Gag Clause Prohibition Compliance Attestation Due December 31st: Why Must Plans Attest Annually, and What’s New This Year?

The Gag Clause Prohibition Compliance Attestation (GCPCA) is a requirement for health plans and health insurance issuers to annually attest their compliance with the prohibition against “gag clauses” in any agreements with providers, provider networks, or entities offering provider network access.

A gag clause is any term in a contractual agreement which directly or indirectly restricts disclosure of certain data and information, such as cost or quality of care data. GCPCA provisions prohibit group health plans and issuers from entering into an agreements containing such restrictive clause.  This attestation must be made by December 31st of each calendar year.  Plans and issuers may delegate the reporting responsibility to a third party, but the Plan or issuer still remains responsible for reviewing its own contracts and attesting to compliance with GCPCA. 

What’s New?

This year, the attestation must include confirmation that downstream agreements entered into by plan service providers are compliant.  While plans and issuers control their own agreements for GCPCA compliance, determining whether a third-party, downstream agreement is compliant appears to be a more daunting task.  At a minimum, plans should obtain assurances of compliance from their third-party services providers that any downstream service agreements they manage are in compliance with GCPCA. 

Why must this attestation be made every year? 

Since new agreements and contractual terms may be entered into at any time, the regulation requires Plans and issuers to make this attestation with respect to the one-year reporting period leading up to December 31st of each year, affirming that any agreements in existence during that period were in compliance with GCPCA.

How can Zenith help?

At Zenith American Solutions, we simplify the complexities of compliance and benefits management so our clients can focus on what matters most - their members. Backed by more than 80 years of experience and powered by advanced technology, we deliver Taft-Hartley third party administration with unmatched expertise and genuine care. From navigating annual requirements like the Gag Clause Prohibition Compliance Attestation to optimizing benefits programs, we stand as a trusted partner committed to ensuring confidence and clarity every step of the way.