I 

114TH CONGRESS 

1ST SESSION H. R. 3323 

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 

JULY 29, 2015 

Mr. CARTER of Georgia 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. 

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’’ or the ‘‘DOC Access Act’’. 

6 SEC. 2. IMPROVING HEALTH CARE COVERAGE UNDER VI7 SION AND DENTAL PLANS. 

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

9 Service Act is amended by inserting after section 2719A 

10 (42 U.S.C. 300gg–19a) the following new section: 


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

2 DENTAL PLANS. 

3 ‘‘(a) IN GENERAL.—Under a group health plan or in4 dividual or health insurance coverage (including such a 

5 plan or coverage offering limited scope dental or vision 

6 benefits), the following shall apply: 

7 ‘‘(1) PAYMENT AMOUNTS FROM COVERED PER8 SONS.— 

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

10 shall provide, with respect to a doctor of optom11 etry, doctor of dental surgery, or doctor of den12 tal medicine that has an agreement to partici13 pate in the plan or coverage and that furnishes 

14 items or services that are not covered by the 

15 plan or coverage to a person enrolled under 

16 such plan or coverage, that the doctor may 

17 charge the enrollee for such items or services 

18 any amount determined by the doctor that is 

19 equal to, or less than, the usual and customary 

20 amount that the doctor charges individuals who 

21 are not so enrolled for such items or services. 

22 ‘‘(B) ITEMS AND SERVICES CONSIDERED

23 COVERED BY A PLAN.—For purposes of sub24 paragraph (A), an item or service shall be con25 sidered, with respect to a plan or coverage, to 

26 be covered by the plan or coverage only if the 


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1 negotiated rate agreed to by such plan or cov2 erage and the doctor for such item or service, 

3 without regard to any cost sharing obligation of 

4 the enrollee, is an amount that is reasonable 

5 and is not nominal or de minimis. 

6 ‘‘(2) CHANGES TO PLANS.—The terms of an 

7 agreement between such a plan or coverage and such 

8 a doctor (including, in the case of a plan or coverage 

9 that provides for a provider network, the negotiated 

10 rate for providers that participate in the network of 

11 such plan or coverage), may be changed only pursu12 ant to a subsequent agreement signed by the doctor 

13 that documents the acknowledgment and acceptance 

14 of the doctor (as applicable) to such changes. 

15 ‘‘(3) DURATION OF LIMITED SCOPE VISION AND

16 DENTAL PLANS.—In the case of an agreement be17 tween such a doctor and such a plan or coverage 

18 that offers limited scope dental or vision benefits, 

19 the agreement may not be for a period that is great20 er than two years. 

21 ‘‘(4) TERMS AND CONDITIONS FOR ANCILLARY

22 SERVICES AND PROCEDURES.—Such plan or cov23 erage may not deny such a doctor participation in 

24 the plan or coverage or remove such a doctor from 

25 participation in the plan or coverage for the sole reaVerDate Sep 11 2014 05:07 Aug 04, 2015 Jkt 049200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H3323.IH H3323

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1 son of the failure of the doctor to accept the terms 

2 and conditions under such agreement for any ancil3 lary service or procedure. 

4 ‘‘(5) CONDITION TO JOIN A PROVIDER NET5 WORK.—The plan or coverage may not require that 

6 such a doctor must participate with, or be 

7 credentialed by, any specific plan or coverage offer8 ing limited scope dental or vision benefits as a condi9 tion to participate in the provider network of such 

10 plan or coverage. 

11 ‘‘(6) NO INTERFERENCE WITH EXISTING RELA12 TIONSHIPS AND REQUIREMENTS.—Unless otherwise 

13 required by law or regulation, such plan or coverage 

14 may not directly communicate with an individual en15 rolled in such plan or coverage in a manner that 

16 interferes with or contravenes any State or Federal 

17 requirement, or doctor-patient relationship in exist18 ence at the time of such communication. 

19 ‘‘(7) NO RESTRICTION ON CHOICE OF LABORA20 TORIES.—The plan or coverage may not, directly or 

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

22 laboratories or choice of source and suppliers of 

23 services or materials provided by the doctor to an in24 dividual who is enrolled under the plan or coverage. 


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

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

3 adversely affected by a violation of this subsection may 

4 bring action for injunctive relief against a plan described 

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

6 injunctive relief, shall recover monetary damages of no 

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

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

9 United States shall have exclusive jurisdiction of civil ac10 tions brought under this subsection. 

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

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

13 apply with respect to the requirements of this section. 

14 ‘‘(d) DEFINITIONS.—In this section: 

15 ‘‘(1) The terms ‘doctor of dental surgery’ and 

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

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

18 legally authorized to practice dentistry by the State 

19 in which the doctor performs such function and who 

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

21 when performing such functions. 

22 ‘‘(2) The term ‘doctor of optometry’ means a 

23 doctor of optometry who is legally authorized to 

24 practice optometry by the State in which the doctor 

25 so practices.’’. 


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

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

3 21(c)(1)) is amended by striking ‘‘The requirements’’ and 

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

Æ 


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