,i  #aae? ,,congress  #a/ ,session  ,h4 
,r4 #afjf  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,m>* #ag1 #bjag,mr4   
,c>t] ( ,georgia 7= himself1 ,mr4       
,loebsack1 ,mr4 ,?ompson ( ,mississippi1
 ,mr4 ,mull91 ,mr4 ,gos>1 & ,mr4        
,pitt5g]7 introduc$ ! foll[+ bill2 :i* 0
 ref]r$ to ! ,committee on ,en]gy &     
,comm]ce  ,a ,,bill  ,to am5d title     
,,xxvii ( ! ,public ,heal? ,s]vice ,act 
to improve heal? c>e cov]age "u vision &
 d5tal plans1 & = o!r purposes4  #a4    
,%ort title ,?is ,act may be cit$ z !   
,d5ti/ & ,optometric ,c>e ,access ,act  
or ! ,,doc ,access ,act4  #b4 ,improv+  
heal? c>e cov]age "u vision & d5tal     
plans  7a7 ,9 g5]al ,title ,,xxvii ( !  
,public ,heal? ,s]vice ,act is am5d$ by 
ins]t+ aft] section #bgai;,a 7#db       
,u4,s4,c4 #cjj;gg-#ai;a7 ! foll[+ new   
section3  #bgai;,b4 ,improv+ cov]age "u 
vision & d5tal plans  7a7 ,9 g5]al ,"u a
 gr\p heal? plan or individual or heal? 
insurance cov]age 7includ+ su* a plan or
 cov]age (f]+ limit$ scope d5tal or     

vision b5efits71 ! foll[+ %all apply3   
7#a7 ,paym5t am\nts f cov]$ p]sons  7,a7
 ,9 g5]al ,! plan or cov]age %all       
provide1 ) respect to a doctor (        
optometry1 doctor ( d5tal surg]y1 or    
doctor ( d5tal m$ic9e t has an agreem5t 
to p>ticipate 9 ! plan or cov]age & t   
furni%es items or s]vices t are n cov]$ 
by ! plan or cov]age to a p]son enroll$ 
"u su* plan or cov]age t ! doctor may   
*>ge ! enrollee = su* items or s]vices  
any am\nt det]m9$ by ! doctor t is equal
 to1 or less ?an1 ! usual & cu/om>y     
am\nt t ! doctor *>ges individuals :o   
are n s enroll$ = su* items or s]vices4 
7,b7 ,items & s]vices consid]$ cov]$ by 
a plan ,= purposes ( subp>agraph 7,a71  
an item or s]vice %all be consid]$1 )   
respect to a plan or cov]age1 to be     
cov]$ by ! plan or cov]age only if !    
negotiat$ rate agre$ to by su* plan or  
cov]age & ! doctor = su* item or s]vice1
 )\t reg>d to any co/ %>+ obligation ( !
 enrollee1 is an am\nt t is reasonable &
 is n nom9al or de m9imis4  7#b7 ,*ange 

to plans ,! t]ms ( an agreem5t betwe5   
su* a plan or cov]age & su* a doctor    
7includ+1 9 ! case ( a plan or cov]age t
 provides = a provid] network1 !        
negotiat$ rate = provid]s t p>ticipate 9
 ! network ( su* plan or cov]age71 may  
be *ang$ only pursuant to a subsequ5t   
agreem5t sign$ by ! doctor t docum5ts ! 
ackn[l$gm5t & acceptance ( ! doctor 7z  
applicable7 to su* *anges4  7#c7        
,duration ( limit$ scope vision & d5tal 
plans ,9 ! case ( an agreem5t betwe5 su*
 a doctor & su* a plan or cov]age t (f]s
 limit$ scope d5tal or vision b5efits1 !
 agreem5t may only ext5d = a t]m beyond 
two ye>s ) ! prior acceptance ( ! doctor
 = ea* t]m ext5sion4  7#d7 ,t]ms &      
conditions = ancill>y s]vices &         
proc$ures ,su* plan or cov]age may n d5y
 su* a doctor p>ticipation 9 ! plan or  
cov]age or remove su* a doctor          
p>ticipation 9 ! plan or cov]age or     
remove su* a doctor f p>ticipation 9 !  
plan or cov]age = ! sole reason (       
failure ( ! doctor to accept ! t]ms &   

