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HR1521119th CongressWALLET

DOC Access Act of 2025

Sponsored By: Representative Carter, Earl L. "Buddy" [R-GA-1]

Introduced

Summary

Protects dental and vision patients from surprise charges and strengthens provider control over contracts. It creates a new federal rule that defines covered services, limits what providers can bill enrollees for noncovered items, requires provider consent for contract extensions after two years, and stops plans from forcing providers to use specific labs.

Show full summary
  • Families and patients: Providers can bill enrollees for noncovered items only up to the usual amount charged to non-enrollees. For dental cleanings a participating dentist may bill only the contracted network fee even if the cleaning exceeds an annual maximum.
  • Providers: Optometrists and dentists must agree to any limited-scope plan extension beyond two years. They may elect for a plan year to be excluded from many of these requirements but not from the two-year contract rule.
  • Plans and insurers: Must treat services as covered when the plan is obligated to pay a reasonable and not nominal amount and cannot limit the laboratory or source of materials that a provider chooses.
  • States and enforcement: The federal secretary will ask each State whether it will enforce these rules. If a State declines or does not respond within 90 days the State will be treated as not substantially enforcing them.

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Bill Overview

Analyzed Economic Effects

2 provisions identified: 0 benefits, 0 costs, 2 mixed.

New rules for dental and vision bills

This bill would set new rules for dental and vision plans and in-network dentists and eye doctors. If a service is not covered, a participating provider could bill you no more than their usual price. For any dental cleaning, you would pay only the in-network fee, even if you pass your annual maximum. Plans could not control which labs or suppliers your dentist or eye doctor uses. A service would count as covered even when plan rules like deductibles, copays, waiting periods, or frequency limits limit payment. These rules would also apply to stand-alone or limited plans; providers could opt out of the billing and lab rules for a plan year, and extensions beyond two years would need the provider’s OK each time.

State enforcement of dental and vision rules

Each year, the Secretary would ask every State if it will enforce these dental and vision rules. If a State says no, or does not answer in 90 days, the federal government would treat it as not enforcing and step in. Where a State’s insurance law conflicts, the State’s rules would control for issuers and limited dental or vision plans it governs. Protections could vary by State.

Sponsors & CoSponsors

Sponsor

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

GA • R

Cosponsors

  • Rep. Clarke, Yvette D. [D-NY-9]

    NY • D

    Sponsored 2/24/2025

  • Rep. Malliotakis, Nicole [R-NY-11]

    NY • R

    Sponsored 3/3/2025

  • Rep. Brownley, Julia [D-CA-26]

    CA • D

    Sponsored 3/5/2025

  • Rep. Wagner, Ann [R-MO-2]

    MO • R

    Sponsored 3/10/2025

  • Rep. Cherfilus-McCormick, Sheila [D-FL-20]

    FL • D

    Sponsored 3/10/2025

  • Rep. Pocan, Mark [D-WI-2]

    WI • D

    Sponsored 3/10/2025

  • Rep. Foster, Bill [D-IL-11]

    IL • D

    Sponsored 3/14/2025

  • Rep. Krishnamoorthi, Raja [D-IL-8]

    IL • D

    Sponsored 3/18/2025

  • Rep. Ramirez, Delia C. [D-IL-3]

    IL • D

    Sponsored 3/18/2025

  • Rep. Valadao, David G. [R-CA-22]

    CA • R

    Sponsored 3/21/2025

  • Rep. Bost, Mike [R-IL-12]

    IL • R

    Sponsored 3/21/2025

  • Rep. Rouzer, David [R-NC-7]

    NC • R

    Sponsored 3/21/2025

  • Rep. Van Drew, Jefferson [R-NJ-2]

    NJ • R

    Sponsored 3/21/2025

  • Rep. Sessions, Pete [R-TX-17]

    TX • R

    Sponsored 3/21/2025

  • Rep. Pettersen, Brittany [D-CO-7]

