text: SECTION 1. SHORT TITLE.
  
      This Act may be cited as the ``Dental and Optometric Care Access 
  Act'' or the ``DOC Access Act''.
  
  SEC. 2. IMPROVING HEALTH CARE COVERAGE UNDER VISION AND DENTAL PLANS.
  
      (a) In General.--Title XXVII of the Public Health Service Act is 
  amended by inserting after section 2719A (42 U.S.C. 300gg-19a) the 
  following new section:
  
  ``SEC. 2719B. IMPROVING COVERAGE UNDER VISION AND DENTAL PLANS.
  
      ``(a) In General.--Under a group health plan or individual or 
  health insurance coverage (including such a plan or coverage offering 
  limited scope dental or vision benefits), the following shall apply:
              ``(1) Payment amounts from covered persons.--
                      ``(A) In general.--The plan or coverage shall 
                  provide, with respect to a doctor of optometry, doctor 
                  of dental surgery, or doctor of dental medicine that 
                  has an agreement to participate in the plan or coverage 
                  and that furnishes items or services that are not 
                  covered by the plan or coverage to a person enrolled 
                  under such plan or coverage, that the doctor may charge 
                  the enrollee for such items or services any amount 
                  determined by the doctor that is equal to, or less 
                  than, the usual and customary amount that the doctor 
                  charges individuals who are not so enrolled for such 
                  items or services.
                      ``(B) Items and services considered covered by a 
                  plan.--For purposes of subparagraph (A), an item or 
                  service shall be considered, with respect to a plan or 
                  coverage, to be covered by the plan or coverage only if 
                  the negotiated rate agreed to by such plan or coverage 
                  and the doctor for such item or service, without regard 
                  to any cost sharing obligation of the enrollee, is an 
                  amount that is reasonable and is not nominal or de 
                  minimis.
              ``(2) Changes to plans.--The terms of an agreement between 
          such a plan or coverage and such a doctor (including, in the 
          case of a plan or coverage that provides for a provider 
          network, the negotiated rate for providers that participate in 
          the network of such plan or coverage), may be changed only 
          pursuant to a subsequent agreement signed by the doctor that 
          documents the acknowledgment and acceptance of the doctor (as 
          applicable) to such changes.
              ``(3) 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, the agreement may not be for a period that is greater 
          than two years.
              ``(4) Terms and conditions for ancillary services and 
          procedures.--Such plan or coverage may not deny such a doctor 
          participation in the plan or coverage or remove such a doctor 
          from participation in the plan or coverage for the sole reason 
          of the failure of the doctor to accept the terms and conditions 
          under such agreement for any ancillary service or procedure.
              ``(5) Condition to join a provider network.--The plan or 
          coverage may not require that such a doctor must participate 
          with, or be credentialed by, any specific plan or coverage 
          offering limited scope dental or vision benefits as a condition 
          to participate in the provider network of such plan or 
          coverage.
              ``(6) No interference with existing relationships and 
          requirements.--Unless otherwise required by law or regulation, 
          such plan or coverage may not directly communicate with an 
          individual enrolled in such plan or coverage in a manner that 
          interferes with or contravenes any State or Federal 
          requirement, or doctor-patient relationship in existence at the 
          time of such communication.
              ``(7) No restriction on choice of laboratories.--The plan 
          or coverage may not, directly or indirectly, restrict or limit, 
          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 coverage.
      ``(b) Private Right of Action.--In addition to any other remedies 
  under State or Federal law, a person adversely affected by a violation 
  of this subsection may bring action for injunctive relief against a 
  plan described in subsection (a) and, upon prevailing, in addition to 
  such injunctive relief, shall recover monetary damages of no more than 
  $1,000 for each day found to be in violation plus attorney's fees and 
  costs. The district courts of the United States shall have exclusive 
  jurisdiction of civil actions brought under this subsection.
      ``(c) Relationship to Exception for Limited, Excepted Benefits.--
  Section 2722(c)(1) shall not apply with respect to the requirements of 
  this section.
      ``(d) Definitions.--In this section:
              ``(1) The terms `doctor of dental surgery' and `doctor of 
          dental medicine' mean a doctor of dental surgery or of dental 
          medicine, as applicable, 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 functions.
              ``(2) 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 practices.''.
      (b) Conforming Amendment.--Section 2722(c)(1) of the Public Health 
  Service Act (42 U.S.C. 300gg-21(c)(1)) is amended by striking ``The 
  requirements'' and inserting ``Subject to section 2719B, the 
  requirements''.
target: Dental and Optometric Care Access Act or the DOC Access Act This bill amends the Public Health Service Act to prohibit group health plans and individual health insurance coverage from setting rates for items and services provided by a doctor of optometry, of dental surgery, or of dental medicine for which the plan or insurer does not pay a substantial amount. An agreement between a plan or insurer and such a doctor: (1) may only be changed with the doctor's acknowledgement and acceptance, and (2) may not last longer than two years if the agreement is for limited scope dental or vision benefits. Such a doctor must be allowed to participate in a: (1) plan or coverage without accepting terms for ancillary services or procedures, and (2) provider network without participating in a specific limited scope dental or vision benefit plan. Plans and insurers may not: (1) directly communicate with an enrolled individual in a manner that interferes with an existing doctor-patient relationship or a state or federal requirement, or (2) restrict such a doctor's choice of laboratories or suppliers. The bill establishes a private right of action for a person adversely affected by a violation of this Act.
feat_title: DOC Access Act