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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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Analysis or Summary
Summary Highlights Roll Backs of Nondiscrimination Protections in Section 1557 Final Rule
July 31, 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, 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
State Actions to Allow Patient Care Reengagement During the COVID-19 Crisis
July 17, 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
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.

Analysis or Summary
Implications for Children of ACA Constitutionality Case
December 20, 2019

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

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.

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.

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