As the year comes to an end, a crucial compliance deadline looms for employers with health plans. Under the Consolidated Appropriations Act (CAA), health plans and insurance issuers must submit a Gag Clause Compliance Attestation by December 31, 2024.
Since its enactment in 2020, this regulation prohibits health plans from including gag clauses—provisions that limit transparency around provider pricing, quality, and claims data. These clauses are especially important for employers looking to make informed decisions about their healthcare offerings.
Key Information:
Who Must Comply?
Fully insured and self-insured group health plans, including ERISA plans, nonfederal government plans, and church plans, must file the attestation. While grandfathered health plans are not exempt, plans offering only excepted benefits or HRAs are not required to submit.
- Fully Insured Plans: If the issuer of the health plan submits the attestation, employers do not need to file it themselves. This ensures the plan remains compliant with CAA requirements.
- Self-Insured Plans: Employers are responsible for ensuring timely submission, even if a third-party administrator (TPA) handles the attestation. Some TPAs may not agree to submit the attestation, so employers must verify compliance themselves.
Why It’s Important:
Employers should review their contracts to confirm they align with these requirements. Failure to comply may lead to penalties, making immediate action essential. It’s vital that agreements with healthcare providers, TPAs, or service providers do not contain gag clauses that restrict access to key cost and quality-of-care data.
Next Steps:
- Review Contracts: Ensure your contracts with healthcare providers, TPAs, or service providers don’t include gag clauses.
- Confirm Submission: Ensure your health plan’s attestation is filed before the December 31, 2024, deadline.
- Use CMS Resources: The attestation process can be completed through the CMS web form, with detailed instructions, user manuals, and FAQs available on the CMS website.
For more information or assistance with the attestation, feel free to reach out. Compliance goes beyond meeting deadlines; it ensures your health plan operates transparently and with integrity for the benefit of your employees.
This reminder is crucial for employers managing healthcare compliance. Don’t let the December deadline catch you off guard!