Gold Card Act Legislation
In an effort to alleviate some of the steps associated with prior authorizations to help prevent delays in care, some state and federal lawmakers have introduced legislation to help reform the practice.
The official names of these laws vary by state, but they are commonly referred to as “Gold Card Acts.” These laws allow certain services to be exempted—or “gold carded”—from prior authorization requirements. They allow health care providers who have consistently met prior authorization requirements and prior approval rates within a specific period to bypass the prior authorization process for certain procedures.1
The following is a quick reference guide to the status of state-specific and federal Gold Card Act legislation.2
Summaries of State-Specific
Legislation Status
Legislation Status
Summaries of
State-Specific
Legislation Status
State-Specific
Legislation Status
Arkansas
Statute or Bill Citation |
AR Ins Code 23-99-1120 |
Legislation Status† |
Effective |
Percentage Rate‡ |
90% |
Time Frame§ |
6 months |
Minimum Number of Claim Approvals|| |
N/A |
Other Considerations¶ |
Evaluate only once per year |
Colorado
Statute or Bill Citation |
CO Ins Code 10-16-112.5 |
Legislation Status† |
Effective |
Percentage Rate‡ |
80% until January 1, 2026 |
Time Frame§ |
12 months |
Minimum Number of Claim Approvals|| |
N/A |
Other Considerations¶ |
Subject to repeal/Colorado House Bill 1149 |
Texas
Statute or Bill Citation |
TX Ins Code 4201.653* |
Legislation Status† |
Effective |
Percentage Rate‡ |
90% |
Time Frame§ |
6 months |
Minimum Number of Claim Approvals|| |
5-20 |
Other Considerations¶ |
Evaluate every 6 months |
Vermont#
Statute or Bill Citation |
18 V.S.A. Section 9418 (h) (1) |
Legislation Status† |
Effective |
Percentage Rate‡ |
TBD |
Time Frame§ |
TBD |
Minimum Number of Claim Approvals|| |
TBD |
Other Considerations¶ |
TBD |
West Virginia**
Statute or Bill Citation |
WV Ins Code 33-25A-8s* |
Legislation Status† |
Effective |
Percentage Rate‡ |
90% |
Time Frame§ |
6 months |
Minimum Number of Claim Approvals|| |
30/year |
Other Considerations¶ |
May audit and rescind anytime |
Wyoming
Statute or Bill Citation |
WY Ins Code 26-55-112 |
Legislation Status† |
Effective January 1, 2026 |
Percentage Rate‡ |
90% |
Time Frame§ |
12 months |
Minimum Number of Claim Approvals|| |
5 |
Other Considerations¶ |
May audit and revoke after 1 year |
Colorado††
Statute or Bill Citation |
House Bill 1149 |
Legislation Status† |
Pending |
Percentage Rate‡ |
TBD |
Time Frame§ |
TBD |
Minimum Number of Claim Approvals|| |
TBD |
Other Considerations¶ |
Bill removes the specifics of 10-16-112.5 |
Kansas
Statute or Bill Citation |
Senate Bill 148 |
Legislation Status† |
Pending |
Percentage Rate‡ |
90% |
Time Frame§ |
6 months |
Minimum Number of Claim Approvals|| |
20 |
Other Considerations¶ |
Evaluate every January and July |
Kentucky
Statute or Bill Citation |
Senate Bill 270 |
Legislation Status† |
Pending |
Percentage Rate‡ |
90% |
Time Frame§ |
6 months |
Minimum Number of Claim Approvals|| |
5/20 |
Other Considerations¶ |
Evaluate every January and July |
New Mexico
Statute or Bill Citation |
Senate Bill 0263 |
Legislation Status† |
Pending |
Percentage Rate‡ |
90% |
Time Frame§ |
6 months |
Minimum Number of Claim Approvals|| |
5/20 |
Other Considerations¶ |
Evaluate every January and June |
New York
Statute or Bill Citation |
Assembly Bill 2352 |
Legislation Status† |
Pending |
Percentage Rate‡ |
90% |
Time Frame§ |
6 months |
