I 

116TH CONGRESS 

1ST SESSION H. R. 3762 

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 15, 2019 

Mr. LOEBSACK (for himself, Mr. CARTER of Georgia, Mr. GOSAR, Mr. VAN

DREW, Mr. SIMPSON, Ms. CLARKE of New York, Mr. FERGUSON, and 

Mr. POCAN) 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 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, 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 item or service is an item or service with re7 spect to which the plan or coverage is obligated 

8 to pay an amount that is reasonable and is not 

9 nominal or de minimis. 

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

11 DENTAL PLANS.—In the case of an agreement be12 tween such a doctor and such a plan or coverage 

13 that offers limited scope dental or vision benefits, 

14 the agreement may only extend for a term beyond 

15 two years with the prior acceptance of the doctor for 

16 each term extension. 

17 ‘‘(3) NO RESTRICTIONS ON CHOICE OF LABORA18 TORIES.—The plan or coverage may not, directly or 

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

20 laboratories or choice of source and suppliers of 

21 services or materials provided by the doctor to an in22 dividual who is enrolled under the plan or coverage. 

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

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

25 adversely affected by a violation of this subsection may 


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1 bring action for injunctive relief against a plan described 

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

3 injunctive relief shall recover monetary damages of no 

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

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

6 United States shall have exclusive jurisdiction of civil ac7 tions brought under this subsection. 

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

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

10 apply with respect to the requirements of this section. 

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

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

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

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

15 legally authorized to practice dentistry by the State 

16 in which the doctor performs such function and who 

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

18 when performing such functions. 

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

20 doctor of optometry who is legally authorized to 

21 practice optometry by the State in which the doctor 

22 so practices.’’. 

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

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


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

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

3 (c) EXCLUSIVE APPLICABILITY OF STATE LAW.— 

4 Notwithstanding any provision of this Act, State law, 

5 which directly affects any standard or requirement relat6 ing to health insurance issuers and dental or vision benefit 

7 plans, shall have exclusive application and the provisions 

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

9 jurisdiction over health insurance issuers and limited 

10 scope dental or vision benefit plans that are directly gov11 erned by such State. 

Æ 


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