Nov 04, 2024
Under The Consolidated Appropriations Act (CAA) of 2021, health insurance carriers and group health plans are required to submit an annual Gag Clause Prohibition Compliance Attestation (GCPCA) to the federal Center for Medicare and Medicaid Services (CMS). This requirement applies to all fully insured, level-funded or self-insured (ASO) coverage in the group and individual markets.
The attestation should cover the period of time since the last attestation and is due no later than December 31 each year.
The Gag Clause Prohibition Rule prohibits plans and carriers—within the constraints of HIPAA and the Privacy Act—from entering into agreements with the following entities that would restrict the ability to share certain cost or quality of care information with plan members or claims data with plan sponsors:
- a provider,
- network or association of providers,
- third-party administrator (TPA), or
- business associate offering access to a network of providers.
CareFirst completed a review of their provider agreements and determined that their contracts are compliant with these requirements.
CareFirst Approach
- Fully insured clients: CareFirst will attest on behalf of all fully insured clients for their active benefits during 2024. If clients had any carve-out benefits or coverage through another carrier at any point in 2024 (excluding excepted benefits), they are responsible for making sure those additional attestations are made as appropriate.
- Self-insured, Level-funded, FlexLink clients: Clients will need to coordinate the submission of their attestation through the CMS HIOS Portal. A representation of CareFirst’s compliance was made available to CareFirst account teams the first week of October, a document for clients to keep on record in support of their attestation. Please reach out to the CareFirst account team for a copy of the document if needed.
Instructions for completing the attestation and additional information can be found on the CMS GCPCA webpage. Any requests for clarification of the regulations or materials published by CMS should be directed to the CMS Helpdesk by emailing CMS_FEPS@cms.hhs.gov and including “GCPCA” in the subject line for faster service.
