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Private Coverage & Exchanges

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Photo: Juan Pulido, Children's Health Children's Medical Center Dallas, Dallas, Texas

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.

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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.

Analysis or Summary
CHA Comments on Proposed Rule to Roll Back Nondiscrimination Protections
August 13, 2019

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

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.

Talking Points
Contact Lawmakers: Setting a Benchmark Payment Rate Could Impede Access to Pediatric Care
July 18, 2019

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

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.

Analysis or Summary
CHA Summary of Price and Quality Transparency Executive Order
June 28, 2019

On June 21, the president issued an executive order (EO) that instructs several federal agencies to take a variety of actions to increase health care price, quality, and data transparency.

Fact Sheet
Frequently Asked Questions About the Federal ECP Petition
June 21, 2019

This set of Frequently Asked Questions provides key information to children’s hospital staff charged with completing/updating the 2021 federal Essential Community Provider (ECP) petition.

Letter or Testimony
CHA Comments on Inflation Index Changes and Impact on Poverty Thresholds
June 21, 2019

CHA submitted comments to the Office of Management and Budget (OMB) on possible changes to the inflation index used to annually update the federal poverty threshold.

Letter or Testimony
CHA Issues Statement for the Record on the Lower Health Care Costs Act
June 18, 2019

On June 17, CHA submitted a statement for the record in advance of the Senate Committee on Health, Education, Labor and Pensions hearing on the Lower Health Care Costs Act.

Policy Position
CHA Joins Allied Groups in Endorsing Child and Adolescent Mental Health Principles
June 13, 2019

Letter or Testimony
CHA Comments on Interstate Health Insurance Sales
May 9, 2019

CHA submitted joint comments on behalf of allied children's groups and joined with the Habilitation Coalition in response to an RFI requesting recommendations on eliminating barriers to selling insurance across state lines.

Analysis or Summary
Summary of Final Annual Guidance for Private Insurance Plans
April 25, 2019

This CHA summary of the 2020 Final Notice of Benefits and Payment Parameters highlights several policies that could impact children’s commercial health coverage.

Analysis or Summary
Implications for Children of TX ACA Court Ruling
March 28, 2019

The Texas Federal District Court issued a ruling that the ACA's individual mandate and the entire law unconstitutional.

Letter or Testimony
Children’s Groups Joint Comments on Annual Private Insurance Rule
February 21, 2019

Six allied children’s organizations joined CHA on a comment letter to CMS in response to the 2020 Proposed Notice of Benefits and Payment Parameters.

Analysis or Summary
Summary of Proposed 2020 Private Insurance Rules
February 1, 2019

CHA summary of the 2020 Proposed Notice of Benefits and Payment Parameters.

Analysis or Summary
2018 State Child Health Policy Trends
February 1, 2019

The complete analysis of the state child health policy trends identified through these calls is available in this new CHA report.

Report
Sharing Data, Saving Lives: The Hospital Agenda for Interoperability
January 22, 2019

The Children’s Hospital Association joined with other leading hospital associations to release a report that sets forth a national agenda for improving interoperability among health information technology (IT) systems.

Analysis or Summary
CHA Summary of Report to President on Policy Changes to Promote Health Care Competition
December 11, 2018

Departments of Health and Human Services, Treasury and Labor released a report to the president, which makes a series of recommendations for federal and/or state policy changes to expand choice and competition in the public and private health care sectors.

Fact Sheet
Health Care Coverage Sources for America’s Children
October 3, 2018

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

Analysis or Summary
FY 2019 Medicare IPPS Rule Summary and Comment Letter
September 18, 2018

The Centers for Medicare & Medicaid Services (CMS) released its FY 2019 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Acute Care Hospital Prospective Payment System (LTCH PPS) proposed rule.

Fact Sheet
Chart of Key Affordable Care Act Insurance Consumer Protections for Children
July 20, 2018

An easy-to-read guide of insurance market reforms under the ACA that are important for children and their families.

Report
Implications of adult network adequacy standards on children’s access to pediatric specialty care
July 16, 2018

CHA is examining the distribution of pediatric health care services, care delivery, and pediatric care utilization to help inform policy decisions related to network adequacy standards that would require the inclusion of specialized pediatric providers in provider networks.

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