DOC Access Act of 2023

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. Short title This Act may be cited as the Dental and Optometric Care Access Act of 2023 DOC Access Act of 2023 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 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, or doctor of dental medicine that has an agreement to participate in the plan or coverage and that provides items or services that are not covered services under the plan or coverage to a person enrolled under such plan or coverage, the doctor may charge the enrollee for such items or services any amount determined by the doctor that is equal to, or less than, the usual and customary amount that the doctor 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 or doctor of dental medicine 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 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 the doctor 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, such a doctor’s choice of laboratories or choice of source and suppliers of services or materials provided by the doctor to an individual who is 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, or doctor of dental medicine 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 (2) The terms doctor of dental surgery doctor of dental medicine (3) The term doctor of optometry . (b) Conforming amendment Section 2722(c)(1) of the Public Health Service Act ( 42 U.S.C. 300gg–21(c)(1) The requirements 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.

Summary: Dentist and Optometric Care Access Act of 2023 or the DOC Access Act of 2023 This bill prohibits private health insurance plans from setting rates for items and services, except for dental cleanings, provided by a doctor of optometry, of dental surgery, or of dental medicine for which the plan does not pay a substantial amount. Additionally, an agreement between a plan and such a doctor for limited scope dental or vision benefits may last longer than two years only with the prior acceptance of the doctor for each term extension. Plans also may not restrict such a doctor's choice of laboratories or suppliers. Such doctors may elect to waive the application of the payment amount and choice of laboratories provisions of this bill. The bill does not supersede state laws regarding health insurers and dental or vision benefit plans.