The Consolidated Appropriations Act (CAA) of 2021 prohibits group health plans and insurance issuers from entering into agreements with providers that restrict the release of price or quality information. These prohibited provisions are known as gag clauses.
Plans must submit an annual Gag Clause Prohibition Compliance Attestation (GCPA) confirming that:
- No gag clauses exist in their provider contracts, and
- The plan will not enter into contracts that include gag clauses in the future.
The attestation applies only to major medical group health plans. Excepted benefits (such as standalone dental or vision) are not required to attest.
Who Must File?
Fully Insured Plans
- The insurance carrier submits the GCPA for all fully insured group medical plans.
- Once the carrier files, both the plan and employer are considered compliant.
- Employers with fully insured plans generally have no action required, unless the carrier contacts them directly. Such requests are rare.
Self Funded and Level Funded Plans
- The employer/plan sponsor is responsible for ensuring the attestation is completed.
- Most employers rely on a TPA or ASO to manage provider contracting and submit the attestation.
- A TPA may submit on the plan’s behalf, but the employer remains the responsible entity.
- Filing obligations may vary for very large or multi-state self funded employers.
Filing Process and Deadline
- Attestations must be submitted through CMS’s Health Insurance Oversight System (HIOS).
- Plans must complete a one-time HIOS registration prior to filing.
- The GCPA is due annually by December 31.
Why the Attestation Matters
The CAA’s broader transparency framework – including price comparison tools, machine-readable files, and cost sharing estimates – depends on the ability of plans and providers to share cost and quality information. The annual GCPA ensures that this foundation is in place.
For fully insured plans, compliance is handled behind the scenes by the carrier. For self funded and level funded plans, the attestation is a meaningful annual requirement and must be coordinated with the plan’s TPA or ASO.