Physician 'gold card' exemptions for prior authorizations gain steam

States are looking at ways to improve the prior authorization process for providers, including "gold card" exemptions. 

Gold carding is a prior authorization reform supported by numerous organizations, including the American Medical Association, American Hospital Association, American Pharmacists Association and American Academy of Family Physicians.

Under these exemptions, physicians that have high prior authorization approval rates are exempt from prior authorization requirements for certain services. 

In recent years, states began to implement these laws. West Virginia was first to pass a "gold card" exemption for providers in 2019. Under that state's policy, providers are exempt from prior authorization rules if they have a 100 percent approval rate on a certain service for six months. More recently, Texas passed a law that exempts physicians who have a 90 percent prior authorization approval rate over a six-month period on certain services from needing to submit prior authorizations for those services. 

Other states are looking at adding these exemptions. For example, Vermont is piloting a program that rewards providers with 100 percent prior authorization approval rates for a procedure performed at least 30 times per year over a six-month window. 

Other states that have introduced gold card legislation include New York, Colorado, Indiana, Kentucky, Mississippi and Oklahoma

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