The CAA requires group health plans to attest annually that they have not entered in an agreement that contains a prohibited gag clause.
The goal of the DOL is to achieve transparency in regard to the price and quality of healthcare utilized in employer sponsored healthcare plans via their authority to regulate plan sponsors.
Remember, these regulations are applicable to Plan Sponsors ONLY (and not to TPAs, PBMs, networks, etc)
Gag clauses can be found in your TPA, PBM, network and any NDA claim analytics agreements.
These provisions are intended to enable plan sponsors to meet their health plan fiduciary duties to plan participants.
Health plans and health insurance issuers are required to attest to their compliance with the gag clause prohibition on an annual basis.
The gag clause prohibition attestation is due on December 31st of each year, starting in 2023. This attestation covers the period from the effective date of the applicable group health plan or health insurance coverage (or December 27, 2020, if later) through the date of the attestation.
Failure to submit the attestation on time may result in enforcement action and penalties, including a daily fine of $100. The gag clause prohibition is a law that protects consumers by ensuring that they have access to important cost and quality information when making decisions about their healthcare.
The gag clause prohibition attestation is submitted electronically through the Gag Clause Prohibition Compliance Attestation website. Users must create an account and provide the required information, including a statement that the health plan or issuer is in compliance with the gag clause prohibition. More information is available on the Gag Clause Prohibition Compliance Attestation website.
The Gag Clause Prohibition Compliance Attestation (GCPCA) requires each plan sponsor to attest that the plan is complying with the gag clause prohibition rule. However, self-insured health plans can delegate the attestation requirement to service providers, such as a third-party administrator (TPA), to complete the attestation on their behalf.
At HealthCare Reporting, we help self-insured health plan sponsors comply with the GCPCA. Our gag clause attestation services are designed to help plans ensure that they are in compliance and that they meet all of the requirements for attestation.