VT
Vermont House Bill H0241

Vermont 2025-2026 Regular Session

Vermont House Bill H0241 Compare Versions

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11 BILL AS INTRODUCED H.241
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55 VT LEG #380443 v.1
66 H.241 1
77 Introduced by Representatives Birong of Vergennes, Bartley of Fairfax, 2
88 Bluemle of Burlington, Bosch of Clarendon, Branagan of 3
99 Georgia, Burditt of West Rutland, Burkhardt of South 4
1010 Burlington, Canfield of Fair Haven, Cole of Hartford, Critchlow 5
1111 of Colchester, Feltus of Lyndon, Galfetti of Barre Town, Greer 6
1212 of Bennington, Gregoire of Fairfield, Harrison of Chittenden, 7
1313 Harvey of Castleton, Higley of Lowell, Hooper of Randolph, 8
1414 Howland of Rutland Town, Kascenska of Burke, Kleppner of 9
1515 Burlington, Labor of Morgan, Laroche of Franklin, Lipsky of 10
1616 Stowe, Luneau of St. Albans City, Maguire of Rutland City, 11
1717 Malay of Pittsford, Marcotte of Coventry, Morgan, L. of 12
1818 Milton, Morgan, M. of Milton, Morris of Springfield, Morrissey 13
1919 of Bennington, Mrowicki of Putney, Nelson of Derby, Noyes of 14
2020 Wolcott, Oliver of Sheldon, Olson of Starksboro, Page of 15
2121 Newport City, Pritchard of Pawlet, Quimby of Lyndon, Sibilia 16
2222 of Dover, Surprenant of Barnard, Sweeney of Shelburne, Toof 17
2323 of St. Albans Town, Wells of Brownington, White of Bethel, 18
2424 and Winter of Ludlow 19
2525 Referred to Committee on 20
2626 Date: 21 BILL AS INTRODUCED H.241
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3030 VT LEG #380443 v.1
3131 Subject: Professions and occupations; Office of Professional Regulation; 1
3232 health care professionals; optometrists 2
3333 Statement of purpose of bill as introduced: This bill proposes to revise and 3
3434 further define the scope of practice for optometrists. It would also create an 4
3535 advanced therapeutic procedures specialty that would allow qualified 5
3636 optometrists to perform certain advanced therapeutic procedures. 6
3737 An act relating to amendments to the scope of practice for optometrists 7
3838 It is hereby enacted by the General Assembly of the State of Vermont: 8
3939 Sec. 1. 26 V.S.A. § 1703 is amended to read: 9
4040 § 1703. DEFINITIONS 10
4141 As used in this chapter: 11
4242 (1) “Board” means the State Board of Optometry. 12
4343 (2)(A) The “practice of optometry” means any one or combination of 13
4444 the following practices: 14
4545 (A)(i) Examining the human eyes and visual system for purposes of: 15
4646 (i)(I) diagnosing refractive and functional ability; or 16
4747 (ii)(II) diagnosing the presence of eye and adnexa disease or 17
4848 injury, treating the disease or injury with the appropriate therapeutic 18
4949 pharmaceutical agents and procedures in accordance with this chapter, and 19
5050 making referrals to the appropriate health care provider when warranted. 20 BILL AS INTRODUCED H.241
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5555 (B)(ii) Diagnosing and correcting anomalies of the refractive and 1
5656 functional ability of the visual system and the enhancement of visual 2
5757 performance including the following: 3
5858 (i)(I) prescribing and using ophthalmic lenses, prisms, 4
5959 autorefractor or other automatic testing devices, frames, ophthalmic aids, and 5
6060 prosthetic materials as consistent with the health of the eye; 6
6161 (ii)(II) prescribing and employing contact lenses; and 7
6262 (iii)(III) administering visual training, vision therapy, orthoptics, 8
6363 and pleoptics. 9
6464 (C)(iii) Prescribing and administering appropriate therapeutic 10
6565 pharmaceutical agents, as defined in this section, for the diagnosis, 11
6666 management, and treatment of the eye and adnexa. 12
6767 (D)(iv) Removing superficial foreign bodies from the eye and 13
6868 adnexa; epilating the eyelashes, including by electrolysis; and punctal dilation, 14
6969 lacrimal irrigation, and punctal plugs insertion. 15
7070 (E)(v) Managing the following types of glaucoma in patients who are 16
7171 16 years of age or older: 17
7272 (i)(I) adult primary open angle glaucoma; 18
7373 (ii)(II) exfoliative glaucoma; 19
7474 (iii)(III) pigmentary glaucoma; 20
7575 (iv)(IV) low tension glaucoma; 21 BILL AS INTRODUCED H.241
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8080 (v)(V) inflammatory (uveitic) glaucoma; and 1
8181 (vi)(VI) emergency treatment of angle closure glaucoma. 2
8282 (vi) For an optometrist holding an advanced therapeutic 3
8383 procedures specialty issued pursuant to subchapter 5 of this chapter, 4
8484 performing the following advanced therapeutic procedures: 5
8585 (I) surgery to remove lesions from the eye and adnexa and the 6
