119-hr1521

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1521 Introduced in House

    (IH) ]

<DOC>

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

_______________________________________________________________________

 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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