Texas’ Gold Card Experiment Stalls: Why Few Providers Win Exemption from Prior Authorizations
Austin, Texas — To streamline the medical preauthorization process for physicians, several states, including Texas, have introduced “gold card” laws aimed at exempting commonly approved procedures or prescriptions from repetitive checks. However, the anticipated simplification has not unfolded as expected, and the laws often fall short of their promise. Under the 2021 Texas gold card law, a health insurer or health maintenance organization (HMO) is required to waive preauthorization if a provider has had a 90% or higher approval rate during a six-month evaluation. This exemption, designed to be automatic, should relieve some of the … Read more