8686 accompanied restoration of tissue, including only the following: 7
8787 (aa) excision and repair of nonrecurrent chalazia; 8
8888 (bb) excision and biopsy of nonrecurrent lesions of the 9
8989 adnexa without characteristics or obvious signs of malignancy, excluding any 10
9090 lesion involving the eyelid margin, involving the lacrimal supply or drainage 11
9191 systems, deeper than the orbicularis muscle, or larger than five millimeters in 12
9292 diameter; 13
9393 (cc) closure of wounds resulting from removal of a lesion; 14
9494 (dd) repair of an eyelid laceration not larger than 2.5 15
9595 centimeters, not deeper than the orbicularis muscle and not involving the 16
9696 eyelid margin or lacrimal drainage structures; and 17
9797 (ee) corneal crosslinking; 18
9898 (II) the following laser procedures: 19
9999 (aa) laser capsulotomy; 20
100100 (bb) laser peripheral iridotomy; and 21 BILL AS INTRODUCED H.241
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105105 (cc) laser trabeculoplasty; and 1
106106 (III) the following injections: 2
107107 (aa) injections of therapeutic pharmaceutical agents into the 3
108108 eyelid or its adnexa, including into the subconjunctival space, and including 4
109109 injections for the removal of chalazia and injections to administer local 5
110110 anesthesia; 6
111111 (bb) injections to perform fluorescein angiography; 7
112112 (cc) injections of epinephrine for treatment of anaphylactic 8
113113 shock; and 9
114114 (dd) if authorized by the Commissioner of Health during a 10
115115 public health emergency, vaccinations for systemic health reasons. 11
116116 (B) The practice of optometry does not include performing any of the 12
117117 practices set forth in section 1720 of this chapter. 13
118118 * * * 14
119119 (6) “Adverse event” means any untoward incident, therapeutic 15
120120 misadventure, iatrogenic injury, or other undesirable outcome directly 16
121121 associated with care or services provided by a health care provider or a health 17
122122 care facility, as those terms are defined in 18 V.S.A. § 9402. 18
123123 (7)(A) “Therapeutic pharmaceutical agent” means any prescription or 19
124124 nonprescription drug used or prescribed for the diagnosis, prevention, 20 BILL AS INTRODUCED H.241
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129129 treatment, or mitigation of abnormal conditions and pathology of the human 1
130130 eye or its adnexa. 2
131131 (B) “Therapeutic pharmaceutical agent” does not include: 3
132132 (i) any drug or other substance that must be administered by 4
133133 intraocular injection or intraocular implementation, except as authorized by 5
134134 subdivision (2)(A)(vi)(III) of this section for an optometrist holding an 6
135135 advanced therapeutic procedures specialty issued pursuant to subchapter 5 of 7
136136 this chapter; or 8
137137 (ii) any drug or other substance that is prohibited under subsection 9
138138 1720(b) of this chapter. 10
139139 Sec. 2. 26 V.S.A. § 1716a is amended to read: 11
140140 § 1716a. RENEWAL 12
141141 (a) Licenses shall be renewed every two years upon payment of the 13
142142 required fee, provided that the person applying for renewal completes at least 14
143143 40 hours of continuing education, approved by the Board, during the preceding 15
144144 two-year period and holds a current cardiopulmonary resuscitation 16
145145 certification. 17
146146 (b) Licensees holding an advanced therapeutic procedures specialty 18
147147 pursuant to subchapter 5 of this chapter shall, during each two-year licensure 19
148148 period, complete an additional five hours of continuing education, approved by 20
149149 the Board, in the advanced procedures. 21 BILL AS INTRODUCED H.241
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154154 Sec. 3. 26 V.S.A. § 1720 is added to read: 1
155155 § 1720. PROHIBITED PRACTICES 2
156156 (a) An optometrist shall not perform any ophthalmic surgeries, with or 3
157157 without the use of lasers, or injection procedures, other than those set forth in 4
158158 subdivision 1703(2)(A)(vi) of this chapter. This prohibition includes the 5
159159 following procedures, which an optometrist is prohibited from performing: 6
160160 (1) retinal laser procedures, laser-assisted in situ keratomileusis 7
161161 (LASIK), photorefractive keratectomy, laser epithelial keratomileusis, or any 8
162162 forms of refractive surgery; 9
163163 (2) penetrating keratoplasty, corneal transplant, or lamellar keratoplasty; 10
164164 (3) the administration of general anesthesia; 11
165165 (4) surgery done with general anesthesia; 12
166166 (5) laser or nonlaser injection in the posterior or vitreous chamber of the 13
167167 eye to treat any macular or retinal disease; 14
