,i  #aaith ,,congress  #ast ,session    
,h4 ,r4 #aeba  ,,in ,,the ,,house ,,of  
,,representatives  ,february #bd1       
#bjbe,mr4 ,carter of ,georgia 7for      
himself and ,ms4 ,clarke of ,new ,york7 
introduced the following bill2 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 plans1 
and for other purposes4  #a4 ,short     
title ,this ,act may be cited as the    
,dental and ,optometric ,care ,access   
,act of #bjbe or the ,,doc ,access ,act 
of #bjbe4  #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 
doctor of dental medicine1 or entity    
that employs such a doctor that has an  
agreement to participate in the plan or 
coverage and that provides items or     
services within the scope of practice of
 such a doctor that are not covered     
services under the plan or coverage to a
 person enrolled under such plan or     
coverage1 such doctor or entity may     
charge the enrollee for such items or   
services any amount determined by such  
doctor or entity that is equal to1 or   
less than1 the usual and customary      
amount that such doctor or entity       
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 surgery1 doctor
 of dental medicine1 or entity that     
employs such a doctor 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 or      
entity 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 such 
doctor or entity 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 limit the    
laboratory or source or supplier of     
services or materials that such a doctor
 or entity may choose with respect to   
items and services within the scope of  
practice of such a doctor that are      
provided by such doctor or entity to an 
individual enrolled under the plan or   
coverage4  7b7 ,notification ,the       
,secretary shall on an annual basis     
notify each ,state of the ,state's      
authority to enforce the provisions of  
subsection 7a7 against a group health   
plan or health insurance coverage       
described in subsection 7a7 pursuant to 
section #bgbc7;a77#a7 and request       

confirmation from the ,state whether or 
not the ,state will enforce the         
provisions of subsection 7a74 ,if a     
,state notifies the ,secretary that the 
,state will not enforce the provisions  
of subsection 7a7 or fails to respond   
within #ij days of the ,secretary's     
request1 the ,secretary shall treat such
 ,state as failing to substantially     
enforce such provisions for purposes of 
subsections 7a77#b7 and 7b7 of section  
#bgbc4  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    
doctor of dental medicine1 or entity    
that employs such a doctor 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 plans 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