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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‡
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&section=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&section=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.