I 

115TH CONGRESS 

1ST SESSION H. R. 1606 

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 

MARCH 17, 2017 

Mr. CARTER of Georgia (for himself, Mr. LOEBSACK, Mr. THOMPSON of Mississippi, Mr. MULLIN, Mr. GOSAR, and Mr. PITTENGER) 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 ‘‘Dentist and Opto5 metric Care Access Act’’ or the ‘‘DOC Access Act’’. 


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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 health insurance coverage (including such a 

10 plan or coverage offering limited scope dental or vision 

11 benefits), the following shall apply: 

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

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

15 shall provide, with respect to a doctor of optom16 etry, doctor of dental surgery, or doctor of den17 tal medicine that has an agreement to partici18 pate in the plan or coverage and that furnishes 

19 items or services that are not covered by the 

20 plan or coverage to a person enrolled under 

21 such plan or coverage that the doctor may 

22 charge the enrollee for such items or services 

23 any amount determined by the doctor that is 

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

25 amount that the doctor charges individuals who 

26 are not so enrolled for such items or services. 


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1 ‘‘(B) ITEMS AND SERVICES CONSIDERED

2 COVERED BY A PLAN.—For purposes of sub3 paragraph (A), an item or service shall be con4 sidered, with respect to a plan or coverage, to 

5 be covered by the plan or coverage only if the 

6 negotiated rate agreed to by such plan or cov7 erage and the doctor for such item or service, 

8 without regard to any cost sharing obligation of 

9 the enrollee, is an amount that is reasonable 

10 and is not nominal or de minimis. 

11 ‘‘(2) CHANGE TO PLANS.—The terms of an 

12 agreement between such a plan or coverage and such 

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

14 that provides for a provider network, the negotiated 

15 rate for providers that participate in the network of 

16 such plan or coverage), may be changed only pursu17 ant to a subsequent agreement signed by the doctor 

18 that documents the acknowledgment and acceptance 

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

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

21 DENTAL PLANS.—In the case of an agreement be22 tween such a doctor and such a plan or coverage 

23 that offers limited scope dental or vision benefits, 

24 the agreement may only extend for a term beyond 


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1 two years with the prior acceptance of the doctor for 

2 each term extension. 

3 ‘‘(4) TERMS AND CONDITIONS FOR ANCILLARY

4 SERVICES AND PROCEDURES.—Such plan or cov5 erage may not deny such a doctor participation in 

6 the plan or coverage or remove such a doctor partici7 pation in the plan or coverage or remove such a doc8 tor from participation in the plan or coverage for the 

9 sole reason of failure of the doctor to accept the 

10 terms and conditions under such agreement for any 

11 ancillary service or procedure. 

12 ‘‘(5) CONDITION TO JOIN A PROVIDER NET13 WORK.—The plan or coverage may not require that 

14 such a doctor must participate with, or be 

15 credentialed by, any specific plan or coverage offer16 ing limited scope dental or vision benefits as a condi17 tion to participate in the provider network of such 

18 plan or coverage. 

19 ‘‘(6) NO INTERFERENCE WITH EXISTING RELA20 TIONSHIPS AND REQUIREMENTS.—Unless otherwise 

21 required by law or regulation, such plan or coverage 

22 may not directly communicate with an individual en23 rolled in such plan or coverage in a manner that 

24 interferes with or contravenes any State or Federal 


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1 requirement, or doctor-patient relationship in exist2 ence at the time of such communication. 

3 ‘‘(7) NO RESTRICTIONS ON CHOICE OF LABORA4 TORIES.—The plan or coverage may not, directly or 

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

6 laboratories or choice of source and suppliers of 

7 services or materials provided by the doctor to an in8 dividual who is enrolled under the plan or coverage. 

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

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

11 adversely affected by a violation of this subsection may 

12 bring action for injunctive relief against a plan described 

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

14 injunctive relief shall recover monetary damages of no 

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

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

17 United States shall have exclusive jurisdiction of civil ac18 tions brought under this subsection. 

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

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

21 apply with respect to the requirements of this section. 

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

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

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

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


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1 legally authorized to practice dentistry by the State 

2 in which the doctor performs such function and who 

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

4 when performing such functions. 

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

6 doctor of optometry who is legally authorized to 

7 practice optometry by the State in which the doctor 

8 so practices.’’. 

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

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

11 21(c)(1)) is amended by striking ‘‘The requirements’’ and 

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

13 (c) EXCLUSIVE APPLICABILITY OF STATE LAW.— 

14 Notwithstanding any provision of this Act, State law, 

15 which directly affects any standard or requirement relat16 ing to health insurance issuers and dental or vision benefit 

17 plans, shall have exclusive application and the provisions 

18 of this Act shall not apply. The State shall retain exclusive 

19 jurisdiction over health insurance issuers and limited 

20 scope dental or vision benefit plans that are governed by 

21 such State. 

Æ 


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