2024 Gag Clause Attestation Guide

For the 2024 Gag Clause Prohibition Compliance Attestation (GCPCA) submission due by December 31, 2024, Aetna will file on behalf of all self-funded (including Aetna Funding Advantage), insured and split-funded plan sponsors that had active coverage in 2024.

Aetna has conducted a review of our provider and vendor contracts and are confident that we are in compliance with the gag clause prohibition requirements. You can request a confirmation of compliance from Aetna by reaching out to your account manager.

Additional information regarding the Gag Clause Prohibition requirements can be found on the CMS website. On this site, plan sponsors can find Frequently Asked Questions, detailed instructions for submitting the attestations, a link to the reporting template, and a link directly to the web form for submission.

In compliance with the Consolidated Appropriations Act (CAA) Prohibition on Gag Clauses provision, AmeriHealth and AmeriHealth Administrators have ensured there are no gag clauses in our provider, vendor, or customer contracts to which the Gag Clause Prohibition applies.

As required by the CAA, self-funded employers must submit a Gag Clause Prohibition Compliance Attestation (GCPCA) annually to the Centers for Medicare & Medicaid Services (CMS) by December 31, 2024. Fully insured customers don’t need to take any action: AmeriHealth will submit attestations on their behalf.

Action is needed from self-funded customers by November 1, 2024

AmeriHealth Administrators will submit the annual attestation covering the dates of December 27, 2023 through December 31, 2024 on behalf of all self-funded customers that are active customers as of December 1, 2024, and submit the required data per the link below. Self-funded customers, however, can opt-out of having AmeriHealth Administrators submit the GCPCA on their behalf, meaning they will be responsible for submitting the GCPCA to CMS directly prior to the December 31, 2024 deadline. For self-funded customers who have AmeriHealth Administrators medical coverage but carve out prescription drug or behavioral health services to other vendors, AmeriHealth Administrators cannot file the attestation for pharmacy and behavioral health provider contracts.

We are also mailing a letter to our self-funded customers beginning this week with these details.

This year, we are asking all self-funded customers to fill out an online form to let us know if they want AmeriHealth Administrators to submit the attestation on their behalf or if they intend to submit it directly.

They should have their Employer Identification Number (EIN) and Client Identification Number (CID) readily available prior to visiting the form. Self-funded customers, whether they choose to opt-out of having AmeriHealth Administrators submit on their behalf or request AmeriHealth Administrators to submit the attestation on their behalf, must notify us by November 1, 2024.

For self-funded customers who opt out, they should follow these steps to submit the Gag Clause Attestation to CMS directly:

1. Go to the Gag Clause Prohibition Compliance Attestation website.
2. Scroll down to “Resources” at the bottom of the page.
3. Click “Enter Webform Now for a GCPCA.”
4. Sign in and submit the attestation.

For any questions about the submission process, refer to the other links in the Resources section: Frequently Asked Questions, Instructions for submitting the GCPCA, or User Manual for submitting the GCPCA.

What is the CAA Prohibition on Gag Clauses?

The CAA Prohibition on Gag Clauses provision requires that a group health plan or insurer may not enter into an agreement with a health care provider, network or association of providers, TPA, or other service provider offering access to a network of providers, which directly or indirectly restrict a group health plan or insurer from providing provider-specific cost or quality-of-care information or data, electronically accessing de-identified claims and encounter information or data for each enrollee, or sharing that information or data with a business associate. For more details, visit the Gag Clause Prohibition Compliance Attestation website.

Confirmation of Compliance – AmeriHealth

AmeriHealth hereby certifies that for the period of December 27, 2020 through the date of an individual account’s attestation (no later than December 31, 2024), AmeriHealth’s agreements with health care providers, networks or associations of providers, TPAs, or with other service providers offering access to a network of providers in which the account and its plan participate with AmeriHealth have been compliant with requirements pertaining to the CAA Prohibition on Gag Clauses.

When submitting the attestation, use the above confirmation of compliance as support.

Confirmation of Compliance – AmeriHealth Administrators

AmeriHealth Administrators hereby certifies that for the period of December 27, 2020 through the date of an individual account’s attestation (no later than December 31, 2024), AmeriHealth Administrators’ agreements with health care providers, networks or associations of providers, TPAs, or with other service providers offering access to a network of providers in which the account and its plan participate with AHA have been compliant with requirements pertaining to the CAA Prohibition on Gag Clauses.

When submitting the attestation, use the above confirmation of compliance as support.

Please continue to direct all CAA and Transparency in Coverage Rule (TCR) questions to the CAA and TCR mailbox.

Capital Blue Cross is preparing to submit the CAA Gag Clause Prohibition Compliance Attestation (GCPCA) on behalf of fully insured and small business ASO group customers. Those groups do not have to take any action for this submission.

For Large Group ASO:

The Gag Clause Prohibition Compliance Attestation covers the period of November 1, 2023 through October 1, 2024.

If you would like Capital Blue Cross to submit the attestation on your group’s behalf for this time period, please complete and submit this form by November 22, 2024. If you submit multiple responses to the questions, your most recent response will be used in our final submission to CMS.

This form must be filled out by a legally authorized employee of the group and will not be accepted from a broker or consultant. If you have any questions about this submission, please contact your Account Executive. Learn more about the Gag Clause Prohibition Compliance Attestation.

We’re writing to inform you about the annual requirement for health plans and insurers to submit a Gag Clause Prohibition Compliance Attestation (GCPCA) to the government, as mandated by the Consolidated Appropriations Act, 2021 (CAA). This year’s attestation is due by December 31, 2024.

