DOC Access Act of 2019

II 116TH CONGRESS 2D SESSION S. 4894 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 SENATE OF THE UNITED STATES NOVEMBER 12, 2020 Mr. MANCHIN (for himself and Mr. CRAMER) introduced the following bill; which was read twice and referred to the Committee on Health, Edu- cation, Labor, and Pensions 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 04:33 Nov 24, 2020 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S4894.IS S4894 pbinns on DSKJLVW7X2PROD with BILLS 2 •S 4894 IS 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 that, with respect to a doctor of 15 optometry, doctor of dental surgery, or doctor 16 of dental medicine that has an agreement to 17 participate in the plan or coverage and that 18 provides items or services that are not covered 19 services under the plan or coverage to a person 20 enrolled under such plan or coverage, the doctor 21 may charge the enrollee for such items or serv- 22 ices any amount determined by the doctor that 23 is equal to, or less than, the usual and cus- 24 tomary amount that the doctor charges individ- 25 VerDate Sep 11 2014 04:33 Nov 24, 2020 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S4894.IS S4894 pbinns on DSKJLVW7X2PROD with BILLS 3 •S 4894 IS uals who are not so enrolled for such items or 1 services. 2 ‘‘(B) ITEMS OR SERVICES CONSIDERED 3 COVERED BY A PLAN.—For purposes of sub- 4 paragraph (A), an item or service shall be con- 5 sidered, with respect to a plan or coverage, to 6 be covered services under the plan or coverage 7 only if the item or service is an item or service 8 with respect to which the plan or coverage is 9 obligated to pay an amount that is reasonable 10 and is not nominal or de minimis. 11 ‘‘(C) EXCEPTION FOR DENTAL CLEAN- 12 ING.—For purposes of subparagraph (A), a 13 doctor of dental surgery or doctor of dental 14 medicine that has an agreement to participate 15 in the plan or coverage may charge an enrollee 16 only the contracted network fee for any dental 17 cleaning, including any dental cleaning that ex- 18 ceeds the annual maximum under the enrollee’s 19 plan or coverage. 20 ‘‘(2) DURATION OF LIMITED SCOPE VISION AND 21 DENTAL PLANS.—In the case of an agreement be- 22 tween such a doctor and such a plan or coverage 23 that offers limited scope dental or vision benefits— 24 VerDate Sep 11 2014 04:33 Nov 24, 2020 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S4894.IS S4894 pbinns on DSKJLVW7X2PROD with BILLS 4 •S 4894 IS ‘‘(A) the agreement may be extended for a 1 term longer than 2 years only with the prior ac- 2 ceptance of the doctor for each such term ex- 3 tension; and 4 ‘‘(B) the agreement may be extended for 5 unlimited terms, subject to subparagraph (A). 6 ‘‘(3) NO RESTRICTIONS ON CHOICE OF LABORA- 7 TORIES.—The plan or coverage may not, directly or 8 indirectly, restrict or limit, such a doctor’s choice of 9 laboratories or choice of source and suppliers of 10 services or materials provided by the doctor to an in- 11 dividual who is enrolled under the plan or coverage. 12 ‘‘(b) PRIVATE RIGHT OF ACTION.—In addition to 13 any other remedies under State or Federal law, a person 14 adversely affected by a violation of this subsection may 15 bring action for injunctive relief against a plan described 16 in subsection (a) and, upon prevailing, in addition to such 17 injunctive relief shall recover monetary damages of no 18 more than $1,000 for each day found to be in violation 19 plus attorney’s fees and costs. The district courts of the 20 United States shall have exclusive jurisdiction of civil ac- 21 tions brought under this subsection. 22 ‘‘(c) RELATIONSHIP TO EXCEPTION FOR LIMITED, 23 EXCEPTED BENEFITS.—Section 2722(c)(1) shall not 24 apply with respect to the requirements of this section. 25 VerDate Sep 11 2014 04:33 Nov 24, 2020 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S4894.IS S4894 pbinns on DSKJLVW7X2PROD with BILLS 5 •S 4894 IS ‘‘(d) ELECTION TO BE EXCLUDED.— 1 ‘‘(1) IN GENERAL.—If a doctor of optometry, 2 doctor of dental surgery, or doctor of dental medi- 3 cine to which the provisions of paragraphs (1) and 4 (3) of subsection (a) otherwise apply makes an elec- 5 tion under this paragraph (in such form and manner 6 as the Secretary may by regulations prescribe), the 7 requirements of such paragraphs insofar as they 8 apply directly to the plan or coverage shall not apply 9 to such plan or coverage for such period, as de- 10 scribed in paragraph (2). 11 ‘‘(2) PERIOD OF ELECTION.—An election under 12 paragraph (1)— 13 ‘‘(A) shall apply for a single specified plan 14 year; 15 ‘‘(B) may be extended through subsequent 16 elections under this subsection; and 17 ‘‘(C) shall not be available with respect to 18 the requirements concerning the duration of 19 limited scope vision and dental plans under sub- 20 section (a)(2). 21 ‘‘(e) DEFINITIONS.—In this section: 22 ‘‘(1) The term ‘covered services’ means dental 23 care or vision care services for which reimbursement 24 is available under a plan or coverage contract, or for 25 VerDate Sep 11 2014 04:33 Nov 24, 2020 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S4894.IS S4894 pbinns on DSKJLVW7X2PROD with BILLS 6 •S 4894 IS which reimbursement would be available but for the 1 application of contractual limitations, including 2 deductibles, copayments, coinsurance, waiting peri- 3 ods, lifetime maximum, frequency limitations, and 4 alternative benefit payments. 5 ‘‘(2) The terms ‘doctor of dental surgery’ and 6 ‘doctor of dental medicine’ mean a doctor of dental 7 surgery or of dental medicine, as applicable, who is 8 legally authorized to practice dentistry by the State 9 in which the doctor performs such function and who 10 is acting within the scope of the license of the doctor 11 when performing such functions. 12 ‘‘(3) The term ‘doctor of optometry’ means a 13 doctor of optometry who is legally authorized to 14 practice optometry by the State in which the doctor 15 so practices.’’. 16 (b) CONFORMING AMENDMENT.—Section 2722(c)(1) 17 of the Public Health Service Act (42 U.S.C. 300gg– 18 21(c)(1)) is amended by striking ‘‘The requirements’’ and 19 inserting ‘‘Subject to section 2719B, the requirements’’. 20 (c) EXCLUSIVE APPLICABILITY OF STATE LAW.— 21 Notwithstanding any amendment made by this Act, State 22 law that directly affects any standard or requirement re- 23 lating to health insurance issuers and dental or vision ben- 24 efit plans, shall have exclusive application and the amend- 25 VerDate Sep 11 2014 04:33 Nov 24, 2020 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S4894.IS S4894 pbinns on DSKJLVW7X2PROD with BILLS 7 •S 4894 IS ments made by this Act shall not apply to the extent that 1 such State law conflicts with such amendments. The State 2 shall retain exclusive jurisdiction over health insurance 3 issuers and limited scope dental or vision benefit plans 4 that are directly governed by such State. 5 Æ VerDate Sep 11 2014 04:33 Nov 24, 2020 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6301 E:\BILLS\S4894.IS S4894 pbinns on DSKJLVW7X2PROD with BILLS