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Private Coverage & Exchanges

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Photo: Joseph M. Cascio, John R. Oishei Children’s Hospital; Buffalo, New York

Understanding Private Coverage

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Over the course of the last year, the administration has issued several rules allowing the sale of health plans that may not cover services children need, give plans and states more flexibility to define essential health benefits, and reduce network adequacy requirements for Exchange plans. These changes could result in children not having access to—or paying more for—needed services. Separately, a Texas court ruled the entire Affordable Care Act unconstitutional as a result of the repeal of the individual mandate penalty.


COVID-19 Update: our resource hub for children’s hospitals tracks policy-related resources helpful to your work during the COVID-19 crisis.

Resources

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Letter or Testimony
CHA comments on proposed rule to streamline prior authorizations through electronic data exchange
January 6, 2021

We submitted comments to CMS on a proposed rule to streamline prior authorizations through electronic data exchange.

Letter or Testimony
Children's Groups' Joint Comments on Annual Private Insurance Rule
January 6, 2021

Five national children's organizations joined with us in comments to CMS on the 2022 proposed Notice of Benefit and Payment Parameters (NBPP).

Analysis or Summary
CHA summary of final surprise billing legislation – the "No Surprises Act"
December 29, 2020

President Trump signed the "No Surprises Act" to address surprise billing.

Analysis or Summary
Congressional Relief Legislation and Children's Hospitals Requests in Response to COVID-19
December 28, 2020

Three congressional packages and one supplemental for COVID-19 relief have passed to date. Read more about them here.

Report
2020 State Child Health Policy Trends
December 18, 2020

Our 2020 State Child Health Policy Trends Overview was informed by responses from children’s hospital GRs in 35 states.

Analysis or Summary
Implications for Children of ACA Constitutionality Case
October 22, 2020

The Fifth Circuit Court of Appeals ruled that the ACA's individual mandate and the entire law is unconstitutional.

Analysis or Summary
State Actions to Allow Patient Care Reengagement During the COVID-19 Crisis
August 28, 2020

This chart provides a general snapshot of state officials’ authorizations to permit health care providers to return to full patient care operations.

Analysis or Summary
Section 1557 Final Rule Summary Highlights Roll Back of Nondiscrimination Protections; Impact of Recent Court Actions
August 28, 2020

HHS released a final rule to roll back key aspects of a former rule that implemented the ACA's non-discrimination provisions, known as Section 1557.

Letter or Testimony
CHA Signs on to Letter to Hill Seeking COBRA Support in COVID-19 Relief Legislation
August 6, 2020

We joined a letter urging Congress to include additional COBRA funding support in the next COVID-19 relief package.

Letter or Testimony
CHA, Hospital Group Letter to Congress Reiterating Position on Surprise Billing
July 30, 2020

We sent a letter to congressional leadership reiterating support for protecting patients from surprise bills.

Analysis or Summary
CHA Summary of Final Annual Rule for Private Insurers
July 1, 2020

We developed a summary of the final 2021 Notice of Benefit and Payment Parameters.

Analysis or Summary
CHA Summary of Interoperability, Pediatric HIT, Information Blocking and Price Transparency Final Rules
June 19, 2020

CHA developed a summary of proposed rules to implement provisions in the 21st Century Cures Act related to interoperability, electronic health records (EHR) certification, and information blocking.

Analysis or Summary
Surprise Billing Legislation Side-by-Side Summary Charts
February 19, 2020

Key Senate and House Committees marked up legislation to protect patients from surprise medical bills.

Fact Sheet
Health Care Coverage Sources for America's Children
February 7, 2020

Children receive health care coverage through an array of programs that protects our nation's kids, and investment in that system remains critical.

Talking Points
Solutions to Protect Patients from Surprise Bills Must Also Protect Children’s Health
January 31, 2020

The House Energy and Commerce Committee approved legislation to address surprise medical bills. Talking points on surprise billing are available.

Letter or Testimony
CHA Comments on Insurer Cost and Price Transparency Proposed Rule
January 29, 2020

CHA submitted comments on a proposed rule that imposes new cost and price transparency requirements on commercial insurers.

Letter or Testimony
CHA Comments on Proposed Changes to TRICARE Reimbursement Methodology for Children's Hospitals
January 29, 2020

CHA submitted a comment letter to the DoD on proposed changes to the TRICARE reimbursement methodology.

Analysis or Summary
2019 State Child Health Policy Trends
January 10, 2020

This CHA report provides an analysis of state child health policy trends identified through calls with GRs and state children's hospital associations.

Policy Position
CHA Joins Allied Groups in Endorsing Child and Adolescent Mental Health Principles
December 16, 2019

CHA endorses Child and Adolescent Mental Health Principles.

Analysis or Summary
Hospital Negotiated Rates Disclosure Final Rule Summary
December 6, 2019

CMS released the Price Transparency Requirements proposed rule on Nov. 15.

Issue Brief
CHA Backgrounder on Recent Immigration Policy Actions
November 4, 2019

This backgrounder provides an overview of recent policy actions by the administration and the courts with implications for immigrants' access to health coverage.

Analysis or Summary
House E&C Subcommittee holds oversight hearing on CMS’ health care actions
October 24, 2019

The House Energy and Commerce Oversight Subcommittee held a hearing examining actions on health insurance coverage under the Trump Administration.

Analysis or Summary
Alston & Bird Backgrounder on Medical Deferred Action Status for Immigrants in Need of Medical Care
September 6, 2019

Alston & Bird prepared a backgrounder on medical deferred action status.

Press Release
Joint Statement from National Hospital Associations on Proposed CY 2020 OPPS Rule
July 29, 2019

National hospital associations asks the administration to reverse course on a new rule dealing with price transparency.

Issue Brief
Section 1332 State Innovation Waivers
July 12, 2019

Section 1332 of the Affordable Care Act (ACA) allows states to seek a waiver of key coverage provisions in the law and to experiment with different health coverage models.

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