Texas' gold card prior authorization rule not worth its weight so far

Texas' physician gold-card rule took effect in October, but providers are not seeing the results they hoped for, the American Medical Association reported March 1. 

Under the law, physicians who have a 90 percent prior authorization approval rate over a six-month period on certain services are exempt from prior authorization requirements for those services. 

The implementation of the law by the Texas Department of Insurance has been problematic, according to the AMA. The Texas Medical Association has reported a lack of enforcement and liberties taken with the rulemaking that create barriers to qualify for the exemption. 

Breast oncologist Debra Patt, MD, PhD, told the AMA there has been a lot of excitement about the gold-carding approach in other states and a bill proposed in Congress last year, but "the devil, as always in healthcare policy, is in the details."

"Payers were supposed to distribute to doctors' guidelines about what they were gold carded for," Dr. Patt said, "That has not happened."

The Texas Medical Association is looking for regulatory and legislative fixes to resolve these issues, according to the AMA. 

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