DOC Access Act of 2025

Bill Number

H.R. 1521

Origin Chamber

House

Congress

119th Congress, Session 1

Policy Area

Health

Status

Introduced

Latest Action

2025-02-24: Referred to the House Committee on Energy and Commerce.

Last Updated

2026-05-13T08:06:11Z

AI-Generated Summary

Purpose

The Dental and Optometric Care Access Act of 2025 (H.R. 1521) aims to enhance access to dental and vision care by amending the Public Health Service Act. It focuses on improving fairness in billing, contract terms, and provider choices for services under group health plans or individual/group health insurance coverage, including those offering limited dental or vision benefits.

Key Provisions

• Billing for Non-Covered Services: Participating doctors of optometry, dental surgery, dental medicine, or their employing entities can charge enrollees (plan participants) for items or services not covered by the plan up to the provider's usual and customary rates for non-enrollees. "Covered services" are defined as those where the plan must pay a reasonable amount (not just a tiny or insignificant fee). An exception applies to dental cleanings, where providers can only charge the contracted network rate, even if it exceeds the plan's annual limit.
• Contract Extensions for Limited Scope Plans: Agreements between providers and plans offering limited dental or vision benefits can extend beyond two years only with the provider's explicit consent for each extension. Unlimited extensions are allowed as long as consent is given each time.
• No Restrictions on Suppliers: Plans cannot limit or restrict the laboratories, sources, or suppliers that providers choose for dental or vision items and services within the provider's licensed scope of practice.
• Enforcement by States and Federal Government: The Secretary of Health and Human Services (HHS) must annually notify states of their authority to enforce these rules and request confirmation. If a state declines or fails to respond within 90 days, HHS will treat it as non-enforcement and step in to apply federal oversight.
• Exclusion Option for Providers: Providers can elect (via HHS regulations) to opt out of the billing and supplier restriction rules for a specific plan year, but this does not apply to contract extension requirements. Elections can be renewed annually.
• Definitions: Key terms include "covered services" (reimbursable dental/vision care, accounting for limits like deductibles or maximums); "doctor of dental surgery/medicine" (state-licensed dentists practicing within their scope); and "doctor of optometry" (state-licensed optometrists).
• State Law Primacy: State laws directly regulating health insurance issuers and dental/vision plans take precedence over these federal changes if they conflict, preserving state control.

Significant Changes to Existing Law

• Inserts a new section (2719B) into title XXVII of the Public Health Service Act (42 U.S.C. 300gg et seq.), which governs health insurance requirements.
• Amends section 2722(c)(1) to make its exceptions for limited benefits subject to the new rules, ensuring broader applicability.
• Overrides the general exception for "limited, excepted benefits" (like standalone dental/vision plans) for these specific protections, closing potential loopholes in current law that might allow restrictive practices.

Potential Impacts

• On Citizens (Enrollees): Improves access to affordable non-covered dental and vision services by capping out-of-pocket charges at fair market rates, potentially reducing surprise billing and encouraging more comprehensive care without exceeding plan limits unfairly.
• On Government Agencies: Increases HHS's role in monitoring and enforcing rules if states opt out, which could strain federal resources but ensure consistent national standards. States retain primary enforcement but face annual federal oversight.
• On Health Plans and Insurers: May raise administrative costs due to new consent requirements for contracts and limits on supplier controls, potentially leading to adjustments in premiums or network designs for dental/vision coverage.
• No Apparent International Relations Impact: The bill is domestic-focused, affecting U.S. health insurance markets without reference to foreign entities or trade.

Main Stakeholders Affected

• Dental and Optometric Providers: Doctors of optometry, dental surgery/medicine, and their employing entities gain flexibility in billing, contracting, and supplier choices, but must navigate opt-out elections.
• Health Insurance Issuers and Plans: Group or individual plans (including limited-scope dental/vision) face new restrictions on contracts and operations, requiring compliance updates.
• Enrollees: Individuals covered by these plans benefit from protections against excessive charges and better provider options.
• States and HHS: States handle primary enforcement with federal backup; HHS gains notification and intervention duties.

