equivalent out-of-state scope; and a 30-day adverse-event reporting requirement tied to the Board of Optometry's processes. The bill sets an effective date of July 1, 2028 to allow OPR and the board time to adopt rules and credentialing processes.

Committee members pressed staff and OPR on Medicaid and fiscal impacts. Counsel explained that expanding scope would require the Agency of Human Services to request a Medicaid state plan amendment for Medicaid to reimburse the newly authorized services when furnished by optometrists. Joint fiscal staff and agency representatives told the committee that no comprehensive analysis had been done to estimate potential Medicaid budgetary effects or utilization changes, and that those impacts were "not specified" in the fiscal materials presented.

Members voiced trade-offs between access and caution: some said allowing optometrists to provide these procedures could increase access in rural areas, while others raised concerns about clinical volume, training sufficiency and insurance coverage. OPR noted it had not found evidence in other states of higher malpractice rates tied to similar scope expansions, and it emphasized the bill's reporting and enforcement provisions.

The committee entertained a motion to "support S64" (mover: Representative John Wayne). The clerk conducted a roll-call; the readout recorded a majority voting yes and at least one recorded no (Representative Yakaboni). The committee said it would forward the bill and noted a separate floor amendment will be taken up on the House floor.

Next steps: the bill proceeds to the floor where the filed amendment to add two board members (one extra optometrist and one ophthalmologist) and a requirement that an optometrist board member hold the specialty by 2031 is expected to be considered.