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.
Dental insurers shouldn't price the care they don't pay for
Why it matters
A bill with 99 cosponsors from both parties would stop dental and vision plans from setting prices on services they barely pay for. Today an insurer can label a procedure 'covered,' put a token amount toward it, and still bind your dentist to a discounted network rate. H.R. 1521 would let providers charge their normal cash price when a plan isn't really footing the bill.
At the center of the bill is a simple line: a service only counts as 'covered' if the plan pays a reasonable amount for it, not a nominal or de minimis one. If the plan pays little or nothing, your dentist or optometrist can charge you their usual cash price instead of a contracted discount the insurer never funded.
Routine dental cleanings are carved out. Even if you blow past your plan's annual maximum, a participating dentist still has to honor the contracted network fee for a cleaning.
The bill also limits two other insurer tactics. A long-term provider contract can roll past two years only if the provider signs off on each extension, and a plan can't steer or restrict which lab or supplier a dentist or optometrist uses.
Enforcement runs through the states first. HHS has to ask each state every year whether it will police these rules, and if a state declines or stays silent for 90 days, the federal government can step in. The bill also says conflicting state law wins and that states keep exclusive authority over the plans they directly govern, so the practical effect could look different depending on where you live.
H.R. 1521 Bill Summary
What H.R. 1521 actually does.
You can be charged the cash price for care your plan doesn't really cover
When a dentist or optometrist provides a service the plan doesn't meaningfully cover, the provider may charge up to the usual and customary price charged to people without the plan.
A few dollars from the insurer no longer counts as 'covered'
A service is treated as covered only if the plan is obligated to pay an amount that is reasonable and more than nominal or de minimis, so a token payment can't lock in a discounted rate.
Cleaning prices stay capped at the network rate
Participating dentists must still charge only the contracted network fee for a dental cleaning, even when the cleaning exceeds the plan's annual maximum.
Long contracts can't auto-renew without the provider's sign-off
For limited-scope dental and vision plans, an agreement can extend past two years only if the provider accepts each extension.
Plans can't dictate your provider's lab or supplier
A plan may not directly or indirectly restrict which laboratory, source, or supplier a participating dentist or optometrist uses for materials or services within their scope of practice.
States enforce first, the federal government as backup
HHS must ask each state annually whether it will enforce the rules. If a state declines or doesn't respond within 90 days, the federal government can enforce them instead.
Who benefits from H.R. 1521?
Dentists in insurance networks
They can charge their normal cash price for services a plan doesn't meaningfully cover, instead of being held to a discount the plan didn't fund.
Optometrists and the practices that employ them
They gain the same pricing freedom for non-covered care and can choose their own labs and suppliers without plan restrictions.
Patients sorting out what their plan actually pays
The line between a covered service and an out-of-pocket one gets sharper, since a plan can't call something covered while paying almost nothing.
States with active insurance oversight
They get an explicit first-line enforcement role and keep exclusive authority where state law directly governs these plans.
Who is affected by H.R. 1521?
Dental and vision insurers
They lose contract tools used to set prices on lightly funded services, auto-extend long agreements, and steer lab and supplier choices.
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
Out-of-pocket prices for services a plan doesn't meaningfully cover could change, though cleaning prices stay tied to the network rate.
State insurance regulators
They may take on enforcement duties and have to work out how state rules interact with the federal standards.
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
The Government Publishing Office's official published text of H.R. 1521 as introduced, with PDF, XML, and plain-text downloads
The section of the Public Health Service Act that this bill inserts new section 2719B after, placing the dental and vision plan rules alongside existing patient protections
The excepted-benefits statute (PHS Act section 2722) governing limited-scope dental and vision plans — the bill's conforming amendment modifies section 2722(c)(1) here
PHS Act section 2723, the state-first and federal-backup enforcement mechanism the bill relies on when a state declines or fails to police these rules
Who is lobbying on H.R. 1521?
5 organizations lobbying on this bill
AMERICAN OPTOMETRIC ASSOCIATION | 8 |
NATIONAL ASSOCIATION OF DENTAL PLANS | 4 |
AMERICAN DENTAL ASSOCIATION | 4 |
AMERICAN OPTOMETRIC ASSOCIATION | 4 |
AMERICAN OPTOMETRIC ASSOCIATION | 4 |
Showing 1-5 of 5 organizations
H.R. 1521 Common Questions
Can my dentist charge full price for something my dental insurance doesn't cover?
Yes. If a dental or vision plan doesn't meaningfully cover an item or service, a participating dentist or optometrist can charge you their usual cash price instead of a contracted discount. The protection covers dentists, optometrists, and the practices that employ them.
What stops a plan from paying a few dollars and calling a service 'covered'?
The bill does. A service counts as covered only if the plan has to pay a reasonable amount for it, not a nominal or token one. Paying almost nothing no longer lets a plan lock your provider into a discounted rate.
Can a dental plan still cap the price of a cleaning after I hit my annual maximum?
Yes. Cleanings are the carve-out. A participating dentist still has to charge only the contracted network fee for a dental cleaning, even one that goes over your plan's annual maximum.
Can my dental or vision insurer force my provider to use a specific lab?
No. A plan can't directly or indirectly restrict which lab, source, or supplier a participating dentist or optometrist uses for materials or services within their scope of practice.
How long can a dental or vision contract auto-renew without the provider's OK?
Two years. For limited-scope dental and vision plans, a contract can extend past two years only if the provider accepts each extension. It can renew indefinitely, but only term by term with that sign-off.
Who enforces this, the federal government or the states?
States get first crack. HHS has to ask each state every year whether it will enforce the rules. If a state says no or doesn't answer within 90 days, the federal government can step in and enforce them.
Can a dentist or optometrist opt out of these rules?
Partly. A provider can elect to be excluded from the pricing and lab-choice rules for a given plan year, and renew that election. They can't opt out of the limit on long contract extensions.
Does state law override this bill where they conflict?
Yes. Where state law on dental or vision plans conflicts with the bill, the state law wins, and states keep exclusive authority over the issuers and plans they directly govern. The real-world effect can vary by state.
Based on H.R. 1521 bill text
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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