H.R. 1521: DOC Access Act of 2025
Sponsor
Earl Carter
Republican · GA-1
Bill Progress
Latest Action · Feb 24, 2025
Referred to the House Committee on Energy and Commerce.
Why it matters
The bill would curb how dental and vision insurers control prices, contracts, and suppliers at a time when provider groups are pressing Congress over access and reimbursement disputes.
The measure leans heavily on state enforcement. HHS would ask states each year whether they will enforce the new rules, and if a state declines or does not respond, the federal government would step in. At the same time, the bill says conflicting state law would control and states keep exclusive jurisdiction over issuers and limited-scope dental or vision plans they directly govern. That means the real-world impact could vary by state, and legal questions about federal versus state authority may become part of the debate.
What does H.R. 1521 do?
Providers can set prices for non-covered services
If a dentist or optometrist provides a service that the plan does not meaningfully cover, the provider may charge the patient up to the usual and customary price charged to people outside the plan.
Tiny insurer payments do not count as real coverage
A service is treated as covered only if the plan must pay a reasonable amount that is more than nominal or de minimis, blocking plans from claiming they cover a service while paying almost nothing.
Special rule keeps dental cleaning prices capped
Participating dentists must still use the contracted network fee for dental cleanings, even when the patient has gone over the plan's annual maximum.
Automatic contract extensions need provider approval
For limited-scope dental and vision plans, contract terms longer than two years can be extended only if the provider agrees to each extension.
Insurers cannot force lab or supplier choices
Plans may not directly or indirectly restrict which lab, source, or supplier a participating dentist or optometrist uses for materials or services within that provider's professional scope.
States get first shot at enforcement
HHS must ask states each year whether they will enforce the rules. If a state refuses or does not respond, the federal government can enforce them instead.
Who benefits from H.R. 1521?
Dentists
They gain more control over pricing for services that plans do not truly cover and more say over whether contracts keep rolling over.
Optometrists
They would be better able to set prices for non-covered care and choose labs or suppliers without insurer restrictions.
Patients needing services beyond plan limits
They may get clearer rules about when a service is really covered and when they are paying out of pocket, instead of facing confusing low-payment plan arrangements.
States with active insurance oversight
They get an explicit enforcement role and retain authority where state law directly governs dental and vision benefit plans.
Who is affected by H.R. 1521?
Dental and vision insurers
They would lose some contract tools used to control provider pricing, contract duration, and vendor selection.
Employers offering dental or vision benefits
Group plans may need to revise network contracts and administrative practices to comply with the new rules.
Patients in plan networks
They could see different out-of-pocket prices for services not meaningfully covered, though cleanings would remain tied to the network rate.
State insurance regulators
They may take on enforcement responsibilities and may need to sort out how state rules interact with the federal standards.
H.R. 1521 Common Questions
Can a dentist charge full price for services my dental insurance doesn't cover?
Yes. Under the DOC Access Act of 2025, a participating dentist may charge up to the usual and customary amount charged to non-enrolled patients for non-covered services (Section 2, Sec. 2719B(a)(1)(A)).
Does the bill stop dental or vision plans from paying only a token amount and calling it covered?
Yes. Under the DOC Access Act of 2025, a service counts as covered only if the plan must pay a reasonable amount that is not nominal or de minimis (Section 2, Sec. 2719B(a)(1)(B)).
Can a dental plan still cap the price of a cleaning after I hit my annual maximum?
Yes. Under the DOC Access Act of 2025, participating dentists must use the contracted network fee for dental cleanings even if the cleaning exceeds the plan's annual maximum (Section 2, Sec. 2719B(a)(1)(C)).
How long can a dental or vision provider contract be extended without approval under this bill?
No longer than 2 years. According to H.R. 1521 Section 2, limited-scope dental and vision agreements can extend beyond 2 years only with the provider's prior acceptance for each extension (Sec. 2719B(a)(2)).
Can dental or vision insurers force providers to use a specific lab or supplier?
No. Under the DOC Access Act of 2025, plans cannot directly or indirectly restrict the lab, source, or supplier chosen by a participating dentist or optometrist within their professional scope (Section 2, Sec. 2719B(a)(3)).
How many days does a state have to respond before HHS can treat it as not enforcing the DOC Access Act?
