I 
118TH CONGRESS 
1ST SESSION H. R. 1385 
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 7, 2023 
Mr. CARTER of Georgia (for himself, Ms. CLARKE of New York, and Mr. SES-
SIONS) 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 of 2023’’ or the ‘‘DOC Access Act of 
2023’’. 
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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: 
‘‘SEC. 2719B. IMPROVING COVERAGE UNDER VISION AND 
DENTAL PLANS. 
‘‘(a) IN GENERAL.—Under a group health plan or in-
dividual 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 PER-
SONS.— 
‘‘(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 serv-
ices any amount determined by the doctor that 
is equal to, or less than, the usual and cus-
tomary amount that the doctor charges individ-
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uals who are not so enrolled for such items or 
services. 
‘‘(B) ITEMS
OR
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 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
CLEAN-
ING.—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 ex-
ceeds 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 be-
tween such a doctor and such a plan or coverage 
that offers limited scope dental or vision benefits— 
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‘‘(A) the agreement may be extended for a 
term longer than 2 years only with the prior ac-
ceptance of the doctor for each such term ex-
tension; and 
‘‘(B) the agreement may be extended for 
unlimited terms, subject to subparagraph (A). 
‘‘(3) NO RESTRICTIONS 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. 
‘‘(b) NOTIFICATION.—The Secretary shall on an an-
nual 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 sub-
section (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 pur-
poses of subsections (a)(2) and (b) of section 2723. 
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‘‘(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 medi-
cine to which the provisions of paragraphs (1) and 
(3) of subsection (a) otherwise apply makes an elec-
tion 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 de-
scribed 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 sub-
section (a)(2). 
‘‘(e) DEFINITIONS.—In this section: 
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‘‘(1) The term ‘covered services’ means dental 
care or vision care services for which reimbursement 
is available under a plan or coverage contract, or for 
which reimbursement would be available but for the 
application of contractual limitations, including 
deductibles, copayments, coinsurance, waiting peri-
ods, lifetime maximum, frequency limitations, and 
alternative benefit payments. 
‘‘(2) 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. 
‘‘(3) 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.’’. 
(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’’. 
(c) EXCLUSIVE APPLICABILITY OF STATE LAW.— 
Notwithstanding any amendment made by this Act, State 
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law that directly affects any standard or requirement re-
lating to health insurance issuers and dental or vision ben-
efit plans, shall have exclusive application and the amend-
ments 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. 
Æ 
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