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Health Plan Options |
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This email is intended for producers with business in DE, PA, NENY, WNY, and WV. REQUIRED BY DEC. 31, 2023 - CAA GAG CLAUSE PROHIBITION COMPLIANCE ATTESTATION - UPDATE
Background:
Among other things, the Consolidated Appropriations Act, 2021 (CAA) generally prohibits group health plans (plans) and health insurance issuers (issuers) from entering into provider agreements that would prevent the disclosure of cost or quality of care information or data, and certain other information to active or eligible participants, beneficiaries, and enrollees of the plan or coverage, plan sponsors, or referring providers, or restrict the plan or issuer from sharing such information with a business associate, consistent with applicable privacy regulations (the Gag Clause Prohibition).
The CAA further requires that plans and insurers annually submit a Gag Clause Prohibition Compliance Attestation (GCPCA) to the Departments of Labor, Health and Human Services (HHS), and the Treasury (collectively, the Departments). A GCPCA is an attestation of compliance with Internal Revenue Code (Code) section 9824, Employee Retirement Income Security Act (ERISA) section 724, and Public Health Service (PHS) Act section 2799A-9, as added by the Consolidated Appropriations Act, 2021 (CAA) and as applicable. This year’s attestation is due by December 31, 2023.
Highmark has conducted reviews to confirm all relevant contracts do not contain terms that could be construed as gag clauses in violation of the CAA's Gag Clause Prohibition.
Fully-Insured Clients:
- Highmark will submit GCPA's on behalf of it's fully-insured and cost-plus clients. Any fully-insured and cost-plus clients wanting to know the attestation was submitted on their behalf will receive official communication confirming it's been completed.
Administrative Services Only (ASO) Clients:
- ASO clients will be responsible for preparing and filing GCPAs.
- This link can be used by ASO clients as it contains instructions as to where and how to submit GCPAs provided by CMS.
- To assist our ASO customers, Highmark will provide all ASO clients with a statement confirming its compliance with the CAA's Gag Clause Prohibition. ASO clients will still need to review contracts they may have with other vendors to ensure Gag Clause Prohibition compliance.
- Please note, Highmark will not have insight into agency acceptance of ASO client's GCPAs so confirmation cannot be supplied by Highmark of ASO client submissions.
Should you have any questions, please contact your specific Client Manager(s). |
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Highmark Inc. is an independent licensee of the Blue Cross Blue Shield Association. Insurance or benefit administration may be provided by or through Highmark Inc. or one of its affiliated Blue companies. Highmark Inc. d/b/a Highmark Blue Shield and certain of its affiliated Blue companies serve Blue Shield members in the 21 counties of central Pennsylvania. As a partner in joint operating agreements, Highmark Blue Shield also provides services in conjunction with a separate health plan in southeastern Pennsylvania. Highmark Inc. or certain of its affiliated Blue companies serve Blue Cross Blue Shield members in the 29 counties of western Pennsylvania, 13 counties in northeast Pennsylvania, the state of West Virginia plus Washington County, Ohio, and the entire state of Delaware. Highmark Blue Cross Blue Shield of Western New York is a trade name of Highmark Western and Northeastern New York Inc., an independent licensee of the Blue Cross Blue Shield Association. Highmark Blue Shield of Northeastern New York (Highmark BSNENY) is a trade name of Highmark Western and Northeastern New York Inc., an independent licensee of the Blue Cross Blue Shield Association. |
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