2024 Approach for Gag Clause Prohibition Compliance Attestation

September 18, 2024

2024 Approach for Gag Clause Prohibition Compliance Attestation
Applies to all groups

This will be the second year that the federal government will require an attestation as part of the Gag Clause Prohibition Compliance Attestation. Under these requirements, both group health plans and health insurance issuers offering group and individual health insurance coverage must submit an attestation of compliance.

The deadline for submitting this reporting to the Centers for Medicare & Medicaid Services is Dec. 31, 2024.

We will support our group customers in the following manner:

Fully Insured, Cost Plus and Minimum Premium Groups: Blue Cross and Blue Shield of Texas will attest on behalf of fully insured group health plans. As an insurer, BCBSTX is required to annually submit a GCPCA attestation. When the issuer of a fully insured group health plan submits its GCPCA, CMS will consider both the fully insured group health plan and issuer to have satisfied the attestation submission requirement. No further action is required from fully insured groups.

ASO Group Approach: Due to the nature of self-funded business, ASO group customers will need to submit their own GCPCA attestation. BCBSTX is providing the following confirmation of compliance regarding our medical provider agreements for self-funded group health plans to use to support their own attestations in the CMS portal:

BCBSTX does not standardly enter into any medical provider agreements that would prohibit disclosure of information consistent with Section 201 of the CAA. BCBSTX’s medical provider agreements also include “compliance with law” provisions that would make any non-standard language that could be viewed as non-compliant with the CAA ineffective. BCBSTX is not aware of any prohibited gag clauses, as defined by CAA, in its medical provider agreements at this time. If any such language is identified, it will be removed from the contract.

These approaches are unchanged from last year’s GCPCA reporting.

The CMS GCPCA website has several resources available to explain the requirements of this attestation, including instructions, FAQs and a user manual with step-by-step submission instructions. These resources may be helpful for groups that need to submit their own attestation to CMS.

Questions: If you have any questions, please contact your BCBSTX representative.

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