Minimum Number of Claim Approvals|| |
N/A |
Other Considerations¶ |
Evaluate every January |
Oregon
Statute or Bill Citation |
House Bill 3134 |
Legislation Status† |
Pending |
Percentage Rate‡ |
80% |
Time Frame§ |
12 months |
Minimum Number of Claim Approvals|| |
5 of the same service |
Other Considerations¶ |
May audit every 12 months |
South Dakota
Statute or Bill Citation |
Senate Bill 0087 |
Legislation Status† |
Pending |
Percentage Rate‡ |
90% |
Time Frame§ |
6 months |
Minimum Number of Claim Approvals|| |
5/20 |
Other Considerations¶ |
Evaluate every 6 months |
South Dakota
Statute or Bill Citation |
Senate Bill 0158 |
Legislation Status† |
Pending |
Percentage Rate‡ |
90% |
Time Frame§ |
12 months |
Minimum Number of Claim Approvals|| |
5/20 |
Other Considerations¶ |
May rescind January and July |
Vermont
Statute or Bill Citation |
Senate Bill 151 |
Legislation Status† |
Pending‡‡ |
Percentage Rate‡ |
90% |
Time Frame§ |
6 months |
Minimum Number of Claim Approvals|| |
20 |
Other Considerations¶ |
Evaluate every January and June |
Alaska
Statute or Bill Citation |
House Bill 187 |
Legislation Status† |
Failed |
Percentage Rate‡ |
Failed |
Time Frame§ |
Failed |
Minimum Number of Claim Approvals|| |
Failed |
Other Considerations¶ |
Failed |
California
Statute or Bill Citation |
Senate Bill 516/598 |
Legislation Status† |
Failed |
Percentage Rate‡ |
Failed |
Time Frame§ |
Failed |
Minimum Number of Claim Approvals|| |
Failed |
Other Considerations¶ |
Failed |
Indiana
Statute or Bill Citation |
Senate Bill 1091 |
Legislation Status† |
Failed |
Percentage Rate‡ |
Failed |
Time Frame§ |
Failed |
Minimum Number of Claim Approvals|| |
Failed |
Other Considerations¶ |
Failed |
Iowa
Statute or Bill Citation |
House Study Bill 130 |
Legislation Status† |
Failed |
Percentage Rate‡ |
Failed |
Time Frame§ |
Failed |
Minimum Number of Claim Approvals|| |
Failed |
Other Considerations¶ |
Failed |
New York
Statute or Bill Citation |
Senate Bill 2680 |
Legislation Status† |
Failed |
Percentage Rate‡ |
Failed |
Time Frame§ |
Failed |
Minimum Number of Claim Approvals|| |
Failed |
Other Considerations¶ |
Failed |
North Carolina
Statute or Bill Citation |
House Bill 649 |
Legislation Status† |
Failed |
Percentage Rate‡ |
Failed |
Time Frame§ |
Failed |
Minimum Number of Claim Approvals|| |
Failed |
Other Considerations¶ |
Failed |
Oklahoma
Statute or Bill Citation |
Senate Bill 756 (Medicaid) |
Legislation Status† |
Failed |
Percentage Rate‡ |
Failed |
Time Frame§ |
Failed |
Minimum Number of Claim Approvals|| |
Failed |
Other Considerations¶ |
Failed |
Oklahoma
Statute or Bill Citation |
House Bill 3862 |
Legislation Status† |
Failed |
Percentage Rate‡ |
Failed |
Time Frame§ |
Failed |
Minimum Number of Claim Approvals|| |
Failed |
Other Considerations¶ |
Failed |
Federal Legislation
Medicare Part C
Statute or Bill Citation |
House Resolution 4968 |
Legislation Status† |
Failed |
Percentage Rate‡ |
Failed |
Time Frame§ |
Failed |
Minimum Number of Claim Approvals|| |
Failed |
Other Considerations¶ |
Failed |
US Congress
Statute or Bill Citation |
House Bill 639 |
Legislation Status† |
Pending |
Percentage Rate‡ |
N/A |
Time Frame§ |
N/A |
Minimum Number of Claim Approvals|| |
N/A |
Other Considerations¶ |
N/A |
Note: The notice requirements imposed upon health plans vary from 24 hours to 5 days. Health plans are automatically obligated to provide notice of exemption to providers. Bills also vary regarding the consideration of claims in appeal. Minimums are presented.
