ERISA Benefits Law Desk ReferenceERISA Benefits Tech, LLC

Part 15 · Chapter 3

CAA Transparency, Reporting, and Fee Disclosure

Law stated as of October 3, 2026 · Health Plan Parity, CAA, and Transparency

Scope and status

This chapter covers the recurring-deliverable layer of CAA/transparency-era compliance: the gag clause prohibition and annual attestation, RxDC reporting, the Transparency in Coverage machine-readable files and price-comparison tool, the §408(b)(2)(B) broker/consultant compensation disclosure, and the health-plan fee fiduciary litigation wave these transparency rules are fueling. These are not one-time projects — they are annual and monthly submissions with fixed deadlines, mostly performed by vendors the plan fiduciary must monitor, and the data they generate is now the raw material of plaintiff-side fee claims.

Citations are to primary authority (ERISA §§408(b)(2)(B), 724, 725; Code §§9824, 9825; PHSA §§2799A-9, -10; the 2020 Transparency in Coverage final rule; and agency guidance). Related questions are treated elsewhere: MHPAEA comparative analyses and the No Surprises Act in this Part's companion chapteri; general §408(b)(2) doctrine and fiduciary-process fundamentals in Part 3 (Fiduciary Duties and Prohibited Transactions); and Form 5500 and participant-disclosure mechanics in Part 4 (Reporting, Disclosure, Recordkeeping, and Claims).

Threshold framing. Run every engagement against the compliance calendar: gag-clause attestation December 31 (annual); RxDC June 1 (annual, prior calendar year); TiC machine-readable files monthly; price-comparison tool at plan-year updates; §408(b)(2)(B) disclosures before contracting/renewal; MHPAEA comparative analyses continuously maintained. Then ask the fiduciary-era question: who performs each deliverable, under what contract terms, and what does the plan's file show about monitoring — because that file is what both DOL and the plaintiffs' bar now request first.

Sections

Part A is shown in full. The other sections are listed by title; their text is available to subscribers.

Part A — Gag Clause Prohibition and Annual Attestation

A1.The prohibition

Part 15, ch. 3, § A1

A group health plan may not enter an agreement with a provider, TPA, network, or other service provider that directly or indirectly restricts the plan from: (1) providing provider-specific cost or quality-of-care information to referring providers, the sponsor, or participants; (2) electronically accessing de-identified claims and encounter information for each participant (consistent with privacy law); or (3) sharing such information with business associates. Reasonable confidentiality protections for rates are permitted; blanket anti-disclosure and data-access denials are not. Statute: ERISA §724; Code §9824; PHSA §2799A-9 (CAA §201; effective Dec. 27, 2020).

A2.The attestation (GCPCA)

Part 15, ch. 3, § A2

Plans must annually attest compliance — the Gag Clause Prohibition Compliance Attestation, submitted through CMS's HIOS system, due December 31 each year (first attestation was due December 31, 2023, covering the period since December 27, 2020). For insured plans, the issuer's attestation covers the insured coverage; for self-insured plans, the plan must attest — a TPA may submit on the plan's behalf by written agreement, but the legal responsibility stays with the plan, and many TPAs refuse to attest. Agency guidance — formal: FAQs About ACA and CAA Implementation Part 57 (Feb. 23, 2023); CMS GCPCA instructions — verify the current-year instructions.

Part B — RxDC Reporting

  1. B1The obligationSubscribers
  2. B2What the data feedsSubscribers

Part C — Transparency in Coverage

  1. C1Machine-readable filesSubscribers
  2. C2The price-comparison toolSubscribers

Part D — §408(b)(2)(B): Broker and Consultant Compensation Disclosure

  1. D1The ruleSubscribers

Part E — The Health-Plan Fee Fiduciary Litigation Wave

  1. E1The theory and the docketSubscribers
  2. E2Standing is the battleground — not a safe harborSubscribers
  3. E3Enforcement-climate noteSubscribers

The first Part of each chapter is open to everyone. The remaining sections, with their authority and practice points, are available to subscribers and to clients of ERISA Benefits Law Group, PLLC whose engagement includes access.

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