Nov 05, 2024
Amwins Connect – November 2024 Question of the Month
Question
If a self-funded or level funded group health plan filed the Gag Clause Prohibition Compliance Attestation (GCPCA) with CMS in 2023, do they have to file it again in 2024?
Answer
Yes, they do!
Submitting of the Attestation must be done annually. The Attestation reports the group health plan to be in compliance with the prohibition against ‘gag clauses’ in any agreements with service providers working with the plan to provide benefits to employees.
Definition of ‘gag clause’ = any contractual term directly or indirectly restricting the plan or insurer from disclosing specified data and information, such as cost or quality of care data.
The Attestation must be submitted to CMS (through the HIOS system) by December 31 of each calendar year. Ultimately, the plan sponsor of a self-funded or level funded group health plan is responsible for the attestation. If a carrier is administering the self-funded or level funded group health plan, the plan sponsor should be communicating with the carrier to see what they may be doing to assist with the process. Or, if a third party administrator is administering the group health plan, the plan sponsor should be working with the TPA to understand what they may be doing to assist with the process.
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