CAA 2021 Transparency Requirements
The Consolidated Appropriations Act of 2021 imposed the most significant new compliance obligations on employer health plans since the ACA. Seven distinct requirements — from gag clause attestation to machine-readable price files — apply to both self-funded and fully insured plans, with self-funded employers bearing the heaviest direct obligations. Most employers are not fully compliant.
Why CAA compliance is different from prior health plan law
Prior health plan compliance law — ERISA, ACA, COBRA, HIPAA — primarily governed the structure and administration of the plan itself. The CAA introduced a new category of obligation: transparency requirements that govern what information the plan must collect, publish, and make available to participants and regulators.
The practical effect is that CAA compliance requires active engagement with service providers — TPAs, PBMs, carriers, and brokers — in ways that prior law did not. An employer cannot simply purchase a group health plan and assume the carrier handles CAA compliance. Self-funded employers are directly responsible for gag clause attestation, MHPAEA analysis, and RxDC reporting. Fully insured employers must verify that their carrier is meeting the obligations that flow through to the plan.
The CAA also introduced the broker compensation disclosure requirement, which has significant implications for ERISA fiduciary duty. Employers who receive compensation disclosures from their broker must review them and determine whether the compensation is reasonable — and document that determination. Failure to do so is a prohibited transaction under ERISA.
The seven CAA compliance requirements
Gag clause attestation
Annual — Dec 31Employers must attest annually that their plan contracts do not include gag clauses that restrict access to cost and quality data. Attestation is submitted via the CMS HIOS portal by December 31 each year. Self-funded employers are directly responsible; fully insured employers must ensure their carrier submits on their behalf.
Penalty: $100/day per affected individual
Mental health parity (MHPAEA) comparative analysis
OngoingPlans must perform and document a comparative analysis of nonquantitative treatment limitations (NQTLs) for mental health and substance use disorder benefits versus medical/surgical benefits. The analysis must be available to regulators and participants on request. The DOL has been actively requesting these analyses and issuing deficiency letters.
Penalty: DOL enforcement; plan correction required
Surprise billing protections (No Surprises Act)
OngoingPlans must implement independent dispute resolution (IDR) processes for out-of-network billing disputes, provide advanced EOBs, and comply with balance billing protections for out-of-network emergency services and certain non-emergency services at in-network facilities. The IDR process has specific timelines and fee structures.
Penalty: Plan correction; participant remedies
RxDC reporting
Annual — Jun 1Plans must report prescription drug and health care spending data to CMS annually. The report covers plan demographics, premium equivalents, medical and drug costs, and the top 50 most costly drugs. Self-funded employers typically rely on their TPA and PBM to compile the data, but the employer is responsible for the filing.
Penalty: Failure-to-file penalties apply
Broker and consultant compensation disclosures
Pre-contractBrokers and consultants who provide services to ERISA health plans must disclose all direct and indirect compensation they receive in connection with the plan. Employers must review these disclosures and determine whether the compensation is reasonable. Failure to obtain required disclosures is a prohibited transaction.
Penalty: Prohibited transaction; excise tax
Transparency in coverage (machine-readable files)
OngoingPlans must publish machine-readable files containing in-network negotiated rates and out-of-network allowed amounts. Self-funded employers are directly responsible; fully insured employers rely on their carrier. The files must be updated monthly and publicly accessible.
Penalty: $100/day per affected individual
Price comparison tool
OngoingPlans must provide participants with an internet-based price comparison tool covering 500 shoppable services (expanded to all services). The tool must show cost-sharing estimates for in-network and out-of-network providers.
Penalty: Plan correction required
Self-funded employer CAA action checklist
Evaluate your plan's CAA transparency obligations and identify gaps.
Step-by-step guide to submitting your annual gag clause attestation.
Free tool
Assess your CAA compliance gaps
The CAA 2026 Compliance Assessment evaluates your plan against all seven CAA transparency requirements and identifies which obligations you may be missing.