CAA Gag Clause Prohibition Compliance Attestation

Optima Health continues to review the requirements under the Consolidated Appropriations Act (CAA). We are gathering information to meet the timelines for the required Gag Clause Prohibition Compliance Attestation (GCPCA), due no later than December 31, 2023.

The Gag Clause provision prohibits group health plans and health insurance issuers from entering into agreements with providers that prevent enrollees, plan sponsors, or referring providers from seeing provider-specific cost and quality data.

Plans and issuers must annually attest to CMS that they are in compliance with all requirements. As a courtesy, Optima Health will attest on behalf of fully insured and self-funded groups. The requirements for these groups are the following:

• Fully insured groups – no action is required.
• Self-funded groups – submit a form with group-specific information.

In the coming weeks, self-funded groups will receive an email with a link to complete an electronic form to collect the required data points. The due date to submit the form is October 1, 2023. We will process the information and submit the attestation to CMS by December 31, 2023.

More details on the regulations and requirements can be found on the CMS website. You can also refer to our frequently asked questions on our website.