What is the Gag Clause Prohibition Requirement?
The Gag Clause Prohibition Requirement of the 2021 Consolidated Appropriations Act (“CAA”) prohibited plans and issuers from entering into an agreement offering access to a network of providers that would directly or indirectly restrict the plan (i) from accessing provider specific cost or quality of care information and/or data, (ii) from accessing de-identified claims data, and (iii) from sharing that information/data with a business associate. However, service providers are allowed to place reasonable restrictions on the public disclosure of such information. The CAA also requires plans to attest to the compliance of their agreements annually.
Who submits a Gag Clause Prohibition Compliance Attestation?
The legal requirement to provide a timely attestation ultimately falls upon the plan. Attestations should be made by the plan directly to the Department through the Health Insurance Oversight System.
Yuzu Health Insurance Services, Inc., in its capacity as a third-party administrator to self-funded health plans, has prepared the below attestation:
Yuzu Health Insurance Services, Inc. does not enter into any administrative contracts provided to self-funded customers that are not compliant with the requirements set forth under the Consolidated Appropriations Act, 2021, Division BB, Section 201 (Pub. L. 116-260).
Where can I find more information about the Gag Clause Attestation?
The Compliance tab on the portal contains a copy of the Gag Clause Attestation.
