America's Benefit Specialist December 2023

GAG CLAUSE PROHIBITION COMPLIANCE REQUIREMENT

By Scott M. Stevens, RHU, CDHC Dodge Partners Insurance Omaha, Nebraska sstevens@dodgepartners.com

The Consolidated Appropriations Act requires an annual “gag clause prohibition compliance attestation” (GCPCA) be submitted by December 31 and annually hereafter. Important ly, carriers/administrators/payers have largely removed any references to gag clauses and prohibitions of sharing pricing and quality data, which was prohibited by the CAA. It is now the responsibility of carriers, administrators and employers to confirm compliance with the gag clause prohibition by way of an annual online attestation. It might come as a surprise that such gag clauses have here tofore existed but, in many instances, they did. Specifically, cer tain agreements between health insurance plans/issuers and healthcare providers/networks would prevent the disclosure of both cost and quality of care data to stakeholders. Healthcare providers/networks are still allowed to place “reasonable restric tions” on the public disclosure of such information. The compliance burden associated with the GCPCA consists of two separate aspects: 1. Confirming your plan is in compliance with the provision (Note: The required Confirmation of Compliance states: ABC Payer hereby confirms that the administrative services it provides to its customers are consistent with the require ments set forth in the Consolidated Appropriations Act, 2021 (PL 116-260), Division BB, Section 201: INCREASING

TRANSPARENCY BY REMOVING GAG CLAUSES ON PRICE AND QUALITY INFORMATION). 2. Submission of the attestation via the federal government link/webform (see below). Employers are encouraged to check with their health plan issuers, administrators, brokers, consultants, etc. to verify if number one and/or two above is/are being handled by their plan issuer/administrator. For more guidance and information on the annual GCPCA compliance requirement, see www.cms.gov/marketplace/ about/oversight/other-insurance-protections/gag-clause-prohi bition-compliance-attestation. To actually make a filing, here is the link: https://hios.cms.gov/HIOS-GCPCA-UI.

Scott Stevens is an employee benefits and consumer-directed healthcare specialist, helping employer organizations of all types reduce their health insurance and related employee benefits costs. His career has included stints as vice president of sales/ marketing for a national insurance company, co-founder and executive vice president of a

TPA and founder of The HSA Toolkit (employer/employee education and sales system). Scott earned a B.S. in marketing/ economics from the State University of New York at Oswego.

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