,,ii #aafth ,,congress #b;d ,session ,s4 #dhid ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,november #ab1 #bjbj,mr4 ,manchin 7for himself and ,mr4 ,cramer7 introduced the following bill2 which was read twice and referred to the ,committee on ,health1 ,education1 ,labor1 and ,pensions ,a ,,bill ,to amend title ,,xxvii of the ,public ,health ,service ,act to improve health care coverage under vision and dental plans1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,dental and ,optometric ,care ,access ,act of #bjai or the ,,doc ,access ,act of #bjai4 #b4 ,improving health care coverage under vision and dental plans 7a7 ,in general ,title ,,xxvii of the ,public ,health ,service ,act is amended by inserting after section #bgai;,a 7#db ,u4,s4,c4 #cjj;gg-#ai;a7 the following new section3 #bgai;,b4 ,improving coverage under vision and dental plans 7a7 ,in general ,under a group health plan or individual or group health insurance coverage 7including such a plan or coverage offering limited scope dental or vision benefits71 the following shall apply3 7#a7 ,payment amounts from covered persons 7,a7 ,in general ,the plan or coverage shall provide that1 with respect to a doctor of optometry1 doctor of dental surgery1 or doctor of dental medicine that has an agreement to participate in the plan or coverage and that provides items or services that are not covered services under the plan or coverage to a person enrolled under such plan or coverage1 the doctor may charge the enrollee for such items or services any amount determined by the doctor that is equal to1 or less than1 the usual and customary amount that the doctor charges individuals who are not so enrolled for such items or services4 7,b7 ,items or services considered covered by a plan ,for purposes of subparagraph 7,a71 an item or service shall be considered1 with respect to a plan or coverage1 to be covered services under the plan or coverage only if the item or service is an item or service with respect to which the plan or coverage is obligated to pay an amount that is reasonable and is not nominal or de minimis4 7,c7 ,exception for dental cleaning ,for purposes of subparagraph 7,a71 a doctor of dental surgery or doctor of dental medicine that has an agreement to participate in the plan or coverage may charge an enrollee only the contracted network fee for any dental cleaning1 including any dental cleaning that exceeds the annual maximum under the enrollee's plan or coverage4 7#b7 ,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-- 7,a7 the agreement may be extended for a term longer than #b years only with the prior acceptance of the doctor for each such term extension2 and 7,b7 the agreement may be extended for unlimited terms1 subject to subparagraph 7,a74 7#c7 ,no restrictions on choice of laboratories ,the plan or coverage may not1 directly or indirectly1 restrict or limit1 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 coverage4 7b7 ,private right of action ,in addition to any other remedies under ,state or ,federal law1 a person adversely affected by a violation of this subsection may bring action for injunctive relief against a plan described in subsection 7a7 and1 upon prevailing1 in addition to such injunctive relief shall recover monetary damages of no more than #a1jjj for each day found to be in violation plus attorney's fees and costs4 ,the district courts of the ,united ,states shall have exclusive jurisdiction of civil actions brought under this subsection4 7c7 ,relationship to exception for limited1 excepted benefits ,section #bgbb7;c77#a7 shall not apply with respect to the requirements of this section4 7d7 ,election ,to be excluded 7#a7 ,in general ,if a doctor of optometry1 doctor of dental surgery1 or doctor of dental medicine to which the provisions of paragraphs 7#a7 and 7#c7 of subsection 7a7 otherwise apply makes an election under this paragraph 7in such form and manner as the ,secretary may by regulations prescribe71 the requirements of such paragraphs insofar as they apply directly to the plan or coverage shall not apply to such plan or coverage for such period1 as described in paragraph 7#b74 7#b7 ,period of election ,an election under paragraph 7#a7-- 7,a7 shall apply for a single specified plan year2 7,b7 may be extended through subsequent elections under this subsection2 and 7,c7 shall not be available with respect to the requirements concerning the duration of limited scope vision and dental plans under subsection 7a77#b74 7e7 ,definitions ,in this section3 7#a7 ,the term covered services means dental care or vision care services for which reimbursement is available under a plan or coverage contract1 or for which reimbursement would be available but for the application of contractual limitations1 including deductibles1 copayments1 coinsurance1 waiting periods1 lifetime maximum1 frequency limitations1 and alternative benefit payments4 7#b7 ,the terms doctor of dental surgery and doctor of dental medicine mean a doctor of dental surgery or of dental medicine1 as applicable1 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 functions4 7#c7 ,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 practices4 4 7b7 ,conforming amendment ,section #bgbb7;c77#a7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ba7;c77#a77 is amended by striking ,the requirements and inserting ,subject to section #bgai;,b1 the requirements4 7c7 ,exclusive applicability of ,state law ,notwithstanding any amendment made by this ,act1 ,state law that directly affects any standard or requirement relating to health insurance issuers and dental or vision benefit plans1 shall have exclusive application and the amendments made by this ,act shall not apply to the extent that such ,state law conflicts with such amendments4 ,the ,state shall retain exclusive jurisdiction over health insurance issuers and limited scope dental or vision benefit plans that are directly governed by such ,state4