    CO • D

    Sponsored 3/25/2025

  • Reschenthaler

    PA • R

    Sponsored 3/25/2025

  • Rep. Mrvan, Frank J. [D-IN-1]

    IN • D

    Sponsored 3/31/2025

  • Rep. LaHood, Darin [R-IL-16]

    IL • R

    Sponsored 3/31/2025

  • Rep. Perez, Marie Gluesenkamp [D-WA-3]

    WA • D

    Sponsored 3/31/2025

  • Rep. Simpson, Michael K. [R-ID-2]

    ID • R

    Sponsored 3/31/2025

  • Rep. Davids, Sharice [D-KS-3]

    KS • D

    Sponsored 3/31/2025

  • Rep. Bishop, Sanford D. [D-GA-2]

    GA • D

    Sponsored 4/1/2025

  • Rep. Schneider, Bradley Scott [D-IL-10]

    IL • D

    Sponsored 4/1/2025

  • Rep. Jackson, Jonathan L. [D-IL-1]

    IL • D

    Sponsored 4/1/2025

  • Rep. Torres, Ritchie [D-NY-15]

    NY • D

    Sponsored 4/1/2025

  • Rep. Meng, Grace [D-NY-6]

    NY • D

    Sponsored 4/3/2025

  • Rep. Castor, Kathy [D-FL-14]

    FL • D

    Sponsored 4/3/2025

  • Rep. Gottheimer, Josh [D-NJ-5]

    NJ • D

    Sponsored 4/7/2025

  • Rep. Johnson, Henry C. "Hank" [D-GA-4]

    GA • D

    Sponsored 4/7/2025

  • Rep. Womack, Steve [R-AR-3]

    AR • R

    Sponsored 4/7/2025

  • Rep. Smith, Christopher H. [R-NJ-4]

    NJ • R

    Sponsored 4/7/2025

  • Rep. Estes, Ron [R-KS-4]

    KS • R

    Sponsored 4/10/2025

  • Rep. Weber, Randy K. Sr. [R-TX-14]

    TX • R

    Sponsored 4/10/2025

  • Rep. Sorensen, Eric [D-IL-17]

    IL • D

    Sponsored 4/24/2025

  • Rep. Rutherford, John H. [R-FL-5]

    FL • R

    Sponsored 4/29/2025

  • Rep. Thompson, Glenn [R-PA-15]

    PA • R

    Sponsored 5/5/2025

  • Rep. Harder, Josh [D-CA-9]

    CA • D

    Sponsored 5/6/2025

  • Rep. Latimer, George [D-NY-16]

    NY • D

    Sponsored 5/8/2025

  • Rep. Quigley, Mike [D-IL-5]

    IL • D

    Sponsored 6/5/2025

  • Rep. Babin, Brian [R-TX-36]

    TX • R

    Sponsored 6/6/2025

  • Rep. Suozzi, Thomas R. [D-NY-3]

    NY • D

    Sponsored 6/9/2025

  • Rep. Rogers, Harold [R-KY-5]

    KY • R

    Sponsored 6/9/2025

  • Rep. Davis, Donald G. [D-NC-1]

    NC • D

    Sponsored 6/10/2025

  • Rep. Budzinski, Nikki [D-IL-13]

    IL • D

    Sponsored 6/17/2025

  • Del. Norton, Eleanor Holmes [D-DC-At Large]

    DC • D

    Sponsored 6/20/2025

  • Rep. Soto, Darren [D-FL-9]

    FL • D

    Sponsored 7/2/2025

  • Rep. Miller, Carol D. [R-WV-1]

    WV • R

    Sponsored 7/17/2025

  • Rep. Sewell, Terri A. [D-AL-7]

    AL • D

    Sponsored 7/17/2025

  • Rep. Harshbarger, Diana [R-TN-1]

    TN • R

    Sponsored 7/21/2025

  • Rep. Correa, J. Luis [D-CA-46]

    CA • D

    Sponsored 7/23/2025

  • Kelly (MS)

