Aetna Gag Clause Attestation and Compliance Guidelines

To comply with Aetna's gag clause attestation, you'll need to understand the requirements and guidelines set by the company. Aetna requires providers to sign an attestation form annually, acknowledging their understanding of the gag clause.

The gag clause prohibits providers from disclosing or discussing Aetna's reimbursement rates or methodologies with patients or third parties. This includes not sharing information about the company's payment policies or procedures.

Providers must also acknowledge that they will not disclose any confidential information about Aetna's business operations or financial data. This is a critical aspect of the attestation process, as it ensures the confidentiality of sensitive information.

To ensure compliance, providers should review the attestation form carefully and sign it only after reading and understanding the terms.

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Group health plans and issuers offering group health insurance coverage must comply with the prohibition on gag clauses. This means they cannot enter into agreements with healthcare providers, TPAs, or other service providers that restrict data and information sharing.

The CAA prohibits gag clauses that restrict plans or issuers from providing provider-specific cost or quality-of-care information to referring providers, plan sponsors, participants, beneficiaries, or enrollees. This includes electronic access to de-identified claims and encounter information upon request.

A gag clause is a contractual term that restricts data and information sharing. Effective December 27, 2020, the CAA prohibits group health plans and issuers from entering into agreements that include gag clause language.

Health plans and issuers must ensure their agreements do not contain provisions that violate the CAA's prohibition on gag clauses. This includes contracts with TPAs or other service providers offering access to a network of providers.

Health plans and issuers must annually submit an attestation of compliance with the CAA's prohibition on gag clauses to the Departments. The first attestation is due no later than December 31, 2023.

The attestation requirement applies to fully insured and self-insured group health plans, including ERISA plans, non-federal governmental plans, and church plans. However, plans that only provide excepted benefits and account-based plans, such as HRAs, are not required to submit an attestation.

Here are the key dates for compliance:

If you're with BlueCross BlueShield of North Carolina, United Healthcare, or Aetna, and have a fully insured, balance (or level) funded, or individual plan, you're in the clear and don't need to file anything.

These carriers will take care of the attestation for you and submit it by the deadlines.

Employers with ASO or self-insured plans, however, need to make sure their contracts with TPAs or other health plan service providers don't include gag clauses, which are prohibited by the CAA.

You should also be prepared to provide the compliance attestation by December 31, 2023.

Employers with self-insured health plans can work with their TPAs to provide the attestation, but the legal responsibility still rests with the health plan.

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A gag clause is a contractual term that directly or indirectly restricts specific data and information that a health plan or issuer can make available to another party.

Effective December 27, 2020, the Consolidated Appropriations Act (CAA) generally prohibits group health plans and issuers offering group health insurance from entering into agreements with health care providers, third-party administrators (TPAs), or other service providers that include certain gag clause language.

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These contracts cannot restrict a plan or issuer from providing provider-specific cost or quality-of-care information or data to referring providers, the plan sponsor, participants, beneficiaries, or enrollees (or individuals eligible to become participants, beneficiaries, or enrollees of the plan or coverage).

Gag clauses are prohibited in contracts with health care providers, networks or associations of providers, TPAs, or other service providers offering access to a network of providers.

For example, if a contract between a TPA and a health plan provides that the plan sponsor's access to provider-specific cost and quality-of-care information is only at the discretion of the TPA, that contractual provision would be considered a prohibited gag clause.

Health plans and issuers must ensure their agreements with these providers do not contain provisions that violate the CAA's prohibition on gag clauses.

Here are the key provisions that gag clauses cannot restrict:

A gag clause is a contractual term that restricts specific data and information that a health plan or issuer can make available to another party. Effective Dec. 27, 2020, the CAA generally prohibits group health plans and issuers offering group health insurance from entering into agreements with health care providers, TPAs or other service providers that include certain gag clause language.

To comply with the CAA's prohibition on gag clauses, plans and issuers must ensure their agreements do not contain provisions that violate the rules.

The CAA prohibits gag clauses that restrict a plan or issuer from providing provider-specific cost or quality-of-care information, electronically accessing de-identified claims and encounter information, or sharing this information with a business associate.

Here are the specific restrictions on gag clauses:

Plans and issuers must annually submit an attestation of their compliance with the CAA's prohibition on gag clauses to the Departments. The first attestation must be submitted no later than Dec. 31, 2023, covering the period beginning Dec. 27, 2020, through the date of the attestation.

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The first Gag Clause Compliance Attestation (GCPCA) is due no later than December 31, 2023. This marks the beginning of the annual compliance process for health plans and issuers.

To submit a GCPCA, health plans and issuers must attest to their compliance with the CAA's prohibition on gag clauses. This includes compliance with Internal Revenue Code section 9824, ERISA section 724, and Public Health Service Act section 2799A-9.

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Annual attestations are due by December 31 of each year, covering the period since the last attestation. Subsequent attestations will continue this pattern, ensuring ongoing compliance.

Health plans and issuers that do not submit their attestations by the deadline may be subject to enforcement action. The Centers for Medicare & Medicaid Services is collecting GCPCAs on behalf of the Departments of Labor, Health and Human Services, and the Treasury.

Documentation and Record-Keeping is crucial for Gag Clause Compliance. You should keep a record of all gag clauses in employment contracts, including the date, employee name, and contract details.

A well-organized record-keeping system helps prevent disputes and ensures compliance with regulations. This can be done using a spreadsheet or a document management software.

You should also keep a record of all communications related to gag clauses, including emails, memos, and meeting notes. This helps track any changes or updates to the clause.

Documentation and record-keeping are essential for demonstrating compliance with regulations, such as the Federal Trade Commission (FTC) guidelines. You can use these records to prove that you have not enforced a gag clause in a way that is prohibited by law.

Aetna gag clause attestation requires employers to understand which plans are affected.

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

Employers with these types of plans need to submit an attestation, regardless of their plan's grandfathered status under the ACA.

Plans that only provide excepted benefits, such as health reimbursement arrangements (HRAs), are exempt from this requirement.

Account-based plans are also not required to submit an attestation, including HRAs.

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