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A Gag Clause Prohibition Compliance Attestation (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 section 201 of Title II (Transparency) of Division BB of ...

Specifically, the gag clause rule prohibits plans and insurance companies from entering into agreements with providers, TPAs, or other service providers that restrict: Provider-specific cost or quality of care information sharing with plan members. Claims data sharing with plan sponsors (and their service providers).

For example, a provision in an agreement between a third-party administrator (TPA) and a self-funded group health plan that allows access to provider-specific cost and quality of care information only at the TPA's discretion would constitute a gag clause.

Reporting entities may authorize an appropriate individual to make the attestation on the organization's behalf. Failure to file could result in enforcement action, which may be a $100-per-day excise tax under the Internal Revenue Code or civil penalty under ERISA. The attestation is to be submitted electronically.

The attestation requirement applies to fully insured and self-insured group health plans, including ERISA plans, non-federal governmental plans and church plans.

Gag clauses are provisions that directly or indirectly prohibit plans from: Disclosing provider-specific cost and quality of care information to referring providers, participants, beneficiaries, enrollees, and individuals eligible to become participants, beneficiaries, or enrollees.

A Gag Clause Prohibition Compliance Attestation (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 section 201 of Title II (Transparency) of Division BB of ...