Overview
The Consolidated Appropriations Act, 2021 (CAA) established protections for consumers related to surprise billing and transparency in health care. The Gag Clause Prohibition Compliance Attestation (GCPCA) is one requirement within the CAA. Furthermore, this attestation is required to ensure compliance with Section 9824 of the Internal Revenue Code, Section 724 of the Employee Retirement Income Security Act (ERISA), and the Public Health Service (PHS) Act section 2799A-9. The GCPCA prohibits group health plans and health insurance issuers from entering into agreements with health care providers, networks or associations of providers, third party administrators (TPAs), or other service providers offering access to a network of providers that would directly or indirectly restrict a plan or issuer from accessing or sharing certain data/information. The first annual filing for the 2021–2022 calendar year is due December 31, 2023. This communication provides an overview of the requirement and MedCost’s support plan for this filing year (see MedCost Support section for details).
Who is required to attest?
Plans and issuers must annually submit an attestation of compliance of the requirements to the Tri-Departments (DOL, HHS, IRS).
When does the coverage period begin?
The coverage period includes plans beginning December 27, 2020, or the effective date of the applicable group health plan through the date of attestation (plan year ending in 2023).
Reporting Deadlines
The annual filing deadline is December 31 of the calendar year immediately following the reference year. The first filing GCPCA report is due by December 31, 2023.
Requirements
The GCPCA requires each plan sponsor to attest that the plan is complying with the rule. However, the GCPCA allows self-insured health plans to delegate the attestation requirement to service providers, such as a TPA, to complete the attestation on the plan’s behalf.
MedCost Support
MedCost has reviewed its network and provider contracts and confirmed that those agreements do not contain provisions that are prohibited by Section 9824 of the Internal Revenue Code, Section 724 of the Employee Retirement Income Security Act (ERISA), and the Public Health Service (PHS) Act section 2799A-9. We are working to obtain similar assurances from third-party networks contracted through MedCost.
MedCost is prepared to provide the attestation statement and satisfy the filing requirements for all employer health plans active with MedCost. This will be included in the standard compliance support services provided to active clients. As the first due date for reporting approaches, we will be providing important updates on our support efforts. Please pay careful attention to those updates.
Employers Utilizing a MedCost PBM Contract
For employers utilizing a MedCost PBM contract, MedCost will coordinate with the PBM and include those plan components in our attestation on behalf of the plan.
Employers Utilizing an Independent PBM Contract
Employers that have independent PBM contracts will be responsible for coordinating with their PBM to ensure the attestation is submitted to CMS with respect to plan components managed by the PBM as MedCost is unable to attest on behalf of those third-party PBMs.
Next Steps
Unless the group chooses to opt out of the support above, MedCost will file the attestation on behalf of all active groups. Once the submission is complete, we will provide a written confirmation for your records.
Please contact your MedCost Account Manager if you have any questions.