,i #aai? ,,congress #a/ ,session ,h4 ,r4 #aeba ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,febru>y #bd1 #bjbe,mr4 ,c>t] ( ,georgia 7= himself & ,ms4 ,cl>ke ( ,new ,york7 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 ! ,d5tal & ,optometric ,c>e ,access ,act ( #bjbe or ! ,,doc ,access ,act ( #bjbe4 #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 gr\p 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 provide t1 ) respect to a doctor ( optometry1 doctor ( d5tal surg]y1 doctor ( d5tal m$ic9e1 or entity t employs su* a doctor t has an agreem5t to p>ticipate 9 ! plan or cov]age & t provides items or s]vices )9 ! scope ( practice ( su* a doctor t are n cov]$ s]vices "u ! plan or cov]age to a p]son enroll$ "u su* plan or cov]age1 su* doctor or entity may *>ge ! enrollee = su* items or s]vices any am\nt det]m9$ by su* doctor or entity t is equal to1 or less ?an1 ! usual & cu/om>y am\nt t su* doctor or entity *>ges individuals :o are n s enroll$ = su* items or s]vices4 7,b7 ,items or s]vices consid]$ cov]$ by a plan ,= purposes ( subp>agraph 7,a71 an item or s]vice %all be consid]$1 ) respect to a plan or cov]age1 to be cov]$ s]vices "u ! plan or cov]age only if ! item or s]vice is an item or s]vice ) respect to :i* ! plan or cov]age is obligat$ to pay an am\nt t is reasonable & is n nom9al or de m9imis4 7,c7 ,exception = d5tal clean+ ,= purposes ( subp>agraph 7,a71 a doctor ( d5tal surg]y1 doctor ( d5tal m$ic9e1 or entity t employs su* a doctor t has an agreem5t to p>ticipate 9 ! plan or cov]age may *>ge an enrollee only ! contract$ network fee = any d5tal clean+1 includ+ any d5tal clean+ t exce$s ! annual maximum "u ! enrollee's plan or cov]age4 7#b7 ,duration ( limit$ scope vision & d5tal plans ,9 ! case ( an agreem5t betwe5 su* a doctor or entity & su* a plan or cov]age t (f]s limit$ scope d5tal or vision b5efits-- 7,a7 ! agreem5t may be ext5d$ = a t]m long] ?an #b ye>s only ) ! prior acceptance ( su* doctor or entity = ea* su* t]m ext5sion2 & 7,b7 ! agreem5t may be ext5d$ = unlimit$ t]ms1 subject to subp>agraph 7,a74 7#c7 ,no re/rictions on *oice ( laboratories ,! plan or cov]age may n1 directly or indirectly1 re/rict or limit ! laboratory or s\rce or suppli] ( s]vices or mat]ials t su* a doctor or entity may *oose ) respect to items & s]vices )9 ! scope ( practice ( su* a doctor t are provid$ by su* doctor or entity to an individual enroll$ "u ! plan or cov]age4 7b7 ,notification ,! ,secret>y %all on an annual basis notify ea* ,/ate ( ! ,/ate's au?ority to en=ce ! provisions ( subsection 7a7 aga9/ a gr\p heal? plan or heal? insurance cov]age describ$ 9 subsection 7a7 pursuant to section #bgbc7;a77#a7 & reque/ confirmation f ! ,/ate :e!r or n ! ,/ate w en=ce ! provisions ( subsection 7a74 ,if a ,/ate notifies ! ,secret>y t ! ,/ate w n en=ce ! provisions ( subsection 7a7 or fails to respond )9 #ij days ( ! ,secret>y's reque/1 ! ,secret>y %all treat su* ,/ate z fail+ to sub/antially en=ce su* provisions = purposes ( subsections 7a77#b7 & 7b7 ( section #bgbc4 7c7 ,relation%ip to exception = limit$1 except$ b5efits ,section #bgbb7;c77#a7 %all n apply ) respect to ! requirem5ts ( ?is section4 7d7 ,election ,to be exclud$ 7#a7 ,9 g5]al ,if a doctor ( optometry1 doctor ( d5tal surg]y1 doctor ( d5tal m$ic9e1 or entity t employs su* a doctor to :i* ! provisions ( p>agraphs 7#a7 & 7#c7 ( subsection 7a7 o!rwise apply makes an election "u ?is p>agraph 79 su* =m & mann] z ! ,secret>y may by regulations prescribe71 ! requirem5ts ( su* p>agraphs ins(> z !y apply directly to ! plan or cov]age %all n apply to su* plan or cov]age = su* p]iod1 z describ$ 9 p>agraph 7#b74 7#b7 ,p]iod ( election ,an election "u p>agraph 7#a7-- 7,a7 %all apply = a s+le specifi$ plan ye>2 7,b7 may be ext5d$ ?r\gh subsequ5t elections "u ?is subsection2 & 7,c7 %all n be available ) respect to ! requirem5ts conc]n+ ! duration ( limit$ scope vision & d5tal plans "u subsection 7a77#b74 7e7 ,def9itions ,9 ?is section3 7#a7 ,! t]m cov]$ s]vices means d5tal c>e or vision c>e s]vices = :i* reimbursem5t is available "u a plan or cov]age contract1 or = :i* reimbursem5t w\ld be available b = ! application ( contractual limitations1 includ+ d$uctibles1 copaym5ts1 co9surance1 wait+ p]iods1 lifetime maximum1 frequ5cy limitations1 & alt]native b5efit paym5ts4 7#b7 ,! t]ms doctor ( d5tal surg]y & doctor ( d5tal m$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#c7 ,! 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 am5dm5t made by ?is ,act1 ,/ate law t directly affects any /&>d or requirem5t relat+ to heal? insurance issu]s & d5tal or vision b5efit plans %all h exclusive application & ! am5dm5ts made by ?is ,act %all n apply to ! ext5t t su* ,/ate law conflicts ) su* am5dm5ts4 ,! ,/ate %all reta9 exclusive jurisdiction ov] heal? insurance issu]s & limit$ scope d5tal or vision b5efit plans t are directly gov]n$ by su* ,/ate4