Congress·In Committee·H.R. 1521

Congress targets new rules for dental and vision plans on fees, contract renewals, and lab choice

DOC Access Act of 2025

about 1 year ago·View on Congress.gov

⏸

Stalled

No legislative action in over 90 days.

Legislative Progress

House

Senate

President

Law

Key Points

Lets in-network dentists and eye doctors charge their usual price (or less) for services a plan does not actually cover, instead of being stuck with a plan-set rate.
From policy text
“provides items or services within the scope of practice of such a doctor that are not covered services under the plan or coverage to a person enrolled under such plan or coverage, such doctor or entity may charge the enrollee for such items or services any amount determined by such doctor or entity that is equal to, or less than, the usual and customary amount that such doctor or entity charges individuals who are not so enrolled for such items or services.”
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Says a service only counts as “covered” if the plan must pay a meaningful amount for it, not a token payment.
From policy text
“an item or service shall be considered, with respect to a plan or coverage, to be covered services under the plan or coverage only if the item or service is an item or service with respect to which the plan or coverage is obligated to pay an amount that is reasonable and is not nominal or de minimis.”
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Creates a special rule for dental cleanings: even if you hit your yearly maximum, the dentist can only charge the in-network contracted fee for a cleaning.
From policy text
“a doctor of dental surgery, doctor of dental medicine, or entity that employs such a doctor that has an agreement to participate in the plan or coverage may charge an enrollee only the contracted network fee for any dental cleaning, including any dental cleaning that exceeds the annual maximum under the enrollee's plan or coverage.”
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Limits automatic renewals of “limited” dental or vision plan contracts: extensions beyond 2 years need the provider’s approval each time, though renewals can keep happening with approval.
From policy text
“the agreement may be extended for a term longer than 2 years only with the prior acceptance of such doctor or entity for each such term extension”
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Bars dental and eye plans from forcing providers to use certain labs or suppliers for materials and services; states can enforce these rules, and state law controls if there’s a conflict.
From policy text
“The plan or coverage may not, directly or indirectly, restrict or limit the laboratory or source or supplier of services or materials that such a doctor or entity may choose with respect to items and services within the scope of practice of such a doctor that are provided by such doctor or entity to an individual enrolled under the plan or coverage.”
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HealthcareConsumer Protection

Impact Analysis

Personal Impact

How this policy affects specific groups of people

Mixed Impacts(1)

Chronic Illness

Neutral

Milestones

2 milestones2 actions

Feb 24, 2025House

Referred to the House Committee on Energy and Commerce.

Feb 24, 2025

Introduced in House

What Happens Next

Projected impacts based on AI analysis

Each year after the law takes effect

States get an annual notice asking if they will enforce the new requirements

Enforcement could look different depending on where you live. If a state says it won’t enforce (or doesn’t answer in 90 days), the federal government can step in under existing law.

As existing contracts come up for renewal

Provider contracts for limited scope dental/vision plans stop auto-extending past 2 years without provider acceptance

Over time, you may see network changes (providers joining/leaving) because renewals would require an active “yes” from the provider for each extension.

After the law takes effect and plans update their rules

Plans stop restricting which labs dentists/optometrists can use for work within their scope

Your provider may be able to choose different labs for glasses, contacts, dentures, crowns, or other work, which can change quality, price, and turnaround time.

Once plan documents and provider agreements are updated

New billing rule takes effect for non-covered items/services in network (with a special rule for dental cleanings)

You may see clearer separation between what your plan truly pays for versus upgrades you choose. Cleanings would be protected at the contracted rate, but upgrades may be billed at the provider’s usual price.