II 

116TH CONGRESS 

2D SESSION S. 4894 

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 SENATE OF THE UNITED STATES 

NOVEMBER 12, 2020 

Mr. MANCHIN (for himself and Mr. CRAMER) introduced the following bill; 

which was read twice and referred to the Committee on Health, Education, Labor, and Pensions 

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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Dental and Optometric 

5 Care Access Act of 2019’’ or the ‘‘DOC Access Act of 

6 2019’’. 


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1 SEC. 2. IMPROVING HEALTH CARE COVERAGE UNDER VI2 SION AND DENTAL PLANS. 

3 (a) IN GENERAL.—Title XXVII of the Public Health 

4 Service Act is amended by inserting after section 2719A 

5 (42 U.S.C. 300gg–19a) the following new section: 

6 ‘‘SEC. 2719B. IMPROVING COVERAGE UNDER VISION AND 

7 DENTAL PLANS. 

8 ‘‘(a) IN GENERAL.—Under a group health plan or in9 dividual or group health insurance coverage (including 

10 such a plan or coverage offering limited scope dental or 

11 vision benefits), the following shall apply: 

12 ‘‘(1) PAYMENT AMOUNTS FROM COVERED PER13 SONS.— 

14 ‘‘(A) IN GENERAL.—The plan or coverage 

15 shall provide that, with respect to a doctor of 

16 optometry, doctor of dental surgery, or doctor 

17 of dental medicine that has an agreement to 

18 participate in the plan or coverage and that 

19 provides items or services that are not covered 

20 services under the plan or coverage to a person 

21 enrolled under such plan or coverage, the doctor 

22 may charge the enrollee for such items or serv23 ices any amount determined by the doctor that 

24 is equal to, or less than, the usual and cus25 tomary amount that the doctor charges individVerDate Sep 11 2014 04:33 Nov 24, 2020 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S4894.IS S4894

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1 uals who are not so enrolled for such items or 

2 services. 

3 ‘‘(B) ITEMS OR SERVICES CONSIDERED

4 COVERED BY A PLAN.—For purposes of sub5 paragraph (A), an item or service shall be con6 sidered, with respect to a plan or coverage, to 

7 be covered services under the plan or coverage 

8 only if the item or service is an item or service 

9 with respect to which the plan or coverage is 

10 obligated to pay an amount that is reasonable 

11 and is not nominal or de minimis. 

12 ‘‘(C) EXCEPTION FOR DENTAL CLEAN13 ING.—For purposes of subparagraph (A), a 

14 doctor of dental surgery or doctor of dental 

15 medicine that has an agreement to participate 

16 in the plan or coverage may charge an enrollee 

17 only the contracted network fee for any dental 

18 cleaning, including any dental cleaning that ex19 ceeds the annual maximum under the enrollee’s 

20 plan or coverage. 

21 ‘‘(2) DURATION OF LIMITED SCOPE VISION AND

22 DENTAL PLANS.—In the case of an agreement be23 tween such a doctor and such a plan or coverage 

24 that offers limited scope dental or vision benefits— 


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1 ‘‘(A) the agreement may be extended for a 

2 term longer than 2 years only with the prior ac3 ceptance of the doctor for each such term ex4 tension; and 

5 ‘‘(B) the agreement may be extended for 

6 unlimited terms, subject to subparagraph (A). 

7 ‘‘(3) NO RESTRICTIONS ON CHOICE OF LABORA8 TORIES.—The plan or coverage may not, directly or 

9 indirectly, restrict or limit, such a doctor’s choice of 

10 laboratories or choice of source and suppliers of 

11 services or materials provided by the doctor to an in12 dividual who is enrolled under the plan or coverage. 

13 ‘‘(b) PRIVATE RIGHT OF ACTION.—In addition to 

14 any other remedies under State or Federal law, a person 

15 adversely affected by a violation of this subsection may 

16 bring action for injunctive relief against a plan described 

17 in subsection (a) and, upon prevailing, in addition to such 

18 injunctive relief shall recover monetary damages of no 

19 more than $1,000 for each day found to be in violation 

20 plus attorney’s fees and costs. The district courts of the 

21 United States shall have exclusive jurisdiction of civil ac22 tions brought under this subsection. 

23 ‘‘(c) RELATIONSHIP TO EXCEPTION FOR LIMITED, 

24 EXCEPTED BENEFITS.—Section 2722(c)(1) shall not 

25 apply with respect to the requirements of this section. 


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1 ‘‘(d) ELECTION TO BE EXCLUDED.— 

2 ‘‘(1) IN GENERAL.—If a doctor of optometry, 

3 doctor of dental surgery, or doctor of dental medi4 cine to which the provisions of paragraphs (1) and 

5 (3) of subsection (a) otherwise apply makes an elec6 tion under this paragraph (in such form and manner 

7 as the Secretary may by regulations prescribe), the 

8 requirements of such paragraphs insofar as they 

9 apply directly to the plan or coverage shall not apply 

10 to such plan or coverage for such period, as de11 scribed in paragraph (2). 

12 ‘‘(2) PERIOD OF ELECTION.—An election under 

13 paragraph (1)— 

14 ‘‘(A) shall apply for a single specified plan 

15 year; 

16 ‘‘(B) may be extended through subsequent 

17 elections under this subsection; and 

18 ‘‘(C) shall not be available with respect to 

19 the requirements concerning the duration of 

20 limited scope vision and dental plans under sub21 section (a)(2). 

22 ‘‘(e) DEFINITIONS.—In this section: 

23 ‘‘(1) The term ‘covered services’ means dental 

24 care or vision care services for which reimbursement 

25 is available under a plan or coverage contract, or for 


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1 which reimbursement would be available but for the 

2 application of contractual limitations, including 

3 deductibles, copayments, coinsurance, waiting peri4 ods, lifetime maximum, frequency limitations, and 

5 alternative benefit payments. 

6 ‘‘(2) The terms ‘doctor of dental surgery’ and 

7 ‘doctor of dental medicine’ mean a doctor of dental 

8 surgery or of dental medicine, as applicable, who is 

9 legally authorized to practice dentistry by the State 

10 in which the doctor performs such function and who 

11 is acting within the scope of the license of the doctor 

12 when performing such functions. 

13 ‘‘(3) The term ‘doctor of optometry’ means a 

14 doctor of optometry who is legally authorized to 

15 practice optometry by the State in which the doctor 

16 so practices.’’. 

17 (b) CONFORMING AMENDMENT.—Section 2722(c)(1) 

18 of the Public Health Service Act (42 U.S.C. 300gg– 

19 21(c)(1)) is amended by striking ‘‘The requirements’’ and 

20 inserting ‘‘Subject to section 2719B, the requirements’’. 

21 (c) EXCLUSIVE APPLICABILITY OF STATE LAW.— 

22 Notwithstanding any amendment made by this Act, State 

23 law that directly affects any standard or requirement re24 lating to health insurance issuers and dental or vision ben25 efit plans, shall have exclusive application and the amendVerDate Sep 11 2014 04:33 Nov 24, 2020 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S4894.IS S4894

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1 ments made by this Act shall not apply to the extent that 

2 such State law conflicts with such amendments. The State 

3 shall retain exclusive jurisdiction over health insurance 

4 issuers and limited scope dental or vision benefit plans 

5 that are directly governed by such State. 

Æ 


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