Under the Consolidated Appropriations Act (CAA) group health plans and health insurance issuers are prohibited from entering into agreements with providers that prevent enrollees, plan sponsors, or referring providers from seeing provider-specific cost and quality data. Plans and issuers must annually attest to CMS that they are in compliance with all requirements, known as the Gag Clause Prohibition Compliance Attestation (GCPCA). Plans and issuers must attest no later than December 31, 2024.
Each carrier has different processes for collecting and submitting gag clause information. We will continue to update this page as the information becomes available. For more information, please refer to CMS.
Aetna
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.
Anthem
Anthem will file the Gag Clause Prohibition Compliance Attestation on behalf of Fully Insured and Administrative Services Only (ASO) clients before the December 31, 2024, deadline. No action is required by clients.
Blue Cross Blue Shield of NC
BCBSNC will continue to file the Gag Clause Prohibition Compliance Attestation for fully insured and balanced funding groups.
ASO groups will continue to file for themselves.
Balanced funding groups will receive a document through Echosign that will allow them to opt-out and file their own attestation. Groups that do not complete this opt-out form will be included in the group filing.
Additional information from BCBSNC can be found here.
Sentara Health Plans
Sentara Health Plans will attest on behalf of Fully Insured and Self-funded groups. The requirements for these groups are the following:
- Fully insured groups – no action is required
- Self-funded and BusinessEDGE® groups – required to submit a form with group information to Sentara Health Plans by October 1, 2024
Self-funded and BusinessEDGE groups will receive an email with a link to complete an electronic form to collect the required data points. The due date to submit the form is October 1, 2024. Sentara will process the information and submit the attestation to CMS by December 31, 2024.
You can also refer to Sentara's frequently asked questions.
UnitedHealthcare
In early September, UnitedHealthcare will send self-funded employers a Confirmation of Compliance, indicating that UnitedHealthcare completed the annual Gag Clause Prohibition Compliance Attestation (GCPCA).
This means that UnitedHealthcare reviewed its contracts and confirms compliance with the Consolidated Appropriations Act (CAA) Gag Clause requirements, which prohibit health plan sponsors and issuers, such as UnitedHealthcare, from having agreements with health care providers, networks or associations of providers, third-party administrators or any other service providers that prevent the disclosure of quality and cost of care information.