* | The full title of the effective Texas “Gold Card Act” statute is Exemption From Preauthorization Requirements for Physicians and Providers Providing Certain Health Care Services. The full title of the effective West Virginia “Gold Card Act” statute is the Health Maintenance Organization Act. 3,4 |
† | The status of the state or agency version of the Gold Card Act legislation (ie, effective, pending, pilot program, in committee, or failed). |
‡ | The prior authorization approval rate history for a particular service over a given period. |
§ | The past time frame from which prior authorization approval rates will be considered. |
‖ | The minimum number of claim approvals during the required time frame. |
¶ | Any legislative requirements other than required percentage rate, required time frame, and minimum number of claims. |
# | Each payer will have specific requirements for Gold Card exemption. Check with payer for details. |
** | West Virginia Senate Bill 833 allows carriers to exclude “pharmaceutical medication” from the Gold Card process. |
†† | New Gold Card Act legislation. The specifics of Colorado House Bill 1149 relating to Gold Card provisions have been removed by amendment. |
‡‡ | In 2020, Vermont passed a Gold Card Pilot Program, codified in 18 V.S.A. Section 9418b (h) (1). However, the Pilot Program does not contain specific criteria typically found in other states’ Gold Card laws. Additional legislation under Senate Bill 151, if passed, would add specific eligibility criteria for HCPs to be exempt from prior authorization requirements under Vermont’s Gold Card law. |
References: 1. New physician “gold card” law will cut prior authorization delays. American Medical Association. Accessed May 21, 2025. https://www.ama-assn.org/practice-management/prior-authorization/new-physician-gold-card-law-will-cut-prior-authorization 2. Data on file. Regeneron Pharmaceuticals, Inc. 3. Insurance code: Title 14. Utilization review and independent review chapter 4201. Utilization review agents. Subchapter A. General provisions. Texas Constitution and Statutes. Accessed May 21, 2025. https://statutes.capitol.texas.gov/Docs/IN/htm/IN.4201.htm 4. West Virginia code: Chapter 33. Insurance. Article 25A. Health Maintenance Organization Act. Accessed May 21, 2025. https://www.wvlegislature.gov/wvcode/ChapterEntire.cfm?chap=33&art=25A§ion=8S
References: 1. New physician “gold card” law will cut prior authorization delays. American Medical Association. Accessed May 21, 2025. https://www.ama-assn.org/practice-management/prior-authorization/new-physician-gold-card-law-will-cut-prior-authorization 2. Data on file. Regeneron Pharmaceuticals, Inc. 3. Insurance code: Title 14. Utilization review and independent review chapter 4201. Utilization review agents. Subchapter A. General provisions. Texas Constitution and Statutes. Accessed May 21, 2025. https://statutes.capitol.texas.gov/Docs/
IN/htm/IN.4201.htm 4. West Virginia code: Chapter 33. Insurance. Article 25A. Health Maintenance Organization Act. Accessed May 21, 2025. https://www.wvlegislature.gov/wvcode/
ChapterEntire.cfm?chap=33&art=25A§ion=8S
This material is provided for informational purposes only, is subject to change, and should not be construed as legal or medical advice. Use of this information to challenge or appeal a coverage or reimbursement delay and/or denial by a payer is the responsibility of the provider.
This material is provided for informational purposes only, is subject to change, and should not be construed as legal or medical advice. Use of this information to challenge or appeal a coverage or reimbursement delay and/or denial by a payer is the responsibility of the provider.