Many Patient's Bill of Rights Provisions Go Into Effect on September 23rd

September 23rd will mark the six-month milestone for the Affordable Care Act and several provisions impacting children and families will go into effect on that date including provisions in the "Patient's Bill of Rights" which:

o Prohibit employer or new individual health plans from excluding coverage of specific benefits associated with a pre-existing condition for any period of time and from denying coverage to a child based on a pre-existing condition.

o Eliminate lifetime dollar limits and establish restricted annual limits (until fully eliminated in 2014) for essential health benefits in employer and new individual health plans.

o Allow a parent/guardian to designate a participating pediatrician as their child's primary care provider and require plans providing emergency services to eliminate the need to prior authorizations, even when the services are out-of-network.

At the end of June, the Obama Administration issued an interim rule addressing how these provisions will provide important safeguards for families in obtaining and utilizing health insurance for themselves and their children.  CCF joined with American Academy of Pediatrics, Children's Defense Fund, Family Voices, First Focus, March of Dimes, National Association of Children's Hospitals and Related Institutions, and Voices for America's Children to recommend ways to make the protections even stronger for families. 

Specifically, the comments asked that revisions to the interim rule ensure that:

o Families with sick children can truly obtain coverage when they most need it, as envisioned by the pre-existing provision on the health reform bill. This includes prohibiting insurers from establishing unreasonable premium increases and/or excessive premiums for families with children with pre-existing conditions. In addition, it is important that guidelines be established for child-only plans establishing open enrollment periods (as allowed under an advisory  released following in interim rule). Without rules on when and how these periods can be applied, it will be difficult for families to access coverage when they most need it; and

o Children can receive the services they need during the phase in of the annual dollar benefit limits. Families with children, especially those with special health care needs, may quickly hit the limits proposed under the interim rule. It is important that the limits more accurately reflect the experiences of these families and that the dollar limits be raised. In addition, it is important that health plans be prohibited from establishing non-dollar limits of families (e.g., restrictions on the number of doctor visits).

In the coming weeks, we will post additional information on the "September 23" reforms so check back in!