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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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The 2019 Notice of Benefit and Payment Parameters, which provides guidance to Exchange plans, gives states new flexibility to determine essential health benefits and review plan network adequacy, and also reduces the minimum percentage of essential community providers (ECPs) — including children's hospital ECPs — that must be in Exchange plan networks. These changes could result in children not having access to — or paying more for — needed services.

The administration has released several new rules that allow for the sale of health plans that may not cover services that children need and is supporting parts of a Texas lawsuit that would repeal pre-existing conditions protections.

Resources

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Issue Brief
Section 1332 State Innovation Waiver Guidance
February 14, 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
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.

Fact Sheet
Frequently Asked Questions About the Federal ECP Petition
July 19, 2018

This set of Frequently Asked Questions provides key information to children’s hospital staff charged with completing/updated the 2020 federal Essential Community Provider (ECP) petition.

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.

Letter or Testimony
2019 Exchange/Commercial Plan Guidance
July 11, 2018

CHA spearheaded a joint comment letter from eight allied children’s groups on the 2019 Draft Notice of Benefit and Payment Parameters (NBPP) and also joined with disability advocacy groups and other safety net providers on separate joint comment letters.

Analysis or Summary
DOJ Position on Texas Lawsuit Calling for ACA Repeal – Implications for Children's Coverage
June 15, 2018

CHA created a fact sheet that provides an overview of the potential implications for children's private coverage of the Department of Justice's (DOJ) decision to not defend key consumer protections of the Affordable Care Act (ACA).

Letter or Testimony
Allied Children’s Groups Comment on Short-term, Limited Duration Insurance Proposed Rule
April 26, 2018

In a letter spearheaded by CHA, nine allied children’s organizations expressed strong concerns with the implications of the Departments of Treasury, Labor and Health and Human Services proposed rule on Short-Term, Limited Duration Insurance (STLDI) plans for children, pregnant women and their families.

Letter or Testimony
Allied Children's Groups Comment on Association Health Plan Proposed Rule
March 9, 2018

Eight allied children's organizations expressed strong concerns to the Department of Labor about its proposed rule on Association Health Plans for children and pregnant women.

Sample or Template
Template Comments on Association Health Plans Proposed Rule
March 1, 2018

Children’s hospitals are encouraged to weigh in with the Department of Labor (DOL) on its proposed rule that would expand access to association health plans (AHPs) in the individual and small group commercial markets.

Analysis or Summary
2017 State Child Health Policy Trends
January 19, 2018

CHA's Policy Analysis team reached out to government relations professionals to inform our understanding of the state policy issues impacting children’s hospitals.

Analysis or Summary
Summary of 2019 Proposed Benefit and Payment Notice
November 10, 2017

Summary of the proposed 2019 Notice of Benefit and Payment Parameters, highlighting provisions that have potential implications for children.

Analysis or Summary
Summary of Bipartisan Health Care Stabilization Act of 2017
October 20, 2017

Summary of the Bipartisan Health Care Stabilization Act of 2017 by Sens. Lamar Alexander, R-Tenn., and Patty Murray, D-Wa.

Analysis or Summary
CHA Summary of Revised Graham-Cassidy Repeal and Replace Bill
September 26, 2017

A high level summary of Graham-Cassidy-Heller-Johnson bill and key provisions impacting children.

Letter or Testimony
CHA Comments on RFI on Market Stabilization and Consumer Choice
July 13, 2017

CHA’s response to CMS focused on access to appropriate providers, affordable care for complex and chronic conditions, and the ability to make informed decisions.

Analysis or Summary
BCRA/AHCA Comparison with Current Law
July 7, 2017

CHA has developed a chart comparing the House and Senate ACA repeal legislation with current law.

Analysis or Summary
Key Provisions in the BCRA that Impact Children's Coverage
June 28, 2017

This CHA factsheet provides a brief overview of the Senate’s Better Care Reconciliation Act (BCRA) provisions with implications for children’s coverage.

Analysis or Summary
Better Care Reconciliation Act Bill Summary
June 23, 2017

CHA developed a summary of the relevant provisions in the discussion draft related to children’s health for the The Better Care Reconciliation Act of 2017.

Analysis or Summary
Summary of Request for Information on Regulatory Relief/Consumer Choice
June 16, 2017

CMS seeks input on ways to create a more patient-centered health care system and stabilize health insurance markets.

Analysis or Summary
American Health Care Act: Provisions Impacting Children
June 1, 2017

The American Health Care Act would convert Medicaid to a per capita cap system in 2020, limiting future federal funding to the states and risking significant reductions in the Medicaid budgets providing the care for over 30 million children.

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Members receive the latest updates and suggest ways to best influence policy issues that impact children's health and children's hospitals in a weekly conference call.

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