Notable Legal, Constitutional, or Political Implications

• Legal: Reinforces federal minimum standards for health insurance while explicitly deferring to state law in conflicts, promoting a federal-state balance under the Public Health Service Act. This could lead to varied implementation across states, with potential litigation over what constitutes a "reasonable" payment or "usual and customary" rate.
• Constitutional: No direct challenges apparent; aligns with Congress's authority over interstate commerce and health policy, avoiding preemption issues by prioritizing state jurisdiction.
• Political: Introduced bipartisanship (by Rep. Carter, R-GA, and Rep. Clarke, D-NY) suggests broad appeal in addressing access gaps in dental/vision care, a common consumer concern. It could influence ongoing Affordable Care Act debates by expanding protections without mandating new coverage.

This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.

Sponsor

Rep. Carter, Earl L. "Buddy" [R-GA-1]

Cosponsors (119)

Rep. Clarke, Yvette D. [D-NY-9], Rep. Malliotakis, Nicole [R-NY-11], Rep. Brownley, Julia [D-CA-26], Rep. Wagner, Ann [R-MO-2], Rep. Cherfilus-McCormick, Sheila [D-FL-20], Rep. Pocan, Mark [D-WI-2], Rep. Foster, Bill [D-IL-11], Rep. Krishnamoorthi, Raja [D-IL-8], Rep. Ramirez, Delia C. [D-IL-3], Rep. Valadao, David G. [R-CA-22], Rep. Bost, Mike [R-IL-12], Rep. Rouzer, David [R-NC-7], Rep. Van Drew, Jefferson [R-NJ-2], Rep. Sessions, Pete [R-TX-17], Rep. Pettersen, Brittany [D-CO-7], Rep. Reschenthaler, Guy [R-PA-14], Rep. Mrvan, Frank J. [D-IN-1], Rep. LaHood, Darin [R-IL-16], Rep. Perez, Marie Gluesenkamp [D-WA-3], Rep. Simpson, Michael K. [R-ID-2], Rep. Davids, Sharice [D-KS-3], Rep. Bishop, Sanford D. [D-GA-2], Rep. Schneider, Bradley Scott [D-IL-10], Rep. Jackson, Jonathan L. [D-IL-1], Rep. Torres, Ritchie [D-NY-15], Rep. Meng, Grace [D-NY-6], Rep. Castor, Kathy [D-FL-14], Rep. Gottheimer, Josh [D-NJ-5], Rep. Johnson, Henry C. "Hank" [D-GA-4], Rep. Womack, Steve [R-AR-3], Rep. Smith, Christopher H. [R-NJ-4], Rep. Estes, Ron [R-KS-4], Rep. Weber, Randy K. Sr. [R-TX-14], Rep. Sorensen, Eric [D-IL-17], Rep. Rutherford, John H. [R-FL-5], Rep. Thompson, Glenn [R-PA-15], Rep. Harder, Josh [D-CA-9], Rep. Latimer, George [D-NY-16], Rep. Quigley, Mike [D-IL-5], Rep. Babin, Brian [R-TX-36], Rep. Suozzi, Thomas R. [D-NY-3], Rep. Rogers, Harold [R-KY-5], Rep. Davis, Donald G. [D-NC-1], Rep. Budzinski, Nikki [D-IL-13], Del. Norton, Eleanor Holmes [D-DC-At Large], Rep. Soto, Darren [D-FL-9], Rep. Miller, Carol D. [R-WV-1], Rep. Sewell, Terri A. [D-AL-7], Rep. Harshbarger, Diana [R-TN-1], Rep. Correa, J. Luis [D-CA-46] and 69 more

Recent Actions

• 2025-02-24: Referred to the House Committee on Energy and Commerce.
• 2025-02-24: Introduced in House
• 2025-02-24: Introduced in House

Bill Versions

• Dental and Optometric Care Access Act of 2025 — issued 2025-02-24 — PDF (7 pages)