168168 (6) surgery related to removal of the eye or adnexa, including the 15
169169 eyeball, from a living human being; 16
170170 (7) surgery requiring full-thickness incision or excision of the cornea or 17
171171 sclera other than paracentesis in an emergency situation requiring immediate 18
172172 reduction of the pressure inside the eye; 19
173173 (8) surgery requiring incision of the iris and ciliary body, including iris 20
174174 diathermy or cryotherapy; 21 BILL AS INTRODUCED H.241
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179179 (9) surgery requiring the incision or removal of the vitreous; 1
180180 (10) surgery requiring incision of the retina; 2
181181 (11) surgical extraction of the crystalline lens; 3
182182 (12) surgical intraocular lens implants; 4
183183 (13) incisional or excisional surgery of the extraocular muscles; 5
184184 (14) surgery of the eyelid for suspected malignancies, for cosmetic 6
185185 purposes, or for cosmetic or mechanical repair of blepharochalasis, ptosis, and 7
186186 tarsorrhaphy; 8
187187 (15) surgery for the removal of lesions involving the eyelid margin, 9
188188 lacrimal supply, or drainage systems; 10
189189 (16) repair of an eyelid laceration larger than 2.5 centimeters, deeper 11
190190 than the orbicularis muscle, or involving the eyelid margin or lacrimal drainage 12
191191 structures; 13
192192 (17) surgery of the bony orbit, including orbital implants; 14
193193 (18) incisional or excisional surgery of the lacrimal system other than 15
194194 probing or related procedures; 16
195195 (19) surgery requiring full-thickness conjunctivoplasty with graft or 17
196196 flap; 18
197197 (20) pterygium surgery; 19
198198 (21) ionizing radiation; 20
199199 (22) intraocular injections penetrating the globe; and 21 BILL AS INTRODUCED H.241
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204204 (23) retrobulbar or intraorbital injections. 1
205205 (b)(1) An optometrist shall not prescribe or administer a drug or other 2
206206 substance that is listed as a Schedule I or II controlled substance pursuant to 3
207207 the federal Controlled Substances Act, 21 U.S.C. § 801 et seq., as amended, 4
208208 except as set forth in subdivision (2) of this subsection. 5
209209 (2) Notwithstanding subdivision (1) of this subsection, an optometrist 6
210210 may prescribe or administer hydrocodone in combination with analgesics, 7
211211 provided that an optometrist shall not prescribe more than a 72-hour supply of 8
212212 hydrocodone and shall not provide any refills of the prescription. 9
213213 Sec. 4. 26 V.S.A. chapter 30, subchapter 5 is amended to read: 10
214214 Subchapter 5. Diagnostic Pharmaceutical Agents Advanced Therapeutic 11
215215 Procedures Specialty 12
216216 § 1723. ADVANCED THERAPEUTIC PROCEDURES SPECIALTY 13
217217 An optometrist who is licensed pursuant to subchapter 3 of this chapter may 14
218218 apply for an advanced therapeutic procedures specialty that authorizes the 15
219219 optometrist to perform the advanced therapeutic procedures set forth in 16
220220 subdivision 1703(2)(A)(vi) of this chapter. 17
221221 § 1724. QUALIFICATIONS FOR ADVANCED THERAPEUTIC 18
222222 PROCEDURES SPECIALTY 19
223223 (a) Generally. An optometrist shall obtain an advanced therapeutic 20
224224 procedures specialty in order to perform the advanced therapeutic procedures 21 BILL AS INTRODUCED H.241
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229229 set forth in subdivision 1703(2)(A)(vi) of this chapter. The Board may grant 1
230230 an advanced therapeutic procedures specialty to an applicant who: 2
231231 (1) is licensed as an optometrist pursuant to subchapter 3 of this chapter; 3
232232 (2) meets the applicable requirements for education and demonstrated 4
233233 competency set forth in subsections (b) and (c) of this section; and 5
234234 (3) has completed the examination requirements set forth in subsection 6
235235 (d) of this section. 7
236236 (b) Educational requirements. 8
237237 (1) In order to obtain an advanced therapeutic procedures specialty, an 9
238238 optometrist who graduated from an optometric school or college prior to 2019 10
239239 shall have completed a postgraduate course sponsored by an organization 11
240240 approved by the Board of Optometry that had a minimum duration of 32 hours 12
241241 and included the following didactic classroom instruction: 13
242242 (A) laser physics, hazards, and safety; 14
243243 (B) biophysics of lasers; 15
244244 (C) laser application in clinical optometry; 16
245245 (D) laser-tissue interactions; 17
246246 (E) laser indications, contraindications, and potential complications; 18
247247 (F) gonioscopy; 19
248248 (G) laser therapy for open-angle glaucoma; 20
