Question

Last December my client filed a Gag Clause Prohibition Compliance Attestation (GCPCA) for their level funded group health plan. Does the plan need to file it again this year?

Answer 

Yes, the required submission must be made every year. The GCPCA attests to a health plan’s (or insurer’s) compliance with the prohibition against “gag clauses” in any agreements with providers, provider networks, or entities offering provider network access—including downstream agreements entered into by plan service providers.  The attestation of compliance must be made no later than December 31 each calendar year.

The definition of a gag clause is any contractual term directly or indirectly restricting the plan or insurer from disclosing specified data and information, such as cost or quality of care data.

Submissions are made through CMS’s Health Insurance Oversight System (HIOS) and are accepted throughout the year. After the initial attestation, each subsequent attestation covers the period from the date of the prior attestation through the date of the subsequent attestation.

For example, if a plan submitted a GCPCA on November 30, 2024, and next submits a GCPCA on November 15, 2025, that GCPCA’s “attestation period” is December 1, 2024, to November 15, 2025, and the “attestation year” is 2025.

Resources

• CMS Webpage with Detailed Instructions and Other Resources
• Compliance Library – Gag Clause Prohibition & Attestation
• Gag Clause Attestation Guide

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