[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1521 Introduced in House (IH)]
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119th CONGRESS
1st Session
H. R. 1521
To amend title XXVII of the Public Health Service Act to improve health
care coverage under vision and dental plans, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
February 24, 2025
Mr. Carter of Georgia (for himself and Ms. Clarke of New York)
introduced the following bill; which was referred to the Committee on
Energy and Commerce
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A BILL
To amend title XXVII of the Public Health Service Act to improve health
care coverage under vision and dental plans, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Dental and Optometric Care Access
Act of 2025'' or the ``DOC Access Act of 2025''.
SEC. 2. IMPROVING HEALTH CARE COVERAGE UNDER VISION AND DENTAL PLANS.
(a) In General.--Title XXVII of the Public Health Service Act is
amended by inserting after section 2719A (42 U.S.C. 300gg-19a) the
following new section:
``SEC. 2719B. IMPROVING COVERAGE UNDER VISION AND DENTAL PLANS.
``(a) In General.--Under a group health plan or individual or group
health insurance coverage (including such a plan or coverage offering
limited scope dental or vision benefits), the following shall apply:
``(1) Payment amounts from covered persons.--
``(A) In general.--The plan or coverage shall
provide that, with respect to a doctor of optometry,
doctor of dental surgery, doctor of dental medicine, or
entity that employs such a doctor that has an agreement
to participate in the plan or coverage and that
provides items or services within the scope of practice
of such a doctor that are not covered services under
the plan or coverage to a person enrolled under such
plan or coverage, such doctor or entity may charge the
enrollee for such items or services any amount
determined by such doctor or entity that is equal to,
or less than, the usual and customary amount that such
doctor or entity charges individuals who are not so
enrolled for such items or services.
``(B) Items or services considered covered by a
plan.--For purposes of subparagraph (A), an item or
service shall be considered, with respect to a plan or
coverage, to be covered services under the plan or
coverage only if the item or service is an item or
service with respect to which the plan or coverage is
obligated to pay an amount that is reasonable and is
not nominal or de minimis.
``(C) Exception for dental cleaning.--For purposes
of subparagraph (A), a doctor of dental surgery, doctor
of dental medicine, or entity that employs such a
doctor that has an agreement to participate in the plan
or coverage may charge an enrollee only the contracted
network fee for any dental cleaning, including any
dental cleaning that exceeds the annual maximum under
the enrollee's plan or coverage.
``(2) Duration of limited scope vision and dental plans.--
In the case of an agreement between such a doctor or entity and
such a plan or coverage that offers limited scope dental or
vision benefits--
``(A) the agreement may be extended for a term
longer than 2 years only with the prior acceptance of
such doctor or entity for each such term extension; and
``(B) the agreement may be extended for unlimited
terms, subject to subparagraph (A).
``(3) No restrictions on choice of laboratories.--The plan
or coverage may not, directly or indirectly, restrict or limit
the laboratory or source or supplier of services or materials
that such a doctor or entity may choose with respect to items
and services within the scope of practice of such a doctor that
are provided by such doctor or entity to an individual enrolled
under the plan or coverage.
``(b) Notification.--The Secretary shall on an annual basis notify
each State of the State's authority to enforce the provisions of
subsection (a) against a group health plan or health insurance coverage
described in subsection (a) pursuant to section 2723(a)(1) and request
confirmation from the State whether or not the State will enforce the
provisions of subsection (a). If a State notifies the Secretary that
the State will not enforce the provisions of subsection (a) or fails to
respond within 90 days of the Secretary's request, the Secretary shall
treat such State as failing to substantially enforce such provisions
for purposes of subsections (a)(2) and (b) of section 2723.
``(c) Relationship to Exception for Limited, Excepted Benefits.--
Section 2722(c)(1) shall not apply with respect to the requirements of
this section.
``(d) Election To Be Excluded.--
``(1) In general.--If a doctor of optometry, doctor of
dental surgery, doctor of dental medicine, or entity that
employs such a doctor to which the provisions of paragraphs (1)
and (3) of subsection (a) otherwise apply makes an election
under this paragraph (in such form and manner as the Secretary
may by regulations prescribe), the requirements of such
paragraphs insofar as they apply directly to the plan or
coverage shall not apply to such plan or coverage for such
period, as described in paragraph (2).
``(2) Period of election.--An election under paragraph
(1)--
``(A) shall apply for a single specified plan year;
``(B) may be extended through subsequent elections
under this subsection; and
``(C) shall not be available with respect to the
requirements concerning the duration of limited scope
vision and dental plans under subsection (a)(2).
``(e) Definitions.--In this section:
``(1) The term `covered services' means dental care or
vision care services for which reimbursement is available under
a plan or coverage contract, or for which reimbursement would
be available but for the application of contractual
limitations, including deductibles, copayments, coinsurance,
waiting periods, lifetime maximum, frequency limitations, and
alternative benefit payments.
``(2) The terms `doctor of dental surgery' and `doctor of
dental medicine' mean a doctor of dental surgery or of dental
medicine, as applicable, who is legally authorized to practice
dentistry by the State in which the doctor performs such
function and who is acting within the scope of the license of
the doctor when performing such functions.
``(3) The term `doctor of optometry' means a doctor of
optometry who is legally authorized to practice optometry by
the State in which the doctor so practices.''.
(b) Conforming Amendment.--Section 2722(c)(1) of the Public Health
Service Act (42 U.S.C. 300gg-21(c)(1)) is amended by striking ``The
requirements'' and inserting ``Subject to section 2719B, the
requirements''.
(c) Exclusive Applicability of State Law.--Notwithstanding any
amendment made by this Act, State law that directly affects any
standard or requirement relating to health insurance issuers and dental
or vision benefit plans shall have exclusive application and the
amendments made by this Act shall not apply to the extent that such
State law conflicts with such amendments. The State shall retain
exclusive jurisdiction over health insurance issuers and limited scope
dental or vision benefit plans that are directly governed by such
State.
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