Sep 14, 2023
The Consolidated Appropriations Act, Section 201, Gag Clauses provision, prohibits health plans and issuers from entering into agreements with providers that prevent the disclosure of cost and quality information.
While the provision itself became effective on December 27, 2020 and Blue Shield determined their provider contracts to be compliant, the first annual compliance attestation is due December 31 of this year, and annually thereafter, to the Centers for Medicare and Medicaid Services (CMS). Blue Shield’s attestation submission will be for provider contracts issued from 2020 – 2023 and will cover submissions for employer groups with active coverage during this period. Please see below for more details.
Fully-Insured/Flex-Funded Groups
Blue Shield will be submitting an annual compliance attestation on behalf of all of their fully-insured/flex-funded groups. This attestation will be for Blue Shield’s provider contracts only. Groups that contract with a third party insurer besides Blue Shield will be responsible for coordinating an attestation submission for these other insurers’ provider contracts.
Self-Funded Groups
Blue Shield will collect an agreement from self-funded administrative services only (ASO) groups, via this intake form, to submit the attestation on the group’s behalf. The deadline to submit a response is October 27, 2023 at 6PM PST. This option is only available to ASO groups that have all their provider networks with Blue Shield. Groups that contract with any providers – such as mental health or pharmacy providers - through a third party besides Blue Shield will be responsible for submitting their own attestation of compliance. By default, if no agreement is received via the intake form, Blue Shield will not submit the attestation on behalf of the group.
Shared Advantage and Shared Advantage Plus groups will need to submit their own attestation to the CMS directly.
Groups that will be submitting the attestation themselves, and Shared Advantage and Shared Advantage Plus groups, may use Blue Shield’s Confirmation of Compliance statement below to submit the attestation to the CMS directly. Instructions are available here.
Blue Shield’s Confirmation of Compliance
Blue Shield of California confirms it is compliant with the federal Consolidated Appropriations Act, Section 201, Gag Clauses provision. Blue Shield will ensure their provider contracts exclude any gag clauses which prevent the sharing of cost and quality data.
Blue Shield is committed to supporting you in complying with health coverage related regulatory requirements. Please view these FAQs for more details. Additional information on CAA and other mandates can be found on the Blue Shield Broker Connection Mandates page.
If you have any additional questions, please contact your Amwins Connect Sales Representative.
