The Benefit Company
The Consolidated Appropriations Act (CAA) continues to roll out plan sponsor responsibilities.
A current compliance item on the horizon is the “Gag Clause Prohibition Requirement.”
Although this requirement TECHNICALLY went into effect on December 20, 2020, the first attestation is due this December (December 31, 2023).
Definition
Plan sponsors must review any group health plan contracts and confirm there are no prohibited gag clauses. Employer plan sponsors must keep a record that this was reviewed and confirmed.
What is a Gag Clause?
When entering into an agreement with a provider, TPA, or other service providers, employer plan sponsors must confirm that the contract does not include contractual language that restricts disclosure of provider-specific costs, quality of care, or the sharing of data with a business associate. (Of course, HIPAA privacy applies in all cases)
How Does the Employer Comply?
CMS has set up a webpage on how to comply and attest. There is a submission and attestation sectioned form that must be completed.
The good news is that many of the TPA, carriers, and other service providers are willing to attest on behalf of the plan. However, it is still the fiduciary responsibility of the employer sponsor to reach out to all parties to ask and confirm that there are no gag clauses present in the contracts.
Remember BOTH fully insured and Self-funded plans are subject to the attestation requirements.
This requirement will continue each year.
- Population Health Data Analytics
- Self Funding
- Strategic and Innovative Design Analysis
- Communication