Gag Clause Attestation Reminder for 2024
· Sep 20, 2024
Background
The Consolidated Appropriations Act, 2021 (CAA) amended the Employee Retirement Income Security Act (ERISA), the Public Health Services Act (PHSA), and the Internal Revenue Code to prohibit group health plans and health insurance carriers (referred to as “issuers” in the rules) from entering into agreements with providers, TPAs, or other service providers that include language that would constitute a “gag clause” (i.e., contract provisions that restrict specific data and information that a plan can make available to another party).
Group health plans are required to submit a gag clause prohibition compliance attestation (GCPCA) each year by December 31 with the first round of GCPCA that was due by December 31, 2023.
Completing the Gag Clause Attestation
The gag clause prohibition and corresponding annual attestation requirements apply to virtually all employer-sponsored health plans, but they do not apply to:
For reporting due by 12/31/24, CMS updated both the instructions and user manual with screen shots, to assist responsible entities with submitting gag clause attestations by December 31, 2024 via CMS’ website portal.
Also, for 2024, minor changes were made to the webform to allow selection of an attestation year and attestation period and to further clarify the type of plan that is being reported and the type of provider agreements included in the attestation. The webform now also includes a text box that allows for an explanation of the attestation if needed.
Action Required for Group Health Plan Sponsors (i.e. Employers)
IMA note: IMA clients should contact their IMA broker rep to obtain a worksheet to track vendors and their responses as well as a GCPCA guide with screenshots to assist with the attestation.
Tips When Attesting on Your Plan’s Behalf
The updated instructions and user manual can be found on CMS’ GCPCA page found here: https://www.cms.gov/marketplace/about/oversight/other-insurance-protections/gag-clause-prohibition-compliance-attestation
IMA will continue to monitor regulator guidance and offer meaningful, practical, timely information. This material should not be considered as a substitute for legal, tax and/or actuarial advice. Contact the appropriate professional counsel for such matters. These materials are not exhaustive and are subject to possible changes in applicable laws, rules, and regulations and their interpretations.