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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

Summaries of
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†
TBD
Time Frame‡
TBD
Minimum Number of Claim Approvals§
TBD
Other Considerations||
See Colorado NPC prior authorization

Georgia

Statute or Bill Citation
GA Ins Code 33-46-20.1
Legislation Status*
Effective
Percentage Rate†
TBD
Time Frame‡
TBD
Minimum Number of Claim Approvals§
TBD
Other Considerations||
Effective July 2026

Iowa

Statute or Bill Citation
IA Ins Code 514F.8
Legislation Status*
Effective
Percentage Rate†
80%
Time Frame‡
12 months
Minimum Number of Claim Approvals§
TBD
Other Considerations||
Publish list of retained and excluded services

Oregon

Statute or Bill Citation
OR Ins Code 743B.250
Legislation Status*
Effective Limited
Percentage Rate†
Response through API
Time Frame‡
Response through API
Minimum Number of Claim Approvals§
Response through API
Other Considerations||
API under 45 CFR 156.223 (b)

South Dakota#

Statute or Bill Citation
SD Ins code 58-17H
Legislation Status*
Effective Limited
Percentage Rate†
80%
Time Frame‡
TBD
Minimum Number of Claim Approvals§
TBD
Other Considerations||
Published on website

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

Vermont

Statute or Bill Citation
18 V.S.A. Section 9418b (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

Arizona

Statute or Bill Citation
Senate Bill 1227
Legislation Status*
Pending
Percentage Rate†
90%
Time Frame‡
6 months
Minimum Number of Claim Approvals§
5
Other Considerations||
If passed, effective date January 1, 2027

Hawaii

Statute or Bill Citation
Senate Bill 2282
Legislation Status*
Pending
Percentage Rate†
TBD
Time Frame‡
TBD
Minimum Number of Claim Approvals§
TBD
Other Considerations||
TBD

Kentucky

Statute or Bill Citation
KY Ins Code 304.17A-600 et seq
Legislation Status*
Pending
Percentage Rate†
Maximum 93%
Time Frame‡
12 months
Minimum Number of Claim Approvals§
24
Other Considerations||
Evaluate only once per year

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

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 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.
# Legislation excludes “pharmaceutical medication” from the Gold Card process.

References: 1. New physician “gold card” law will cut prior authorization delays. American Medical Association. Accessed June 24, 2026. 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. 

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. 

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.