CurrentBlue Cross Blue Shield - South CarolinaPolicy N/A

CAA Compliance Amendment — Gag Clause Attestation and RxDC Reporting

Amendment to employer group contract specifying Blue Cross and Blue Shield of South Carolina's obligations to complete gag-clause compliance attestations and RxDC reporting on behalf of group health plans, and employer responsibilities for providing information and indemnification.

Policy Summary

PayerBlue Cross Blue Shield - South Carolina

PolicyCAA Compliance Amendment — Gag Clause Attestation and RxDC Reporting

Policy CodePolicy N/A

Change TypeAdministrative / contractual compliance

Effective DateSeptember 1, 2023

Next Review DateN/A

Key ActionCorporation will complete and submit initial and annual gag-clause attestations and annual RxDC reports on behalf of the Employer; Employer must provide requested information and indemnify the Corporation as required.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Dec 31, 2023initial gag-clause attestation deadline

annualgag-clause attestation recurrence

30 daysRxDC reporting timeframe

no costRxDC reporting cost

Dec 27, 2020

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compliance representation date

CAA Compliance Duties and Employer Obligations

Conditions and responsibilities for attestations and reporting under the Contract amendment:

ALL of the following

ALL of the following
- Initial gag-clause attestation: Corporation will complete and submit the initial Clause Prohibition Compliance Attestation on behalf of the Group Health Plan by December 31, 2023, covering the effective date of the Group Health Plan through the date of submission unless Employer directs otherwise.
- Annual gag-clause attestation: Corporation will complete and submit by no later than December 31 of each calendar year that this Contract is in effect an annual Clause Prohibition Compliance Attestation on behalf of the Group Health Plan for that calendar year, unless Employer directs otherwise.
- Employer compliance representation: Employer represents and warrants that the Group Health Plan has been compliant with Code section 9824, ERISA section 724, and PHSA section 2799A-9 since December 27, 2020 and will remain compliant prospectively during the Contract term.

Employer information provision: Employer will provide to the Corporation, upon request and in the timeframe and manner specified by the Corporation, all information the Corporation requires to complete and submit the Clause Prohibition Compliance Attestation; if Employer fails to provide requested information, the Corporation may, in its discretion, use its best efforts to complete and submit the attestation in good faith.

Survival on termination: If this Contract terminates during a calendar year and there is no successor agreement, this Section survives through December 31 of that calendar year; the Corporation will complete and submit required attestations for the portion of the year the Contract was in effect (including completing the initial attestation if termination occurs on or before December 31, 2023).

RxDC reporting and employer data: Corporation will submit annual RxDC (prescription drug and health care spending) reports required under the CAA on behalf of the Employer at no cost for reportable items insured by the Corporation; Employer will supply the average monthly premium (or premium equivalent) for the reference year within 30 days of the initial group outreach.

Employer indemnification: 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 attestations or RxDC reports on behalf of the Group Health Plan, including submissions made where Employer failed to provide requested information.

Codes and Reporting Timeframes

Not applicablemixed

RxDC reporting timeframe — 30 days from initial group outreach

Timeframe to supply employer premium dataEmployer must supply the average monthly premium (or premium equivalent) for the reference year within 30 days of the initial group outreach

Report submission frequencyCorporation will submit RxDC reports on an annual basis

Scope of reportsReports cover prescription drug and health care spending (RxDC) required under the Consolidated Appropriations Act (CAA) for items insured by Corporation

Cost to EmployerCorporation will submit RxDC reports on behalf of Employer at no cost

Actions, Submissions, and Employer Responsibilities

Prior Authorization

Gag‑Clause Attestation Submission (initial and annual)

Corporation will complete and submit the initial Clause Prohibition Compliance Attestation on behalf of the Group Health Plan by December 31, 2023, and will complete and submit an annual Clause Prohibition Compliance Attestation by December 31 of each calendar year the Contract is in effect, unless Employer directs otherwise.

Initial attestation covers the effective date of the Group Health Plan through the date of submission unless Employer directs otherwise.
Annual attestations cover the applicable calendar year unless Employer directs otherwise.

Documentation Required

RxDC Reporting Requirement and Employer Data Deadline

Corporation will submit annual RxDC (prescription drug and health care spending) reports required under the CAA on behalf of the Employer at no cost; Employer must supply the average monthly premium (or premium equivalent) for the reference year within 30 days of initial group outreach.

Key Definitions

Clause Prohibition Compliance Attestation definition — gag-clause attestation and statutory references

DefinitionClause Prohibition Compliance Attestation (gag-clause attestation): an attestation required pursuant to IRC section 9824, ERISA section 724, and PHSA section 2799A-9 (as applicable) regarding prohibited gag clauses in agreements with providers and third-party administrators

Initial attestation deadlineCorporation will complete and submit the initial attestation on behalf of the Group Health Plan by no later than December 31, 2023

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

Coverage scopeAbsent written direction from the Employer, attestations will cover all agreements between the Group Health Plan (or Employer on behalf of the Group Health Plan) and any health care provider, network, third-party administrator, or other service provider offering access to a network of providers

RxDC reports definition — prescription drug and health care spending reports required under the CAA

Policy Summary

PayerBlue Cross Blue Shield - South Carolina

PolicyCAA Compliance Amendment — Gag Clause Attestation and RxDC Reporting

Policy CodePolicy N/A

Change TypeAdministrative / contractual compliance

Effective DateSeptember 1, 2023

Next Review DateN/A

SourceLink

On This Page

Reports apply to reportable items and services insured by Corporation.
Employer must provide average monthly premium (or premium equivalent) amount for the reference year by no later than 30 days from the initial group outreach.

Documentation Required

Provide Requested Information and Indemnify Corporation

Employer must provide to the Corporation, upon request and in the timeframe and manner specified, all information the Corporation requires to complete and submit attestations and RxDC reports, and Employer agrees to defend, indemnify, and hold harmless the Corporation for claims arising from the Corporation's completion/submission of those attestations or reports, including where Employer failed to provide requested information.

If Employer fails to provide requested information, Corporation may use its best efforts, in its discretion, to complete and submit attestations in good faith.
Indemnification covers claims, demands, liabilities, damages, losses, suits, costs (including reasonable legal costs) and judgments related to the Corporation's submissions.

DefinitionRxDC reports: prescription drug and health care spending reports required under the Consolidated Appropriations Act (CAA) that the Corporation will submit on behalf of the Employer for reportable items insured by Corporation

Who files the reportsCorporation will submit RxDC reports on behalf of Employer

Employer data obligationEmployer must provide average monthly premium (or premium equivalent) for the reference year to Corporation within 30 days of initial group outreach

Indemnification related to reportsEmployer agrees to defend, indemnify, and hold harmless Corporation for claims arising from Corporation's completion and submission of RxDC reports, including when Employer fails to provide requested information