Deadline for Submitting Gag Clause Attestation: December 31, 2024

As the year draws to a close, a critical compliance deadline approaches for employers with health plans. The Consolidated Appropriations Act (CAA) requires health plans and insurance issuers to annually submit a Gag Clause Compliance Attestation by December 31, 2024.

This regulation, in effect since 2020, prohibits health plans from entering into agreements that include gag clauses—clauses that prevent transparency on provider pricing, quality, and claims data. Gag clauses have significant implications, especially for employers seeking to make informed decisions about their healthcare offerings.

What You Need to Know:

• Who Needs to Comply? Fully insured and self-insured group health plans, including ERISA plans, nonfederal government plans, and church plans, must submit an attestation. Grandfathered health plans are not exempt, but plans offering only excepted benefits or HRAs are not required to submit.
• Fully Insured Plans: If the health plan’s issuer submits the attestation, employers don’t need to worry about filing it themselves. This compliance ensures that the plan is up to date with the CAA requirements.
• Self-Insured Plans: The responsibility ultimately falls on the employer to ensure timely submission, even if a third-party administrator (TPA) is handling the attestation. Some TPAs might not agree to submit the attestation, meaning employers need to ensure they are compliant.

Why It Matters:

Employers must review their contracts to ensure they align with these requirements. Non-compliance could result in penalties, so it’s crucial to take action now. Make sure your agreements with healthcare providers, TPAs, or service providers don't include gag clauses that restrict access to essential cost and quality-of-care information.

Next Steps:

1. Review Contracts: Ensure no gag clauses exist in your contracts with health care providers, TPAs, or other service providers.
2. Confirm Submission: Make sure your health plan’s attestation is submitted before the December 31, 2024, deadline.
3. Utilize CMS Resources: Submitting the attestation is a straightforward process through the CMS web form. The necessary instructions, user manuals, and FAQs are available on the CMS website.

For more details or assistance with the attestation, feel free to reach out. Compliance is not just about meeting deadlines; it's about ensuring your health plan operates with transparency and integrity for the benefit of your employees.

This reminder is crucial for employers navigating the intricate world of healthcare compliance. Don’t let the December deadline catch you by surprise!