Heads-up to group health plans: December 31 gag clause attestation deadline approaches

The Consolidated Appropriations Act of 2021 prohibits group health plans from agreeing to avoid making certain disclosures of provider-specific cost or quality-of-care information—referred to as the gag clause prohibition. The Act also requires health plans and insurers offering group health insurance coverage to attest annually that they’re in compliance with the gag clause prohibition. Group health plans and their issuers must submit their attestation through the Centers for Medicare and Medicaid Services (CMS) website annually by December 31.

Background

A prohibited gag clause directly or indirectly restricts the plan or the issuer from providing, accessing, or sharing information like provider-specific price; quality of care; electronic access to de-identified claims; or data that refers to providers, participants, or those eligible to participate.

Gag clauses might be found in agreements between a plan or an issuer and a healthcare provider, a network or an association of providers, a third-party administrator, or another service provider offering access to a provider network. Reasonable restrictions on the public disclosure of this information are permitted.

Attestation requirement