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% |
| 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|| |
| 20 |
| Other Considerations¶ |
| Evaluate every 6 months |
W. 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 |
Alaska
| Statute or Bill Citation |
| House Bill 187 |
| Legislation Status† |
| Pending |
| Percentage Rate‡ |
| 80% |
| Time Frame§ |
| 12 Months |
| Minimum Number of Claim Approvals|| |
| 10 |
| Other Considerations¶ |
| Evaluate every 12 months |
California
| Statute or Bill Citation |
| Senate Bill 516/598 |
| Legislation Status† |
| Pending |
| Percentage Rate‡ |
| 90% |
| Time Frame§ |
| 12 Months |
| Minimum Number of Claim Approvals|| |
| 15/25 |
| Other Considerations¶ |
| Provider with plan for 36 months |
Colorodo#
| 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 |
Indiana
| Statute or Bill Citation |
| Senate Bill 1091 |
| Legislation Status† |
| Pending |
| Percentage Rate‡ |
| 85% |
| Time Frame§ |
| 12 months |
| Minimum Number of Claim Approvals|| |
| 30/50 |
| Other Considerations¶ |
| Provider with plan for 36 months |
Iowa
| Statute or Bill Citation |
| House Study Bill 130 |
| Legislation Status† |
| Pending |
| Percentage Rate‡ |
| 80% |
| Time Frame§ |
| 6 months |
| Minimum Number of Claim Approvals|| |
| 5/20 |
| Other Considerations¶ |
| Evaluate every January and June |
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 York
| Statute or Bill Citation |
| Senate Bill 2680 |
| Legislation Status† |
| Pending |
| Percentage Rate‡ |
| 90% |
| Time Frame§ |
| 6 months |
| Minimum Number of Claim Approvals|| |
| N/A |
| Other Considerations¶ |
| Evaluate every January |
North Carolina
| Statute or Bill Citation |
| House Bill 649 |
| Legislation Status† |
| Pending |
| Percentage Rate‡ |
| 80% |
| Time Frame§ |
| 12 months |
| Minimum Number of Claim Approvals|| |
| 10 |
| Other Considerations¶ |
| Evaluate every 12 months |
Oklahoma
| Statute or Bill Citation |
| Senate Bill 756 (Medicaid) |
| Legislation Status† |
| Pending |
| Percentage Rate‡ |
| 90% |
| Time Frame§ |
| 6 months |
| Minimum Number of Claim Approvals|| |
| 5/20 |
| Other Considerations¶ |
| Evaluate every 6 months |
Oklahoma
| Statute or Bill Citation |
| House Bill 3862 |
| Legislation Status† |
| Pending |
| Percentage Rate‡ |
| 80% |
| Time Frame§ |
| 3 months |
| Minimum Number of Claim Approvals|| |
| 10 |
| Other Considerations¶ |
| Evaluate every 12 months |
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 |
Connecticut
| Statute or Bill Citation |
| House Bill 5447 |
| Legislation Status† |
| Failed |
| Percentage Rate‡ |
| Failed |
| Time Frame§ |
| Failed |
| Minimum Number of Claim Approvals|| |
| Failed |
| Other Considerations¶ |
| Failed |
Kentucky
| Statute or Bill Citation |
| House Bill 134 |
| Legislation Status† |
| Failed |
| Percentage Rate‡ |
| Failed |
| Time Frame§ |
| Failed |
| Minimum Number of Claim Approvals|| |
| Failed |
| Other Considerations¶ |
| Failed |
Louisiana††
| Statute or Bill Citation |
| Senate Bill 112 |
| Legislation Status† |
| Failed |
| Percentage Rate‡ |
| Failed |
| Time Frame§ |
| Failed |
| Minimum Number of Claim Approvals|| |
| Failed |
| Other Considerations¶ |
| Failed |
Mississippi
| Statute or Bill Citation |
| Senate Bill 2449 |
| Legislation Status† |
| Failed |
| Percentage Rate‡ |
| Failed |
| Time Frame§ |
| Failed |
| Minimum Number of Claim Approvals|| |
| Failed |
| Other Considerations¶ |
| Failed |
Missouri
| Statute or Bill Citation |
| Senate Bill 947 |
| Legislation Status† |
| Failed |
| Percentage Rate‡ |
| Failed |
| Time Frame§ |
| Failed |
| Minimum Number of Claim Approvals|| |
| Failed |
| Other Considerations¶ |
| Failed |
Nebraska
| Statute or Bill Citation |
| Legislative Bill 210 |
| 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 1409 |
| Legislation Status† |
| Failed |
| Percentage Rate‡ |
| Failed |
| Time Frame§ |
| Failed |
| Minimum Number of Claim Approvals|| |
| Failed |
| Other Considerations¶ |
| Failed |
Tennessee
| Statute or Bill Citation |
| Senate Bill 1758 |
| 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† |
| Pending |
| Percentage Rate‡ |
| 90% |
| Time Frame§ |
| Plan year |
| Minimum Number of Claim Approvals|| |
| 10 |
| Other Considerations¶ |
| Evaluate 1 time per plan year |
Medicare Part C
| Statute or Bill Citation |
| House Resolution 7995 |
| Legislation Status† |
| Failed |
| Percentage Rate‡ |
| Failed |
| Time Frame§ |
| Failed |
| Minimum Number of Claim Approvals|| |
| Failed |
| Other Considerations¶ |
| Failed |
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. |
| # | 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. |
| †† | Pages relating to Gold Card provisions were deleted from the final amended version of Senate Bill 112. |
References: 1. New physician “gold card” law will cut prior authorization delays. American Medical Association. Accessed May 8, 2024. 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 8, 2024. 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 8, 2024. 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 8, 2024. 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 8, 2024. 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 8, 2024. 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.