September 21, 2023
The Consolidated Appropriations Act (CAA) of 2021 prohibits group health plans and health insurance issuers from entering into certain agreements with service providers. Specifically agreements that would directly or indirectly restrict a group health plan or an insurer from providing provider-specific cost or quality of care information or data; electronically accessing de-identified claims and encounter information or data for each enrollee; or sharing that information or data with a business associate.
The CAA also requires group health plans and issuers to report compliance with this provision annually to the Department of Health and Human Services (HHS). The first Gag Clause Prohibition Compliance Attestation (GCPCA) is due December 31, 2023. The initial GCPCA covers the period beginning on December 27, 2020, (or the effective date of the applicable group health plan or health insurance coverage, if later) through the date of attestation with subsequent attestations due annually by December 31.
Premera will submit the attestation to HHS as required on behalf of our fully insured groups; this includes terminated groups that were active at some point during the period of 12/27/20 to 12/31/2023. Fully insured groups active with Premera during the initial attestation period are not required to take any action to comply with the requirement. However, groups covered under a different carrier at any point during the period should contact those carriers to determine if they plan to submit on the group’s behalf.
Update:
Self-funded groups, including OptiFlex, may use the statement of compliance below to support the customer’s responsibility to complete their attestation.
Gag Clause Prohibition Statement of Compliance
Additional resources, including instruction manuals for GCPCA submission, are available on the CMS website at Gag Clause Prohibition Compliance Attestation | CMS.