‘‘(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 
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) CHANGE
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 only extend for a term beyond 
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two years with the prior acceptance of the doctor for 
each term extension. 
‘‘(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 partici-
pation in the plan or coverage or remove such a doc-
tor from participation in the plan or coverage for the 
sole reason of failure of the doctor to accept the 
terms and conditions under such agreement for any 
ancillary 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 
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requirement, or doctor-patient relationship in exist-
ence at the time of such communication. 
‘‘(7) 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) 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 
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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.’’. 
(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 provision of this Act, State law, 
which directly affects any standard or requirement relat-
ing to health insurance issuers and dental or vision benefit 
plans, shall have exclusive application and the provisions 
of this Act shall not apply. The State shall retain exclusive 
jurisdiction over health insurance issuers and limited 
scope dental or vision benefit plans that are governed by 
such State. 
Æ 
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