A Gag clause is a provision in a contract between the health plan and provider that restricts how much information a provider can share with an enrollee or limits recommendation for a specific treatment option.
Section 202 (division BB) allows enrollees, plan sponsors, and referring providers to see cost and quality data on providers and promotes the use of de-identified claims data and encounter information for quality improvement and plan administration purposes.
Market impact of this provision effects Individual Family Plan (IFP), Small Business Markets (SBM), Core, Premier, Administrative Services Only (ASO) and Shared Advantage (SA) lines of business.