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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Dental and Optometric 
Care Access Act’’ or the ‘‘DOC Access Act’’. 
SEC. 2. IMPROVING HEALTH CARE COVERAGE UNDER VI-
SION 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) the following new section: 
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‘‘SEC. 2719B. IMPROVING COVERAGE UNDER VISION AND 
DENTAL PLANS. 
‘‘(a) IN GENERAL.—Under a group health plan or in-
dividual or 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 PER-
SONS.— 
‘‘(A) IN GENERAL.—The plan or coverage 
shall provide, with respect to a doctor of optom-
etry, doctor of dental surgery, or doctor of den-
tal medicine that has an agreement to partici-
pate in the plan or coverage and that furnishes 
items or services that are not covered by the 
plan or coverage to a person enrolled under 
such plan or coverage, that 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
AND
SERVICES
CONSIDERED 
COVERED BY A PLAN.—For purposes of sub-
paragraph (A), an item or service shall be con-
sidered, with respect to a plan or coverage, to 
be covered by the plan or coverage only if the 
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negotiated rate agreed to by such plan or cov-
erage and the doctor for such item or service, 
without regard to any cost sharing obligation of 
the enrollee, is an amount that is reasonable 
and is not nominal or de minimis. 
‘‘(2) CHANGES TO PLANS.—The terms of an 
agreement between such a plan or coverage and such 
a doctor (including, in the case of a plan or coverage 
that provides for a provider network, the negotiated 
rate for providers that participate in the network of 
such plan or coverage), may be changed only pursu-
ant to a subsequent agreement signed by the doctor 
that documents the acknowledgment and acceptance 
of the doctor (as applicable) to such changes. 
‘‘(3) DURATION OF LIMITED SCOPE VISION AND 
DENTAL PLANS.—In the case of an agreement be-
tween such a doctor and such a plan or coverage 
that offers limited scope dental or vision benefits, 
the agreement may not be for a period that is great-
er than two years. 
‘‘(4) TERMS AND CONDITIONS FOR ANCILLARY 
SERVICES
AND
PROCEDURES.—Such plan or cov-
erage may not deny such a doctor participation in 
the plan or coverage or remove such a doctor from 
participation in the plan or coverage for the sole rea-
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son of the failure of the doctor to accept the terms 
and conditions under such agreement for any ancil-
lary service or procedure. 
‘‘(5) CONDITION
TO
JOIN
A
PROVIDER
NET-
WORK.—The plan or coverage may not require that 
such a doctor must participate with, or be 
credentialed by, any specific plan or coverage offer-
ing limited scope dental or vision benefits as a condi-
tion to participate in the provider network of such 
plan or coverage. 
‘‘(6) NO INTERFERENCE WITH EXISTING RELA-
TIONSHIPS AND REQUIREMENTS.—Unless otherwise 
required by law or regulation, such plan or coverage 
may not directly communicate with an individual en-
rolled in such plan or coverage in a manner that 
interferes with or contravenes any State or Federal 
requirement, or doctor-patient relationship in exist-
ence at the time of such communication. 
‘‘(7) NO RESTRICTION ON CHOICE OF LABORA-
TORIES.—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 in-
dividual who is enrolled under the plan or coverage. 
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‘‘(b) PRIVATE RIGHT OF ACTION.—In addition to 
any other remedies under State or Federal law, a person 
adversely affected by a violation of this subsection may 
bring action for injunctive relief against a plan described 
in subsection (a) and, upon prevailing, in addition to such 
injunctive relief, shall recover monetary damages of no 
more than $1,000 for each day found to be in violation 
plus attorney’s fees and costs. The district courts of the 
United States shall have exclusive jurisdiction of civil ac-
tions brought under this subsection. 
‘‘(c) RELATIONSHIP TO EXCEPTION FOR LIMITED, 
EXCEPTED
BENEFITS.—Section 2722(c)(1) shall not 
apply with respect to the requirements of this section. 
‘‘(d) DEFINITIONS.—In this section: 
‘‘(1) The terms ‘doctor of dental surgery’ and 
‘doctor of dental medicine’ mean a doctor of dental 
surgery or of dental medicine, as applicable, who is 
legally authorized to practice dentistry by the State 
in which the doctor performs such function and who 
is acting within the scope of the license of the doctor 
when performing such functions. 
‘‘(2) The term ‘doctor of optometry’ means a 
doctor of optometry who is legally authorized to 
practice optometry by the State in which the doctor 
so practices.’’. 
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(b) CONFORMING AMENDMENT.—Section 2722(c)(1) 
of the Public Health Service Act (42 U.S.C. 300gg– 
21(c)(1)) is amended by striking ‘‘The requirements’’ and 
inserting ‘‘Subject to section 2719B, the requirements’’. 
Æ 
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