What is it? As stated under Internal Revenue Code Section 9824, ERISA Section 724, and PHS Act Section 2799A-9, issuers and group health plans are prohibited from entering into certain 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 Consolidated Appropriations Act of 2021 added a requirement for issuers and group health plans to submit an annual Gag Clause Prohibition Compliance Attestation (GCPCA), beginning in 2023. 

Who will submit the GCPCA? As the issuer of your group health plan, Sanford Health Plan enters into and maintains provider networks through our provider agreements. By maintaining these agreements, Sanford Health Plan is in the best position to submit the GCPCA on your behalf, and plans to complete the submission unless other arrangements are desired.  

When is it due? GCPCA is required to be submitted annually, by December 31st of each year. Once Sanford Health Plan has submitted the attestation on your behalf, we will send a follow-up communication notifying you that this has been completed. 

What information will be submitted to HHS on behalf of group health plans? When reporting on behalf of multiple entities, HHS requires that a “Reporting Entity Template” be completed and uploaded as part of the GCPCA submission. Sanford Health Plan will complete the template using data already available in our system to report: 

1. Group Health Plan Name 
2. Group Health Plan (or plan sponsor) EIN 
3. Group Health Plan Type (e.g., ERISA, Non-Federal Government Plan)
4. Mailing Address for the Group Health Plan
5. Name of Group Health Plan Point-of-Contact
6. Email Address of Group Health Plan Point-of-Contact
7. Phone Number for Group Health Plan Point-of-Contact

The template and other instructional details about the GCPCA can be downloaded from the CMS website: https://www.cms.gov/cciio/programs-and-initiatives/other-insurance-protections/gag-clause-prohibition-compliance

What are my next steps? If you have questions or concerns about what information we may currently have on file regarding your group health plan as listed above (e.g., point-of-contact information), please contact your Account Manager to confirm or update your information before October 25, 2024. More information on the Gag Clause Prohibition Compliance Attestation can be found at the CMS website linked above. 

Thank you for your partnership,

Sanford Health Plan