Warner Pacific is committed to helping you and your groups navigate the complex landscape of the Gag Clause. Our goal is to give you the guidance you need to help your clients comply. Read below to find out more.
Restrictions include:
It's important to note that if the issuer of a fully insured health plan submits the attestation, the plan itself is not required to provide a separate one.
For self-insured health plans, written agreements can be established with TPAs to submit the attestation, but the ultimate responsibility for compliance rests with the health plan.
When the issuer of a fully insured group health plan submits a compliance attestation on behalf of the plan, it satisfies the attestation submission requirement for both parties.
For employers with self-insured health plans, compliance can also be achieved through written agreements.
By entering into an agreement where the plan's service provider, such as a TPA, submits the attestation, employers can fulfill their obligations. It's important to note that even with this arrangement, the responsibility for providing a timely attestation remains with the health plan.
The attestation requirement applies to a wide range of health plans, including fully insured and self-insured group health plans, such as ERISA plans, non-federal governmental plans, and church plans. This requirement extends to both grandfathered and non-grandfathered plans under the Affordable Care Act (ACA).
However, it's worth noting that plans offering excepted benefits and account-based plans, like health reimbursement arrangements (HRAs), are exempt from the attestation requirement.
Understanding whether your plan falls under this requirement is essential for compliance. To review a list of who the attestation requirement does and does not apply to, please click here.
To ensure compliance, it's crucial to know where and how to submit your attestation. The federal government has launched a dedicated site for health plans and issuers to submit their attestations. You can access the site here.
Detailed instructions for submission, a user manual for the submission system, and an Excel template for reporting entities are also all available on this site here.
Understanding the submission process is essential to meet the December 31, 2023, deadline. Warner Pacific is committed to helping you navigate these steps successfully.
We understand the importance of staying current with compliance obligations, and we're here to assist you.
If you have any questions or need guidance, don't hesitate to call us at (800) 801-2300.
Sources: GO COMPASS, U.S. Department of the Treasury, U.S. Department of Labor, U.S. Department of Health & Human Services, Centers for Medicare & Medicaid Services
What Is the Gag Clause?
Established by the Consolidated Appropriations Act (CAA) of 2021, the Gag Clause has significant implications for health plans, third-party administrators (TPAs) and insurance issuers. Essentially, the CAA generally prohibits group health plans and issuers offering group health insurance from entering into agreements with health care providers, TPAs or other service providers that include certain gag clause language.Restrictions include:
- Provider-specific information: Health plans can’t be prevented from providing data on provider-specific costs or the quality of care to plan sponsors, participants, beneficiaries or enrollees.
- Claims information access: Health plans have to allow electronic access to de-identified claims and encounter data for each participant, beneficiary or enrollee upon request.
- Information sharing: The Gag Clause doesn't permit contracts that prevent the sharing of information as described above, including sharing with a business associate.
Deadline & Obligations for Employers
Employers should check contracts with TPAs and other healthcare service providers to ensure they don't violate the prohibition on gag clauses. This is important for employers with fully insured or self-insured health plans, as they are responsible for submitting compliance attestations by December 31, 2023.It's important to note that if the issuer of a fully insured health plan submits the attestation, the plan itself is not required to provide a separate one.
For self-insured health plans, written agreements can be established with TPAs to submit the attestation, but the ultimate responsibility for compliance rests with the health plan.
Streamlining Compliance Through Issuers and TPAs
In the case of fully insured group health plans, both the health plan and the issuer must submit a compliance attestation every year. But, there's a simplified approach available:When the issuer of a fully insured group health plan submits a compliance attestation on behalf of the plan, it satisfies the attestation submission requirement for both parties.
For employers with self-insured health plans, compliance can also be achieved through written agreements.
By entering into an agreement where the plan's service provider, such as a TPA, submits the attestation, employers can fulfill their obligations. It's important to note that even with this arrangement, the responsibility for providing a timely attestation remains with the health plan.
Who Must Submit Attestations?
The attestation requirement applies to a wide range of health plans, including fully insured and self-insured group health plans, such as ERISA plans, non-federal governmental plans, and church plans. This requirement extends to both grandfathered and non-grandfathered plans under the Affordable Care Act (ACA). However, it's worth noting that plans offering excepted benefits and account-based plans, like health reimbursement arrangements (HRAs), are exempt from the attestation requirement.
Understanding whether your plan falls under this requirement is essential for compliance. To review a list of who the attestation requirement does and does not apply to, please click here.
Carriers Navigating Gag Clause Compliance
California
| California Carriers | Carrier Response |
Aetna |
Response |
Anthem Blue Cross |
Response |
Balance by CCHP |
Carrier response pending |
Blue Shield of California |
Response |
CaliforniaChoice |
Carrier response pending |
Cigna |
Response |
Cigna + Oscar |
Response |
Community Care Health |
Carrier response pending |
Covered California for Small Business |
Refer to Carrier Guidelines |
Health Net |
Response |
Kaiser Permanente |
Response |
MediExcel Health Plan |
Response |
SHARP Health Plan |
Carrier response pending |
Sutter Health Plus |
Carrier response pending |
UnitedHealthcare |
Response |
Western Health Advantage |
Carrier response pending |
Colorado
Colorado Partners |
Carrier Response |
39North Health Plans |
Carrier response pending |
Aetna |
Response |
|
Anthem Blue Cross |
Response |
Cigna |
Response |
CoAdvantage |
Carrier response pending |
Gravie |
Response |
HealthEZ |
Carrier response pending |
InTandem |
Carrier response pending |
JustWorks |
Response |
Kaiser Permanente |
Response |
UnitedHealthcare |
Response |
Texas
Texas Partners |
Carrier Response |
Baylor Scott & White |
Response |
BCBS of TX |
Response |
For specific questions about self-insured Gag Clause compliance about states not listed, please call your Sales Consultant at (800) 801-2300.
How and Where to Submit Attestations
To ensure compliance, it's crucial to know where and how to submit your attestation. The federal government has launched a dedicated site for health plans and issuers to submit their attestations. You can access the site here.Detailed instructions for submission, a user manual for the submission system, and an Excel template for reporting entities are also all available on this site here.
Understanding the submission process is essential to meet the December 31, 2023, deadline. Warner Pacific is committed to helping you navigate these steps successfully.
Stay Informed With Warner Pacific
The regulatory landscape is ever-evolving, and compliance requirements may change. Warner Pacific is dedicated to keeping you informed with up-to-date information from carriers and TPAs.We understand the importance of staying current with compliance obligations, and we're here to assist you.
If you have any questions or need guidance, don't hesitate to call us at (800) 801-2300.
Sources: GO COMPASS, U.S. Department of the Treasury, U.S. Department of Labor, U.S. Department of Health & Human Services, Centers for Medicare & Medicaid Services