Skip to content

Find resources to help with recovery if you’ve been impacted by Hurricanes Milton and Helene. Learn More

Baldwin Bulletin

Updated Resources Available for Next Gag Clause Prohibition Compliance Attestation Due December 31, 2024

The Baldwin Group
|
Updated: August 13, 2024
|
2 minute read

On May 24, 2024, the U.S. Department of Labor (“DOL”) issued updated annual submission instructions, a user manual, and an Excel template to assist health plans and health insurance issuers in submitting their annual attestation of compliance with the Consolidated Appropriations Act’s (“CAA”) gag clause prohibition. Section 4 of the updated instructions has a list of the changes made since 2023.  These resources can be used to submit the next gag clause attestation which is due by December 31, 2024.

Employer Action Items

Employers should review their contracts with issuers, third-party administrators (“TPAs”) and other health plan service providers to confirm that they do not contain prohibited gag clauses. Also, employers should review what action they may need to take to comply with the gag clause attestation requirement, keeping in mind that such action may vary depending on whether the plan is fully insured or self-insured.

  • Fully Insured Health Plans. The employer does not need to provide an attestation if the issuer for the plan provides the attestation.
  • Self-funded Health Plans. Employers can enter into written agreements with their TPA(s) to prepare and submit the attestation.  However, legal responsibility for performance of the attestation requirements nevertheless remains with the health plan sponsor. Not all TPAs will agree to submit the attestation, so employers should coordinate with their TPAs if there are multiple components to confirm that all required attestations are being filed.

Summary

The CAA prohibits health plans and issuers from entering contracts with health care providers, TPAs or other service providers that contain gag clauses. A gag clause is a clause that restricts the plan or issuer from providing, accessing, or sharing certain information about provider price and quality and de-identified claims.

Plans and issuers must annually submit an attestation of compliance with the CAA’s gag clause prohibition to the Departments of Labor, Health and Human Services, and the Treasury (Departments). The Centers for Medicare & Medicaid Services (“CMS”) is collecting the attestations on behalf of the Departments. The first attestation was due by December 31, 2023, and subsequent attestations are due by December 31 of each following year.

The attestation due by this December should cover the period since the last attestation. For example, an attestation submitted on October 10, 2024, for a responsible entity (formerly referred to as a reporting entity) that submitted its attestation for the prior attestation year on November 30, 2023, would have an attestation period of December 1, 2023, to October 10, 2024, and an attestation year of 2024.

Additional Resources


Related Insights

Stay in the know

Our experts monitor your industry and global events to provide meaningful insights and help break down what you need to know, potential impacts, and how you should respond.

Compliance Alert
IRS Expands List of Preventive Care Benefits for High Deductible Health Plans (“HDHP”)
Overview On Oct. 17, 2024, the IRS issued Notice 2024-75 (“Notice”) to expand the list of preventive care benefits permitted...
Baldwin Bulletin
Upcoming Compliance Deadlines - October
Employers must comply with numerous reporting and disclosure requirements in connection with their group health plans.  Please note the following...
Baldwin Bulletin
The California Corner: California State Disability Insurance Changes for 2025
California State Disability Insurance (“CA SDI”) is a program that provides short-term income replacement benefits to eligible workers who are...
Baldwin Bulletin
The California Corner: SB 729 –Coverage for Infertility and Fertility Medical Services
On September 29, 2024, California’s Governor Gavin Newsom signed SB 729 into law, modifying requirements related to coverage of infertility...
Baldwin Bulletin
Understanding Imputed Income for Purposes of Federal Taxation of Benefits
Imputed income is the value of any non-cash benefit or income an employee receives that is not part of their...
Let's make it possible

Partner with us to build solutions that align with your business, individual, or employee needs and open new possibilities for your future.

Connect with us