249249 (H) laser therapy for angle closure glaucoma; 21 BILL AS INTRODUCED H.241
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254254 (I) posterior capsulotomy; 1
255255 (J) common complications involving lids, lashes, and the lacrimal 2
256256 system; 3
257257 (K) medicolegal aspects of anterior segment procedures; 4
258258 (L) peripheral iridotomy; 5
259259 (M) laser trabeculoplasty; 6
260260 (N) minor surgical procedures; 7
261261 (O) overview of surgical instruments, asepsis, and occupational 8
262262 safety and health considerations; 9
263263 (P) surgical anatomy of the eyelids; 10
264264 (Q) emergency surgical procedures; 11
265265 (R) chalazion management; 12
266266 (S) techniques for and complications with local anesthesia; 13
267267 (T) anaphylaxis and other emergencies that may occur in an office 14
268268 setting; 15
269269 (U) radiofrequency surgery; 16
270270 (V) postoperative wound care; and 17
271271 (W) clinical or laboratory experience that includes both video 18
272272 demonstration and in vitro observation or participation. 19 BILL AS INTRODUCED H.241
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277277 (2) An optometrist who graduated from an optometric school or college 1
278278 in 2019 or later shall not be required to complete additional postgraduate 2
279279 coursework in order to obtain an advanced therapeutic procedures specialty. 3
280280 (c) Preceptorship requirements; competency demonstration. 4
281281 (1) In order to demonstrate competency for an advanced therapeutic 5
282282 procedures specialty, an optometrist shall complete a preceptorship during 6
283283 which the optometrist gains at least eight hours of clinical training that is 7
284284 supervised by a preceptor and demonstrates clinical proficiency with hands-on 8
285285 experience performing the following procedures on live, human patients: 9
286286 (A) at least two laser trabeculoplasties; 10
287287 (B) at least two posterior capsulotomies; 11
288288 (C) at least two laser peripheral iridotomies; 12
289289 (D) at least two chalazion excisions; 13
290290 (E) at least two chalazion intralesional injections; and 14
291291 (F) at least two excisions or drainages of an authorized lesion of two 15
292292 millimeters or greater in size. 16
293293 (2) The preceptor shall be either: 17
294294 (A) an optometrist with a substantially similar scope of practice who 18
295295 has been licensed in Vermont or any other U.S. jurisdiction to provide the 19
296296 advanced procedures set forth in subdivision 1703(2)(A)(vi) of this chapter for 20
297297 at least three years; or 21 BILL AS INTRODUCED H.241
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302302 (B) an ophthalmologist. 1
303303 (3) The preceptorship shall involve direct and in-person supervision of 2
304304 the optometrist by the preceptor. 3
305305 (4) The preceptorship shall take place in a state in which the preceptor is 4
306306 licensed and authorized to perform the advanced procedures. 5
307307 (5) The preceptor shall certify that the optometrist has competently 6
308308 completed the required procedures and provide a log of the completed 7
309309 procedures to the Board. 8
310310 (d) Examination requirements. The applicant shall successfully pass 9
311311 written and clinical examinations administered by the National Board of 10
312312 Examiners in Optometry (NBEO), including the NBEO Injections Skill 11
313313 Examination (ISE), the NBEO Laser and Surgical Procedures Examination 12
314314 (LSPE), and any other examination required by the Board by rule. 13
315315 (e) Advanced therapeutic procedures specialty by endorsement. 14
316316 (1) The Board may issue an advanced therapeutic procedures specialty 15
317317 to an applicant who is licensed and in good standing in another U.S. 16
318318 jurisdiction and who: 17
319319 (A) has an expanded scope of practice that is substantially equivalent 18
320320 to or broader than the expanded scope of practice permitted by this subchapter; 19
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326326 (B) has been in good standing in the expanded scope of practice in 1
327327 the other jurisdiction for at least three years. 2
328328 (2) An optometrist whose advanced therapeutic procedures specialty 3
329329 was issued by endorsement pursuant to this subsection may serve as a 4
330330 preceptor in this State. 5
331331 § 1725. REPORTING REQUIREMENTS 6
332332 An optometrist shall report any adverse event related to an advanced 7
333333 procedure within 30 days following the event. 8
334334 Sec. 5. 26 V.S.A. § 1727 is redesignated to read: 9
335335 § 1727 1705. EXPIRATION DATE 10
336336 Sec. 6. EFFECTIVE DATE 11
337337 This act shall take effect on January 1, 2027. 12