    MS • R

    Sponsored 8/29/2025

  • Rep. Stefanik, Elise M. [R-NY-21]

    NY • R

    Sponsored 8/29/2025

  • Rep. Gonzalez, Vicente [D-TX-34]

    TX • D

    Sponsored 9/4/2025

  • Rep. Norcross, Donald [D-NJ-1]

    NJ • D

    Sponsored 9/9/2025

  • Rep. Lee, Susie [D-NV-3]

    NV • D

    Sponsored 9/23/2025

  • Rep. Pappas, Chris [D-NH-1]

    NH • D

    Sponsored 9/30/2025

  • Rep. Fields, Cleo [D-LA-6]

    LA • D

    Sponsored 10/3/2025

  • Rep. Murphy, Gregory F. [R-NC-3]

    NC • R

    Sponsored 10/3/2025

  • Rep. Titus, Dina [D-NV-1]

    NV • D

    Sponsored 10/3/2025

  • Rep. Mannion, John W. [D-NY-22]

    NY • D

    Sponsored 10/3/2025

  • Rep. Schmidt, Derek [R-KS-2]

    KS • R

    Sponsored 10/3/2025

  • Rep. Ezell, Mike [R-MS-4]

    MS • R

    Sponsored 10/3/2025

  • Rep. Wilson, Joe [R-SC-2]

    SC • R

    Sponsored 10/8/2025

  • Rep. Tlaib, Rashida [D-MI-12]

    MI • D

    Sponsored 10/8/2025

  • Rep. Owens, Burgess [R-UT-4]

    UT • R

    Sponsored 10/8/2025

  • Rep. Mann, Tracey [R-KS-1]

    KS • R

    Sponsored 10/8/2025

  • Rep. Vindman, Eugene Simon [D-VA-7]

    VA • D

    Sponsored 10/8/2025

  • Rep. McBride, Sarah [D-DE-At Large]

    DE • D

    Sponsored 10/10/2025

  • Rep. Baumgartner, Michael [R-WA-5]

    WA • R

    Sponsored 10/10/2025

  • Rep. Beatty, Joyce [D-OH-3]

    OH • D

    Sponsored 10/14/2025

  • Rep. Barrett, Tom [R-MI-7]

    MI • R

    Sponsored 10/17/2025

  • Rep. Mullin, Kevin [D-CA-15]

    CA • D

    Sponsored 10/17/2025

  • Rep. Davis, Danny K. [D-IL-7]

    IL • D

    Sponsored 10/21/2025

  • Rep. Bergman, Jack [R-MI-1]

    MI • R

    Sponsored 10/21/2025

  • Rep. Swalwell, Eric [D-CA-14]

    CA • D

    Sponsored 10/21/2025

  • Rep. Panetta, Jimmy [D-CA-19]

    CA • D

    Sponsored 10/28/2025

  • Rep. Neguse, Joe [D-CO-2]

    CO • D

    Sponsored 10/28/2025

  • Rep. Vasquez, Gabe [D-NM-2]

    NM • D

    Sponsored 11/4/2025

  • Rep. Pingree, Chellie [D-ME-1]

    ME • D

    Sponsored 11/4/2025

  • Rep. Hoyle, Val T. [D-OR-4]

    OR • D

    Sponsored 11/7/2025

  • Rep. Mackenzie, Ryan [R-PA-7]

    PA • R

    Sponsored 11/12/2025

  • Rep. Craig, Angie [D-MN-2]

    MN • D

    Sponsored 11/17/2025

  • Rep. Goldman, Craig A. [R-TX-12]

    TX • R

    Sponsored 11/20/2025

  • Rep. Williams, Roger [R-TX-25]

    TX • R

    Sponsored 12/1/2025

  • Rep. Norman, Ralph [R-SC-5]

    SC • R

    Sponsored 12/2/2025

  • Rep. Miller, Mary E. [R-IL-15]

    IL • R

    Sponsored 12/3/2025

  • Rep. Simon, Lateefah [D-CA-12]

