Gag Clause Compliance Attestation

• Healthcare providers;
• Provider networks or associations;
• Third-party administrators (TPAs); and
• Other service providers offering access to a provider network.

Key Updates

• Annual Attestation Deadline: The attestation must be submitted each year by December 31, covering the prior plan year (January 1 – December 31).
• Downstream Agreements: Plans must ensure that service providers and their subcontractors do not include gag clauses in downstream agreements. MotivHealth’s Administrative Services Agreements include provisions prohibiting these restrictions.
• Data Access Restrictions: CMS clarified that contracts may not impose limits on the scope, scale, frequency, or method of accessing de-identified claims data. Clauses restricting audits to once per year, limiting data fields, or requiring access only at vendor premises may violate the law.
• Disclosure of Noncompliance: If a prohibited clause is identified, the plan must still submit an attestation and disclose the issue in the “Additional Information” section of the CMS form, along with steps taken to correct it.
• Updated CMS Instructions & Forms: CMS has updated the GCPCA portal, instructions, and templates to reflect these requirements.

How MotivHealth Supports Our Clients

• MotivHealth will file the attestation for services administered by MotivHealth.
• Each ASO client remains responsible for ensuring that any additional service providers (such as PBMs or carve-out vendors) also submit their own attestations.
• ASO clients may choose to complete their own filing through the CMS HIOS GCPCA portal.
• If you do not want MotivHealth to file your attestation, you must notify your MotivHealth Account Manager no later than November 30.

Questions or Assistance

MotivHealth Insurance Company is keeping our groups up to date about the Consolidated Appropriations Act (CAA) gag clause provision. The law prohibits group health plans offering group health coverage from entering into an agreement that bans disclosing certain price and quality information.  The gag clause provision applies to agreements between a plan and

1. a healthcare provider,
2. network or association of providers,
3. third-party administrator, or
4. another service provider offering access to a network of providers

Group health plans and issuers are required to submit an attestation to confirm compliance with the prohibition on gag clauses.

MotivHealth attests that the administrative services provided under its Administrative Services agreements are consistent with the requirements set forth in Section 201 of the Consolidated Appropriations Act, 2021.

The Annual Attestation Deadline is December 31.

Fully Insured Clients

MotivHealth will file the Gag Clause Prohibition Compliance Attestation on their behalf by the deadline.

Administrative Service Only (ASO) Clients

MotivHealth will file the Gag Clause Prohibition Compliance Attestation on their behalf by the deadline. ASO clients can complete their own attestation through the CMS HIOS portal.  ASO clients must work with any third-party or carveout vendor they work with for any portion of their data requiring attestation, such as carveout PBM.

If any ASO client does not want MotivHealth to complete the attestation, they must notify their MotivHealth Account Manager no later than November 30.

Please contact your MotivHealth Account Manager should you have any questions.

Download Letter: Gag Clause Attestation Notice