90 days. According to H.R. 1521 Section 2, if a state does not respond within 90 days of the Secretary's request, it is treated as failing to substantially enforce the rules (Sec. 2719B(b)).
Can a dentist or optometrist opt out of some DOC Access Act requirements for one plan year?
Yes. Under the DOC Access Act of 2025, providers may elect to be excluded from the pricing and lab-choice rules for a single specified plan year, with renewals allowed, but not from the contract-duration rule (Section 2, Sec. 2719B(d)).
Which providers are covered by the DOC Access Act pricing protections?
The bill covers doctors of optometry, doctors of dental surgery, doctors of dental medicine, and entities employing them, under the DOC Access Act of 2025 (Section 2, Sec. 2719B(a)(1)(A)).
Does state law override the DOC Access Act if there is a conflict?
Yes. According to H.R. 1521 Section 2, the federal amendments do not apply to the extent they conflict with state law, and states keep exclusive jurisdiction over directly governed issuers and limited-scope dental or vision plans.
Does the DOC Access Act apply to individual plans as well as group dental and vision coverage?
Yes. Under the DOC Access Act of 2025, the rules apply to group health plans, individual health insurance coverage, and group health insurance coverage, including limited-scope dental or vision benefits (Section 2).
Based on H.R. 1521 bill text
HR1521 Legislative Journey
House: Committee Action
Feb 24, 2025
Referred to the House Committee on Energy and Commerce.
About the Sponsor
Earl Carter
Republican, Georgia's 1st congressional district · 11 years in Congress
Committees: Energy and Commerce, the Budget
View full profile →
Cosponsors (99)
This bill has 99 cosponsors: 58 Democrats, 41 Republicans, reflecting bipartisan support. Cosponsors represent 37 states: Alabama, Arkansas, Arizona, and 34 more.
Yvette Clarke
Democrat · NY
Nicole Malliotakis
Republican · NY
Julia Brownley
Democrat · CA
Ann Wagner
Republican · MO
Sheila Cherfilus-McCormick
Democrat · FL
Mark Pocan
Democrat · WI
Bill Foster
Democrat · IL
Raja Krishnamoorthi
Democrat · IL
Delia Ramirez
Democrat · IL
David Valadao
Republican · CA
Mike Bost
Republican · IL
David Rouzer
Republican · NC
Committee Sponsors
Energy and Commerce Committee
10 of 54 committee members cosponsored
24 Republicans across this committee haven't cosponsored yet. Mobilize their constituents
H.R. 1521 Quick Facts
- Committee
- Energy and Commerce
- Chamber
- House
- Policy
- Health
- Introduced
- Feb 24, 2025
Referred to the House Committee on Energy and Commerce.
Feb 24, 2025
Official Sources
Official bill text, cosponsors, and legislative history for the DOC Access Act of 2025
Explains the state-primary, federal-backup enforcement framework under the Public Health Service Act — the same mechanism this bill uses for dental and vision plan oversight
The committee to which H.R. 1521 was referred for consideration
The section of the Public Health Service Act that this bill inserts a new section after, establishing dental and vision plan rules alongside existing patient protections
The existing statute governing excepted benefits like limited-scope dental and vision plans — this bill’s conforming amendment modifies this section
Department of Labor guidance on what qualifies as excepted benefits, including limited-scope dental and vision coverage that this bill regulates
Who is lobbying on H.R. 1521?
14 organizations lobbying on this bill
AMERICAN OPTOMETRIC ASSOCIATION | 8 |
AMERICAN DENTAL ASSOCIATION | 4 |
AMERICAN ASSOCIATION OF ORAL AND MAXILLOFACIAL SURGEONS | 4 |
AMERICAN OPTOMETRIC ASSOCIATION | 4 |
AMERICAN OPTOMETRIC ASSOCIATION | 4 |
AMERICAN DENTAL ASSOCIATION | 4 |
NATIONAL ASSOCIATION OF DENTAL PLANS | 4 |
AMERICAN OPTOMETRIC ASSOCIATION | 4 |
VSP | 4 |
AMERICAN MEDICAL ASSOCIATION | 4 |
Showing 1-10 of 14 organizations
H.R. 1521 Bill Text
“To amend title XXVII of the Public Health Service Act to improve health care coverage under vision and dental plans, and for other purposes.”
Source: U.S. Government Publishing Office
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