DOC Access Act of 2019

I 116TH CONGRESS 1ST SESSION H. R. 3762 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 15, 2019 Mr. LOEBSACK (for himself, Mr. CARTER of Georgia, Mr. GOSAR, Mr. VAN DREW, Mr. SIMPSON, Ms. CLARKE of New York, Mr. FERGUSON, and Mr. POCAN) introduced the following bill; which was referred to the Com- mittee 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- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Dental and Optometric 4 Care Access Act of 2019’’ or the ‘‘DOC Access Act of 5 2019’’. 6 VerDate Sep 11 2014 21:48 Jul 23, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H3762.IH H3762 kjohnson on DSK79L0C42 with BILLS 2 •HR 3762 IH SEC. 2. IMPROVING HEALTH CARE COVERAGE UNDER VI- 1 SION AND DENTAL PLANS. 2 (a) IN GENERAL.—Title XXVII of the Public Health 3 Service Act is amended by inserting after section 2719A 4 (42 U.S.C. 300gg–19a) the following new section: 5 ‘‘SEC. 2719B. IMPROVING COVERAGE UNDER VISION AND 6 DENTAL PLANS. 7 ‘‘(a) IN GENERAL.—Under a group health plan or in- 8 dividual or group health insurance coverage (including 9 such a plan or coverage offering limited scope dental or 10 vision benefits), the following shall apply: 11 ‘‘(1) PAYMENT AMOUNTS FROM COVERED PER- 12 SONS.— 13 ‘‘(A) IN GENERAL.—The plan or coverage 14 shall provide, with respect to a doctor of optom- 15 etry, doctor of dental surgery, or doctor of den- 16 tal medicine that has an agreement to partici- 17 pate in the plan or coverage and that furnishes 18 items or services that are not covered by the 19 plan or coverage to a person enrolled under 20 such plan or coverage that the doctor may 21 charge the enrollee for such items or services 22 any amount determined by the doctor that is 23 equal to, or less than, the usual and customary 24 amount that the doctor charges individuals who 25 are not so enrolled for such items or services. 26 VerDate Sep 11 2014 21:48 Jul 23, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3762.IH H3762 kjohnson on DSK79L0C42 with BILLS 3 •HR 3762 IH ‘‘(B) ITEMS AND SERVICES CONSIDERED 1 COVERED BY A PLAN.—For purposes of sub- 2 paragraph (A), an item or service shall be con- 3 sidered, with respect to a plan or coverage, to 4 be covered by the plan or coverage only if the 5 item or service is an item or service with re- 6 spect to which the plan or coverage is obligated 7 to pay an amount that is reasonable and is not 8 nominal or de minimis. 9 ‘‘(2) DURATION OF LIMITED SCOPE VISION AND 10 DENTAL PLANS.—In the case of an agreement be- 11 tween such a doctor and such a plan or coverage 12 that offers limited scope dental or vision benefits, 13 the agreement may only extend for a term beyond 14 two years with the prior acceptance of the doctor for 15 each term extension. 16 ‘‘(3) NO RESTRICTIONS ON CHOICE OF LABORA- 17 TORIES.—The plan or coverage may not, directly or 18 indirectly, restrict or limit, such a doctor’s choice of 19 laboratories or choice of source and suppliers of 20 services or materials provided by the doctor to an in- 21 dividual who is enrolled under the plan or coverage. 22 ‘‘(b) PRIVATE RIGHT OF ACTION.—In addition to 23 any other remedies under State or Federal law, a person 24 adversely affected by a violation of this subsection may 25 VerDate Sep 11 2014 21:48 Jul 23, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H3762.IH H3762 kjohnson on DSK79L0C42 with BILLS 4 •HR 3762 IH bring action for injunctive relief against a plan described 1 in subsection (a) and, upon prevailing, in addition to such 2 injunctive relief shall recover monetary damages of no 3 more than $1,000 for each day found to be in violation 4 plus attorney’s fees and costs. The district courts of the 5 United States shall have exclusive jurisdiction of civil ac- 6 tions brought under this subsection. 7 ‘‘(c) RELATIONSHIP TO EXCEPTION FOR LIMITED, 8 EXCEPTED BENEFITS.—Section 2722(c)(1) shall not 9 apply with respect to the requirements of this section. 10 ‘‘(d) DEFINITIONS.—In this section: 11 ‘‘(1) The terms ‘doctor of dental surgery’ and 12 ‘doctor of dental medicine’ mean a doctor of dental 13 surgery or of dental medicine, as applicable, who is 14 legally authorized to practice dentistry by the State 15 in which the doctor performs such function and who 16 is acting within the scope of the license of the doctor 17 when performing such functions. 18 ‘‘(2) The term ‘doctor of optometry’ means a 19 doctor of optometry who is legally authorized to 20 practice optometry by the State in which the doctor 21 so practices.’’. 22 (b) CONFORMING AMENDMENT.—Section 2722(c)(1) 23 of the Public Health Service Act (42 U.S.C. 300gg– 24 VerDate Sep 11 2014 21:48 Jul 23, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H3762.IH H3762 kjohnson on DSK79L0C42 with BILLS 5 •HR 3762 IH 21(c)(1)) is amended by striking ‘‘The requirements’’ and 1 inserting ‘‘Subject to section 2719B, the requirements’’. 2 (c) EXCLUSIVE APPLICABILITY OF STATE LAW.— 3 Notwithstanding any provision of this Act, State law, 4 which directly affects any standard or requirement relat- 5 ing to health insurance issuers and dental or vision benefit 6 plans, shall have exclusive application and the provisions 7 of this Act shall not apply. The State shall retain exclusive 8 jurisdiction over health insurance issuers and limited 9 scope dental or vision benefit plans that are directly gov- 10 erned by such State. 11 Æ VerDate Sep 11 2014 21:48 Jul 23, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6301 E:\BILLS\H3762.IH H3762 kjohnson on DSK79L0C42 with BILLS