Five Facts About the Annual Gag Clause Prohibition Compliance Attestation
Allison B. Bans • June 9, 2023
- Effective December 27, 2020, the Consolidated Appropriations Act, 2021 (“CAA”), as part of its transparency in health care protections, prohibits group health plans and issuers from entering into agreements that directly or indirectly restrict them from: (1) providing cost or quality of care information to referring providers, the plan sponsor, participants, or individuals eligible to become participants; or (2) accessing deidentified claims and encounter information with respect to participants; and (3) sharing information described in (1) or (2) with a HIPAA business associate.
- Such “gag clauses” may be found in agreements between a group health plan or issuer and any of the following parties: (1) a health care provider; (2) a network or association or providers; (3) a third party administrator (“TPA”); or (4) another service provider offering access to a network of providers.
- Group health plans and issuers must annually submit to the Departments of Labor, Health and Human Services, and Treasury (“Departments”) an annual Gag Clause Prohibition Compliance Attestation (“Attestation”). The first Attestation is due no later than December 31, 2023, covering the period beginning December 27, 2020 through the date of Attestation. Subsequent Attestations are due by December 31 of each year thereafter.
- If a plan is self-insured, it can rely on another entity (e.g., a TPA or pharmacy benefit manager) to submit the Attestation if the plan enters into a written agreement with the entity that indicates that they will attest on the plan’s behalf. However, if the other entity fails to do so, the legal requirement to provide the Attestation remains with the plan. If a plan is insured, it can rely on the issuer to submit the Attestation.
- The Departments launched a website for submitting the Attestations and have issued instructions, a system user manual, and a reporting entity excel template.
For more information regarding the principal requirements under the CAA that apply to employer-sponsored group health plans, see our updated CAA Chart.
Employee burnout has become an epidemic in today’s modern workplace. So much so that the World Health Organization (WHO) officially recognizes it as an “occupational phenomenon.”1
While many used to consider mounting workplace stress an individual employee problem, these days, it’s become an employer’s responsibility to prevent burnout before it hurts productivity and business performance—not to mention your employees’ physical and mental health.
Luckily, you can prevent burnout from affecting your workforce in several ways. This article will explore the causes and signs of employee burnout and the steps you can take to create a positive work environment where employees feel safe from toxic stress levels.
If you're a small business owner, you may have heard of the acronym PCORI and the fees that come with it. But what is PCORI, and how does it apply to your organization?
Under the Affordable Care Act (ACA), sponsors of self-insured health plans must pay a fee to fund the federal Patient-Centered Outcomes Research Institute (PCORI). PCORI is an independent organization the ACA created to conduct research to help healthcare consumers make better decisions for their specific needs and outcomes. It also performs research related to clinical effectiveness.
Employers offering a self-insured medical reimbursement health plan, such as a health reimbursement arrangement (HRA), must pay this fee by July 31 each year via Form 7201. This fee was initially set to expire in 2019, but Congress extended it through September 30, 20292, due to the Further Consolidated Appropriations Act of 20203.
