Legislative Update

New Guidance from CMS and DOL on CAA Section 201 – Access to Employer Data by Alex Jung, Alex Jung Consulting & MBGH Board Member

Please use this new guidance with your carriers if you encounter resistance or refusal from them to provide you with your claims data:

Section 201 of the Consolidated Appropriations Act (CAA) was enacted last year and the DOL just released guidance around access to employer data. The Gag Clause Prohibition Compliance Attestation System (GCPCAS) states that you cannot withhold cost, quality and utilization data. See the following excerpt from the guidance: "These provisions prohibit group health plans and health insurance issuers offering group health insurance coverage from entering into an agreement with a health care provider network or association of providers, third party administrator (TPA/ASO), or other service provider offering access to a network of providers that would directly or indirectly restrict a plan or issuer from:

1.     providing provider specific cost or quality of care information or data, through a consumer engagement tool or any other means, to referring providers, the plan sponsor, participants, beneficiaries, or enrollees, or individuals eligible to become participants, beneficiaries, or enrollees of the plan or coverage; and 2.     electronically accessing de-identified claims and encounter information or data for each participant, beneficiary or enrollee in the plan or coverage upon request. Plans and issuers must ensure that their agreements with healthcare providers, networks or associations of providers or other service providers offering access to a network of providers do not contain these or other provisions that violate the prohibition on gag clauses under Code Section 9824, ERISA Section 724, and PHS Act Section 2799A-9." Note that a federal statute supersedes any and all agreements between parties.

MBGH will keep you informed as these issues progress!