ASR Supports Clients with Gag-Clause Attestations


The Consolidated Appropriations Act, 2021 (CAA) prohibits gag clauses in contracts between a group health plan and certain service providers.

What is a gag clause?

A gag clause is a contractual term that directly or indirectly restricts specific data and information that a plan can make available to another party.  Under this CAA provision, a health plan is prohibited from entering into an agreement with a provider, network or association of providers, third-party administrator, or other service provider offering access to a network of providers that would directly or indirectly restrict the plan from the following:

  1. Making available provider-specific cost and quality of care information to referring providers, the Plan sponsor, members, or an individual eligible to become a member
  2. Accessing de-identified claims and encounter information electronically for each member
  3. Sharing such information (consistent with Privacy laws)

Provider contracts may, however, prohibit plans from publicly disclosing this information.

What are the requirements for a health plan?

Plans must attest to the Departments of Labor, Treasury, and HHS each year that they have no such clauses in their contracts.  The first attestation is due no later than 31 December 2023, covering the period beginning 27 December 2020, or the effective date of the applicable group health plan (if later), through the date of attestation.  Subsequent attestations, covering the period since the last preceding attestation, are due by 31 December of each year thereafter.

How will ASR support clients in this attestation?

ASR will submit the required medical and prescription-drug attestations for our clients annually, beginning with the attestation due 31 December 2023.  Contact ASR Health Benefits at (616) 957-1751 or (800) 968-2449 for more information.