conditions "u su* agreem5t = any        
ancill>y s]vice or proc$ure4  7#e7      
,condition to jo9 a provid] network ,!  
plan or cov]age may n require t su* a   
doctor mu/ p>ticipate )1 or be cr$5tial$
 by1 any specific plan or cov]age (f]+  
limit$ scope d5tal or vision b5efits z a
 condition to p>ticipate 9 ! provid]    
network ( su* plan or cov]age4  7#f7 ,no
 int]f]5ce ) exi/+ relation%ips &       
requirem5ts ,unless o!rwise requir$ by  
law or regulation1 su* plan or cov]age  
may n directly communicate ) an         
individual enroll$ 9 su* plan or cov]age
 9 a mann] t int]f]es ) or contrav5es   
any ,/ate or ,f$]al requirem5t1 or      
doctor-pati5t relation%ip 9 exi/5ce at !
 "t ( su* communication4  7#g7 ,no      
re/rictions on *oice ( laboratories ,!  
plan or cov]age may n1 directly or      
indirectly1 re/rict or limit1 su* a     
doctor's *oice ( laboratories or *oice (
 s\rce & suppli]s ( s]vices or mat]ials 
provid$ by ! doctor to an individual :o 
is enroll$ "u ! plan or cov]age4  7b7   

,private "r ( action ,9 addition to any 
o!r rem$ies "u ,/ate or ,f$]al law1 a   
p]son adv]sely affect$ by a violation ( 
?is subsection may br+ action =         
injunctive relief aga9/ a plan describ$ 
9 subsection 7a7 &1 ^u prevail+1 9      
addition to su* injunctive relief %all  
recov] monet>y damages ( no m ?an #a1jjj
 = ea* day f\nd to be 9 violation plus  
attorney's fees & co/s4 ,! di/rict c\rts
 ( ! ,unit$ ,/ates %all h exclusive     
jurisdiction ( civil actions br\ght "u  
?is subsection4  7c7 ,relation%ip to    
exception = limit$1 except$ b5efits     
,section #bgbb7;c77#a7 %all n apply )   
respect to ! requirem5ts ( ?is section4 
7d7 ,def9itions ,9 ?is section3  7#a7 ,!
 t]ms doctor ( d5tal surg]y & doctor (  
d5tal m$ic9e mean a doctor ( d5tal      
surg]y or ( d5tal m$ic9e1 z applicable1 
:o is legally au?oriz$ to practice      
d5ti/ry by ! ,/ate 9 :i* ! doctor p]=ms 
su* function & :o is act+ )9 ! scope ( !
 lic5se ( ! doctor :5 p]=m+ su*         
functions4  7#b7 ,! t]m doctor (        

optometry means a doctor ( optometry :o 
is legally au?oriz$ to practice         
optometry by ! ,/ate 9 :i* ! doctor s   
practices4  4  7b7 ,con=m+ am5dm5t      
,section #bgbb7;c77#a7 ( ! ,public      
,heal? ,s]vice ,act 7#db ,u4,s4,c4      
#cjj;gg-#ba7;c77#a77 is am5d$ by /rik+  
,! requirem5ts & ins]t+ ,subject to     
section #bgai;,b1 ! requirem5ts4  7c7   
,exclusive applicability ( /ate law     
,not)/&+ any provision ( ?is ,act1 ,/ate
 law1 :i* directly affects any /&>d or  
requirem5t relat+ to heal? insurance    
issu]s & d5tal or vision b5efit plans1  
%all h exclusive application & !        
provisions ( ?is ,act %all n apply4 ,!  
,/ate %all reta9 exclusive jurisdiction 
ov] heal? insurance issu]s & limit$     
scope d5tal or vision b5efit plans t are
 gov]n$ by su* ,/ate4