Texas enacted first-of-its-kind legislation this year establishing a gold carding program for prior authorization for physicians.
Under the new law, physicians who had prior authorization requests approved by an insurance plan at least 90% of the time over the last six months for a particular service would be exempted, or gold carded, from having to complete prior authorization for that service for the plan. These gold-carding provisions apply to state-regulated commercial HMO plans, preferred provider benefit plans, exclusive provider benefit plans and certain Employees Retirement System of Texas and Teacher Retirement System of Texas plans. Additionally, the legislation requires that a review for peer-to-peer review must be a Texas-licensed physician of the same or similar specialty.
Selective application of prior authorization is the first principle in the Consensus Statement on Improving the Prior Authorization Process (PDF) agreed to by AHIP and BCBSA, among other stakeholders. It is also a principle supported by over 100 organizations as part of the Prior Authorization and Utilization Management Reform Principles (PDF). Advocates for prior authorization reform are excited to watch the implementation of the important new law.
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