Title: DOC Access Act
Policy area: Health

Summary:
Dentist and Optometric Care Access Act or the DOC Access Act
This bill amends the Public Health Service Act to prohibit group health plans and individual health insurance coverage from setting rates for items and services provided by a doctor of optometry, of dental surgery, or of dental medicine for which the plan or insurer does not pay a substantial amount.
An agreement between a plan or insurer and such a doctor: (1) may only be changed with the doctor's acknowledgement and acceptance, and (2) may last longer than two years only with the prior acceptance of the doctor for each term extension if the agreement is for limited scope dental or vision benefits.
Such a doctor must be allowed to participate in: (1) a plan or coverage without accepting terms for ancillary services or procedures, and (2) a provider network without participating in a specific limited scope dental or vision benefit plan.
Plans and insurers may not: (1) directly communicate with an enrolled individual in a manner that interferes with an existing doctor-patient relationship or a state or federal requirement, or (2) restrict such a doctor's choice of laboratories or suppliers.
The bill establishes a private right of action for a person adversely affected by a violation of this bill.
The bill is preempted by state laws regarding health insurers and dental or vision benefit plans.

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1606 Introduced in House (IH)]

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115th CONGRESS
  1st Session
                                H. R. 1606

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 17, 2017

   Mr. Carter of Georgia (for himself, Mr. Loebsack, Mr. Thompson of 
 Mississippi, Mr. Mullin, Mr. Gosar, and Mr. Pittenger) 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 Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Dentist and Optometric Care Access 
Act'' or the ``DOC Access Act''.

SEC. 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) the 
following new section:

``SEC. 2719B. IMPROVING COVERAGE UNDER VISION AND DENTAL PLANS.

    ``(a) In General.--Under a group health plan or individual 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 persons.--
                    ``(A) In general.--The plan or coverage shall 
                provide, 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 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 subparagraph (A), an item or 
                service shall be considered, 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 coverage 
                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 
        pursuant 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 between 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 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 coverage may not deny such a doctor 
        participation in the plan or coverage or remove such a doctor 
        participation in the plan or coverage or remove such a doctor 
        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 network.--The plan or 
        coverage may not require that such a doctor must participate 
        with, or be credentialed by, any specific plan or coverage 
        offering limited scope dental or vision benefits as a condition 
        to participate in the provider network of such plan or 
        coverage.
            ``(6) No interference with existing relationships and 
        requirements.--Unless otherwise required by law or regulation, 
        such plan or coverage may not directly communicate with an 
        individual enrolled in such plan or coverage in a manner that 
        interferes with or contravenes any State or Federal 
        requirement, or doctor-patient relationship in existence at the 
        time of such communication.
            ``(7) 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) 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 actions 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.''.
    (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 relating 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.
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