Blue Shield of California Announces Plan for Gag Clause Compliance Attestation


Blue Shield of California has assured its commitment to comply with the gag clauses provision, which disallows the clauses in contracts between health plans and providers, thereby enabling a freer flow of provider pricing and quality data. The gag clauses provision has been effective since December 27, 2020, and the first attestation of compliance to the Centers for Medicare and Medicaid Services (CMS) is due by December 31, 2023. This provision does not apply to standalone dental, vision, or life insurance plans.


Group plans are not allowed to enter into contracts that directly or indirectly restrict them from sharing financial information with referring providers or accessing and sharing de-identified, HIPAA-compliant member and beneficiary claims and encounter data. As part of this compliance, Blue Shield of California has announced plans to submit its annual attestation ahead of the deadline. The insurer also clarified that it's not requiring a written agreement stating it will submit the gag clause attestation on behalf of the fully-insured group. It is currently coordinating with self-funded group plan sponsors to ensure a single attestation is submitted. More information on this process will be released soon.

For further details and FAQs regarding Blue Shield's plans to meet the gag clauses provision requirements, please see Blue Shield's official informational flyer.