Rep. Buddy Carter, R-Ga. Credit: House
Rep. Buddy Carter, R-Ga., is reviving the fight for legislation that could have a big effect on employers' self-insured dental plans and vision plans.
Carter has introduced a version of the Dental and Optometric Care Access Act bill, or DOC Access Act bill, for the 119th Congress.
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The 119th Congress began Jan. 3.
The new bill would affect how group dental plans and group vision plans work with the dentists, optometrists and other care providers who treat the patients.
Related: The surge in provider-insurer contract disputes is leaving patients in the lurch
Carter introduced the bill with Rep. Pete Sessions, R-Texas, and a Democrat: Rep. Yvette Clarke, D-N.Y.
The bill is under the jurisdiction of the House Energy and Commerce Committee.
Bill terms: The DOC Access Act bill would prohibit group plans from limiting patients' choice of labs.
The bill would also keep a plan from setting prices for services or materials unless the plan pays more than a minimal amount for the services or materials.
Another provision would keep plans from including provider contract provisions that automatically make the agreements last more than two years. Providers would have to actively agree to accept longer-term relationships.
Any state laws governing dental care or vision care provider networks would preempt the DOC Access Act provisions.
Legislative mechanics: The DOC Access Act bill is similar to bills previously introduced in every Congress since the 114th Congress, which began in 2015.
The bill could have a higher chance of becoming law than in the past because Republicans now control the House, Senate and White House.
The Republican congressional leaders who are in place appear to be more interested in provider contracting bills.
One question is who might introduce a companion bill in the Senate. In the past, Sen. Joe Manchin, D-W.Va., sponsored the Senate version of the bill, but he has retired.
The backdrop: Since 1974, the Employee Retirement Income Security Act has blocked states from regulating employers' self-insured plans, and the federal agreement has tended to avoid regulating provider network agreements.
Supporters of ERISA preemption contend that it keeps conflicting state laws from driving up benefits costs for multistate employers.
Supporters of tough provider network contracting strategies say they help protect employers and plan participants from rising costs.
In recent years, pharmacies, physicians and other providers have fought harder to weaken ERISA preemption and to ban or restrict some provider network contracting strategies.
In recent weeks, for example, lawmakers have organized a bipartisan group that's promoting federal efforts to tighten the rules governing pharmacy benefit managers.
A new House bill could eliminate health plans' efforts to make patients submit requests for coverage through prior authorization reviews.
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