Jan 24, 2024Medicare Part D: Plan Sponsors Must Complete Disclosure to CMS by March 1
Medicare Part D: Plan Sponsors Must Complete Disclosure to CMS by March 1. Learn more in this latest Compliance Advisory.
This is a reminder that the first “Gag Clause Attestation” is due by December 31, 2023! Learn what you need to know here.
We want to remind you that the first “Gag Clause Attestation” is due by December 31, 2023!
The Consolidated Appropriations Act of 2021 (CAA) prohibited group health plan issuers from entering into agreements with service providers, TPAs, or other providers that include language that would constitute a “gag clause.” A gag clause is a contract provision that restricts specific date and information that the Plan can make available to another party. An example of now-prohibited language would be a clause in the contract with the insurance carrier whereby the carrier places restrictions on the disclosure of provider-specific cost or quality of care information or data to referring providers or the Plan Sponsor (or participants/enrollees).
This prohibition (and attestation-filing) applies to all employer-sponsored health insurance plans except for HIPAA-excepted benefits (e.g., stand-alone dental, vision, Retiree-only plans, and most healthcare FSAs) or account-based programs (e.g., HRAs). There is no exemption for non-ERISA (e.g., Church or Governmental) or ACA-Grandfathered Plans.
While the law itself became effective December 27, 2020 (and the actual gag clause prohibition took effect August 20, 2021), the first attestation of compliance is due not later than December 31, 2023. This is an annual reporting requirement; however, the initial attestation may cover the 2021, 2022, and 2023 calendar years.
The legal onus is on the Plan Issuer (i.e., insurance carrier for fully-insured Plans) to submit the attestation to the Departments; however, since employers that sponsor self-funded Plans technically function as a Plan Issuer themselves, they may wish to engage their Plan’s TPA/vendor to determine if the TPA/vendor will submit the attestation on their Plan’s behalf.
For more detailed information and technical guidance, please visit the CMS website dedicated to this process.
Your M&G Account Manager would be happy to assist you with any questions you may have regarding this matter; please contact us to schedule a discussion.
We look forward to continually serving you!
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