Oct 25, 2024
The Consolidated Appropriations Act, 2021 (CAA) includes an annual attestation requirement for plans to certify their compliance with the gag clause prohibition. This is referred to as the annual Gag Clause Prohibition Compliance Attestation, or “GCPCA”. The gag clause prohibition in the CAA prohibits health plans from entering contracts that restrict specific data and information that a plan can make available to another party. Plans must annually submit an attestation that they have not entered any prohibited contractual restrictions.
The initial GCPCA was due no later than December 31, 2023. This attestation covered the period from the date of CAA enactment (December 27, 2020) through the date of the attestation. Subsequent attestations will cover the period since the last preceding attestation and will be due by December 31 of each year thereafter.
What you need to know
The statute requires group health plans, and health insurance issuers offering group health insurance coverage (as well as individual health insurance coverage), to annually submit a GCPCA. This means both the issuer and the group health plan are required to submit a GCPCA with respect to a fully insured plan.
For employer-sponsored group health plans, the GCPCA applies to both fully insured and self-insured plans regardless of grandfathered status:
Employers sponsoring a fully insured medical plan should have no action item with respect to the GCPCA. Health Net is directly responsible for completing the GCPCA, and there is no need for the employer to separately complete the attestation.
When the insurance carrier submits a GCPCA on behalf of the plan, both the plan and the issuer will be considered to have satisfied the attestation submission requirement.
Employers sponsoring a self-insured medical plan need to consult with the TPA to determine which party will complete the attestation. Although the plan (employer) is directly responsible for the GCPCA, it is likely that most TPAs will agree to contractually assume the attestation requirement.
Currently, Health Net of California and Health Net of Oregon do not have any Self-insured plans.
What's next?
- Health Net will meet all regulatory obligations for the initial GCPCA due on 12/31/2024.
- The group does not need to take any action regarding the attestation or pay any fees to the plan for the attestation.
