By December 31st of each year, insurance companies and plans sponsor of group health plans are required to provide the Centers for Medicare and Medicaid Services (CMS) with information certifying that their plan or policies do not include illegal gag provisions. The due date for the subsequent attestation is December 31, 2024.
Clients are receiving notifications from carriers and TPAs regarding their plan to adhere to the Gag Clause Prohibition Compliance Attestation. Once more, it appears that the different carriers/TPAs will not handle the attestation requirements the same way.
For fully insured plans both the plan and carrier must file attestation if the group health plan is fully insured; however, the plan shouldn’t need to take any more action if the carrier does so on behalf of the fully insured arrangement. The employer is responsible for filing the attestation if the carrier declines to submit or request information from the employer to allow submission on the employee’s behalf
For self-funded plans including level-funded plans, the plan sponsor may sign a formal contract with the provider (TPA, PBM) to have the provider submit the attestation on the plan’s behalf. TPAs may ask the employer for information in order to facilitate filing on the plan’s behalf, TPAs have declared they will not submit the attestation for the plan.
Have Questions? and want to read more about the changes Gag Clause Attestation Due December 31, 2024 for more details.
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