What do I need to know?

• Highmark conducted a review of relevant participating provider and vendor contracts and determined that we are in compliance with CAA rules regarding gag clause prohibitions.
• Highmark will file the GCPCA for all fully-insured clients by December 31, 2024.
• Client Managers will send a letter to their ASO clients by November 1, 2024, with a link to the CMS site that provides detailed instructions on how to submit the attestation. A sample of the letter can be found here.

In compliance with the Consolidated Appropriations Act (CAA) Prohibition on Gag Clauses provision, Independence Blue Cross (IBX) and Independence Administrators have ensured that there are no gag clauses in our provider, vendor, or customer contracts to which the Gag Clause Prohibition applies.

As required by the CAA, self-funded employers must submit a Gag Clause Prohibition Compliance Attestation (GCPCA) annually to the Centers for Medicare & Medicaid Services (CMS) by December 31, 2024. Fully insured customers don’t need to take any action. IBX and Independence Administrators will submit attestations on their behalf.

Action is needed from self-funded customers by November 1, 2024

IBX and Independence Administrators will submit the annual attestation covering the dates of December 27, 2023 through December 31, 2024 on behalf of all self-funded customers that are active customers as of December 1, 2024, and submit the required data per the link below. Self-funded customers, however, can opt-out of having IBX and Independence Administrators submit the GCPCA on their behalf, meaning they will be responsible for submitting the GCPCA to CMS directly prior to the December 31, 2024 deadline. For self-funded customers who have IBX or Independence Administrators medical but carve out prescription drug or behavioral health services to other vendors, IBX and Independence Administrators cannot file the attestation for pharmacy and behavioral health provider contracts.

We are also mailing a letter to our self-funded customers beginning this week with these details.

• IBX letter
• Independence Administrators letter

This year, we are asking all self-funded customers to go to an online form to let us know if they want IBX and Independence Administrators to submit the attestation on their behalf or if they intend to submit it directly.

They should have their Employer Identification Number (EIN) and Client Identification Number (CID) readily available prior to visiting the form. Self-funded customers, whether they choose to opt-out of having IBX and Independence Administrators submit on their behalf or request IBX and Independence Administrators to submit the attestation on their behalf, must notify us by November 1, 2024.

For self-funded customers who opt-out, they should follow these steps to submit the Gag Clause Attestation to CMS directly:

1. Go to the Gag Clause Prohibition Compliance Attestation website.
2. Scroll down to “Resources” at the bottom of the page.
3. Click “Enter Webform Now for a GCPCA.”
4. Sign in and submit the attestation.

For any questions about the submission process, refer to the other links in the “Resources” section: Frequently Asked Questions, Instructions for submitting the GCPCA, or User Manual for submitting the GCPCA.

What is the CAA Prohibition on Gag Clauses?

The CAA Prohibition on Gag Clauses provision requires that a group health plan or insurer may not enter into an agreement with a health care provider, network or association of providers, TPA, or other service provider offering access to a network of providers, which directly or indirectly restrict a group health plan or insurer from providing provider-specific cost or quality-of-care information or data, electronically accessing de-identified claims and encounter information or data for each enrollee, or sharing that information or data with a business associate. For more details, visit the Gag Clause Prohibition Compliance Attestation website.

Confirmation of Compliance – Independence Blue Cross

Independence Blue Cross (IBX) hereby certifies that for the period of December 27, 2020 through the date of an individual account’s attestation (no later than December 31, 2024), IBX’s agreements with health care providers, networks or associations of providers, TPAs, or with other service providers offering access to a network of providers in which the account and its plan participate with IBX have been compliant with requirements pertaining to the CAA Prohibition on Gag Clauses.

When submitting the attestation, use the above confirmation of compliance as support.

Confirmation of Compliance – Independence Administrators

Independence Administrators hereby certifies that for the period of December 27, 2020 through the date of an individual account’s attestation (no later than December 31, 2024), Independence Administrators agreements with health care providers, networks or associations of providers, TPAs, or with other service providers offering access to a network of providers in which the account and its plan participate with Independence Administrators have been compliant with requirements pertaining to the CAA Prohibition on Gag Clauses.

When submitting the attestation, use the above confirmation of compliance as support.

Please continue to direct all CAA and Transparency in Coverage Rule (TCR) questions to the CAA and TCR mailbox.

The CAA provision requires an annual “gag clause prohibition compliance attestation” (GCPCA). UnitedHealthcare completed the review of agreements and ensured compliance with the prohibition on gag clauses on price or quality information as required under the CAA Gag Clause.

• UnitedHealthcare will attest for fully insured and Level Funded customers
• For ASO customers, UnitedHealthcare is providing a Confirmation of Compliance (pdf) to support the customers doing their own attestation.
• For customers with both fully insured and self-funded business, UnitedHealthcare will attest for fully insured plans and customers must attest for the self-funded plans

UMR and Surest will follow the same process. Brokers may share the following UMR or Surest branded documents with customers, as appropriate:

• If you have a customer who has UMR, there is a UMR branded Confirmation of Compliance (pdf).
• If you have a customer who has a Surest plan, there is a Surest branded Confirmation of Compliance (pdf).

Attestation deadline is Dec. 31, 2024.

You may use the Confirmation of Compliance to support your attestation for any UnitedHealthcare administered medical, behavioral and pharmacy business. If pharmacy coverage is through OptumRx Direct, you will need to attest for that separately.