    CA • D

    Sponsored 12/5/2025

  • Rep. Ansari, Yassamin [D-AZ-3]

    AZ • D

    Sponsored 12/11/2025

  • Rep. Bynum, Janelle S. [D-OR-5]

    OR • D

    Sponsored 12/12/2025

  • Rep. Gillen, Laura [D-NY-4]

    NY • D

    Sponsored 12/15/2025

  • Rescom. Hernández, Pablo Jose [D-PR-At Large]

    PR • D

    Sponsored 12/17/2025

  • Rep. Evans, Gabe [R-CO-8]

    CO • R

    Sponsored 12/17/2025

  • Rep. Fry, Russell [R-SC-7]

    SC • R

    Sponsored 12/18/2025

  • Rep. Randall, Emily [D-WA-6]

    WA • D

    Sponsored 1/12/2026

  • Rep. Ross, Deborah K. [D-NC-2]

    NC • D

    Sponsored 1/14/2026

  • Rep. Westerman, Bruce [R-AR-4]

    AR • R

    Sponsored 1/21/2026

  • Rep. Moore, Riley M. [R-WV-2]

    WV • R

    Sponsored 2/3/2026

  • Rep. Langworthy, Nicholas A. [R-NY-23]

    NY • R

    Sponsored 2/5/2026

  • Rep. McDonald Rivet, Kristen [D-MI-8]

    MI • D

    Sponsored 2/10/2026

  • Rep. Walkinshaw, James R. [D-VA-11]

    VA • D

    Sponsored 3/12/2026

  • Rep. DelBene, Suzan K. [D-WA-1]

    WA • D

    Sponsored 3/17/2026

  • Rep. Amo, Gabe [D-RI-1]

    RI • D

    Sponsored 3/18/2026

  • Rep. Stansbury, Melanie A. [D-NM-1]

    NM • D

    Sponsored 3/19/2026

  • Rep. Biggs, Sheri [R-SC-3]

    SC • R

    Sponsored 3/24/2026

  • Rep. Whitesides, George [D-CA-27]

    CA • D

    Sponsored 3/25/2026

  • Rep. Lofgren, Zoe [D-CA-18]

    CA • D

    Sponsored 3/25/2026

  • Rep. Gooden, Lance [R-TX-5]

    TX • R

    Sponsored 4/6/2026

  • Rep. Larsen, Rick [D-WA-2]

    WA • D

    Sponsored 4/6/2026

  • Rep. Kiggans, Jennifer A. [R-VA-2]

    VA • R

    Sponsored 4/6/2026

  • Rep. Van Orden, Derrick [R-WI-3]

    WI • R

    Sponsored 4/21/2026

  • Rep. Tiffany, Thomas P. [R-WI-7]

    WI • R

    Sponsored 4/9/2026

  • Rep. McGuire, John J. [R-VA-5]

    VA • R

    Sponsored 4/15/2026

  • Rep. Kelly, Mike [R-PA-16]

    PA • R

    Sponsored 4/15/2026

  • Rep. Hageman, Harriet M. [R-WY-At Large]

    WY • R

    Sponsored 4/13/2026

  • Rep. Garcia, Sylvia R. [D-TX-29]

    TX • D

    Sponsored 4/16/2026

  • Rep. Scholten, Hillary J. [D-MI-3]

    MI • D

    Sponsored 4/16/2026

  • Rep. Guest, Michael [R-MS-3]

    MS • R

    Sponsored 4/27/2026

  • Rep. Van Epps, Matt [R-TN-7]

    TN • R

    Sponsored 5/4/2026

  • Rep. García, Jesús G. "Chuy" [D-IL-4]

    IL • D

    Sponsored 5/12/2026

  • Rep. Dingell, Debbie [D-MI-6]

    MI • D

    Sponsored 9/14/2026

  • Rep. Schakowsky, Janice D. [D-IL-9]

    IL • D

    Sponsored 9/15/2026

Roll Call Votes

No roll call votes available for this bill.

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