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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%
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.
** 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&section=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&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.