CurrentBlue Cross Blue Shield - South CarolinaPolicy N/A

CAA compliance amendments (Gag Clause Attestation & RxDC reporting)

Amendments to the Employer Master Group Contract establishing the carrier's obligations to complete and submit CAA-required Gag Clause Prohibition Compliance Attestations and RxDC reports on behalf of the Group Health Plan and the Employer's cooperation and indemnification responsibilities.

Policy Summary

PayerBlue Cross Blue Shield - South Carolina

PolicyCAA compliance amendments (Gag Clause Attestation & RxDC reporting)

Policy CodePolicy N/A

Change TypeInformational amendment — compliance obligations

Effective DateSep 1, 2023

Next Review DateN/A

Key ActionCarrier will complete and submit initial and annual Gag Clause attestations and annual RxDC reports on behalf of the Group Health Plan; Employer must provide requested information to enable submissions.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Dec 31, 2023initial gag attestation deadline

annualattestation recurrence

30 daysemployer response timeframe

since Dec 27, 2020lookback start

required

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Contractual Coverage Obligations

Contract obligations and employer cooperation

Contractual responsibilities and conditions governing the carrier's attestations and reporting on behalf of the Group Health Plan and the Employer's cooperation and indemnification obligations.

ALL of the following

ALL of the following
- The Corporation will complete and submit the initial Gag Clause Prohibition Compliance Attestation on behalf of the Group Health Plan by no later than December 31, 2023.
- The initial attestation covers the period from December 27, 2020 (or, if later, the Group Health Plan effective date) through the date of submission.
ALL of the following
- The Corporation will complete and submit the annual Gag Clause Prohibition Compliance Attestation on behalf of the Group Health Plan by no later than December 31 of each calendar year that this Contract is in effect.
- Absent written direction from the Employer, each attestation will cover any and all agreements between the Group Health Plan (or Employer on behalf of the Group Health Plan) and any health care provider, network or association of providers, third‑party administrator, or other service provider offering access to a network of health care providers.
ALL of the following
- On an annual basis the Corporation will submit RxDC (prescription drug and health care spending) reports required under the CAA on behalf of the Employer, at no cost, for reportable items and services insured by the Corporation.
- For each reference year, Employer will supply the Corporation, by no later than 30 days from the initial group outreach following the reference year, with the average monthly premium (or premium equivalent) amount that Employer paid or will pay toward coverage on behalf of members (including dependents) for the reference year.

ALL of the following

The Employer represents and warrants that the Group Health Plan has been and will be in compliance with applicable CAA/Code/ERISA/PHSA provisions since December 27, 2020, with regard to agreements between the Group Health Plan (or Employer on behalf of the Group Health Plan) and providers, networks, TPAs, or other service providers, if applicable.
The Employer will provide to the Corporation, upon request and in the timeframe and manner specified by the Corporation, all information required to complete and submit the Gag Clause attestation and RxDC reports.
If Employer fails to provide requested information
- The Corporation may, in its discretion, use its best efforts to complete and submit a Gag Clause Prohibition Compliance Attestation on behalf of the Group Health Plan in good faith.

ALL of the following

The Employer agrees to defend, indemnify, and hold harmless the Corporation and its directors, officers, agents, employees, affiliates, successors, and assigns from and against any and all claims, demands, liabilities, damages, losses, suits, costs (including reasonable legal costs) and judgments arising out of or related to the Corporation's completion and submission of one or more Gag Clause attestations or RxDC reports on behalf of the Group Health Plan, including submissions made where the Employer failed to provide requested information.
If this Contract terminates during a calendar year and there is no successor agreement, this Section survives termination and remains in effect through December 31 of that calendar year; the Corporation will complete and submit the applicable attestation(s) for the portion of the period the Contract was in effect.

ALL of the following

The Employer acknowledges that the Corporation will rely entirely on the Employer's representations, warranties, and any information provided by the Employer in completing and submitting each Gag Clause Prohibition Compliance Attestation and RxDC report on behalf of the Group Health Plan.

Attestations & Reporting Actions the Carrier Will Perform

Documentation Required

CAA attestations and Employer reporting obligations

The Corporation will complete and submit the initial Gag Clause Prohibition Compliance Attestation by no later than December 31, 2023, covering agreements from December 27, 2020 (or the plan effective date if later) through the submission date, and will submit an annual Gag Clause Prohibition Compliance Attestation by no later than December 31 of each calendar year while the Contract is in effect. The Corporation will also submit annual RxDC (prescription drug and health care spending) reports on behalf of the Employer at no cost for reportable items and services insured by the Corporation; Employer must supply the average monthly premium (or premium equivalent) for the reference year within 30 days of the Corporation's initial outreach for that year. Employer must provide requested information to enable these submissions and agrees to defend, indemnify, and hold harmless the Corporation and its affiliates for claims related to completion and submission of attestations and RxDC reports, including where Employer failed to provide requested information.

Initial Gag Clause Attestation deadline: by no later than December 31, 2023; coverage lookback: from December 27, 2020 (or plan effective date if later) through submission. [Source: chunk 2]
Annual Gag Clause Attestation recurrence: by no later than December 31 of each calendar year while the Contract is in effect. [Source: chunk 2]
If the Contract terminates during a calendar year after December 31, 2023, the Corporation will still complete and submit an annual attestation for the portion of that year the Contract was in effect. [Source: chunk 5]
RxDC reporting: Corporation will submit annual RxDC reports on behalf of Employer at no cost for reportable items insured by Corporation. Employer must supply the average monthly premium (or premium equivalent) for the reference year within 30 days of the Corporation's initial outreach. [Source: chunk 5]

Key Definitions

Gag Clause Prohibition Compliance Attestation — definition & key deadlines

What it isGag Clause Prohibition Compliance Attestation submitted by the Corporation on behalf of the Employer's Group Health Plan pursuant to IRC §9824, ERISA §724, and PHSA §2799A-9 and applicable federal guidance.

Coverage period for initial attestationCovers agreements from December 27, 2020 (or the Group Health Plan effective date if later) through the date of submission.

Initial attestation deadlineCorporation will complete and submit the initial attestation by no later than December 31, 2023.

Recurring requirementCorporation will complete and submit an annual attestation by no later than December 31 of each calendar year the Contract is in effect.

Scope absent Employer directionAbsent written direction from the Employer (Purchaser), the attestation will cover any and all agreements between the Group Health Plan (or Employer on behalf of the Plan) and any health care provider, network or association of providers, third‑party administrator, or other service provider offering access to a network of health care providers.