Compliance Alert | Gag Clause Prohibition Compliance Attestation (GCPCA)

For 2025, the Gag Clause Prohibition Compliance Attestation is due to CMS by December 31, 2025 and covers the period from January 1, 2025, through the date of attestation.

Title II (Transparency) of Division BB of the Consolidated Appropriations Act (“CAA”) prohibits group health plans from entering into an agreement with a health care provider, network or association of providers, third-party administrator (TPA), or other service provider that include language that would constitute a “gag clause.” Specifically, these agreements cannot directly or indirectly: 

• Block or bar disclosure of provider-specific costs; 
• Block or bar disclosure of provider-specific Quality-of-Care data; 
• Block or bar electronic access of de-identified claims information; 
• Prohibit sharing any of the preceding information with a Plan Member or Business Associate 

However, the prohibition on gag clauses does not prevent health care providers, networks or associations of providers, or other service providers from placing reasonable restrictions on any of the information covered by the gag clause requirements.

Fully insured group health plans (excluding HRAs): Typically the Gag Clause Prohibition Compliance Attestation (GCPCA) requirements are met by the insurance carriers. 

Self-funded and level-funded group health plans (excluding HRAs):  The Plan Sponsor/Employer should work with their Third-Party Administrator (TPA), Pharmacy Benefits Manager (PBM), and/or another service provider to meet the requirements of this attestation. If an insurer or TPA is not willing to make the attestation on behalf of their clients, the responsibility for making the filing remains with the Plan Sponsor/Employer. 

The Compliance Attestation must be filed online through the Center for Medicare & Medicaid Services’ Health Insurance Oversight Systems at CMS Gag Clause Attestation Portal. For more information and instructions, click here or copy/paste the following into your browser: https://regtap.cms.gov/reg_librarye.php?i=5479.

The gag clause provisions became effective on December 27, 2020, and group health plans are legally required under the CAA to submit an annual attestation of compliance (a “Compliance Attestation”) to the United States Departments of Labor, Health and Human Services, and the Treasury. These group health plans include ERISA-governed plans, non-Federal government plans, and church plans subject to the Internal revenue code. Both grandfathered and non-grandfathered group health plans must comply with the attestation. (A plan, however, is not required to attest with respect to any excepted benefits or health reimbursement arrangements.)

Remember, the Compliance Attestation is due no later than December 31, 2025, and covers the period from January 1, 2025, through the date of attestation. 

Contact your Account Executive if you have any questions or need assistance on determining if you need to file this directly.