Washington, D.C. – Congressman Michael C. Burgess, M.D. (R-TX) and Congressman Vicente Gonzalez (D-TX) introduced H.R. 7995, the Gold Card Act of 2022. This legislation will exempt qualifying providers from prior authorization requirements under Medicare Advantage plans.
“Before coming to Congress, I practiced medicine for nearly 30 years and understand the frustration that comes from waiting on the government to tell me if I can provide certain treatments to my Medicare patients,” said Congressman Michael Burgess, M.D. “I am grateful for fellow Texan, Congressman Vincente Gonzalez, for joining me in introducing this critical legislation that will allow patients to receive quality care in a timely manner by streamlining the prior authorization process for physicians. I have seen the support of this legislation in my home state and am confident that GOLD carding policy will be effective in improving clinical results.”
“I am proud to introduce the GOLD CARD Act with Dr. Burgess to remove barriers for patients to receive the care they deserve,” said Congressman Vicente Gonzalez. “No person’s care should be put on hold by bureaucratic red-tape. I urge our colleagues to support this critical legislation and ensure South Texans, and all Americans, receive top notch care.”
What others are saying:
“Since most medical services are ultimately approved, the GOLD CARD Act is a commonsense approach to addressing the unnecessary burdens caused by the widespread use of prior authorization. Neurosurgical patients suffer from painful and life-threatening neurologic conditions such as brain tumors, debilitating degenerative spine disorders, stroke and Parkinson’s Disease, and without timely care, they often face permanent neurologic damage and sometimes death. If adopted, Rep. Burgess’ and Gonzalez’s legislation would be a significant step in making sure our seniors get the care they need when they need it, and America’s neurosurgeons are proud to endorse this bill,” said John K. Ratliff, MD, FAANS, a practicing neurosurgeon at Stanford University, and chair of the American Association of Neurological Surgeons/Congress of Neurological Surgeons Washington Committee.
“Almost daily, prior authorization frustrates physicians by complicating patient care with unnecessary administrative hassles,” said American Medical Association President Gerald E. Harmon, M.D. “In a recent American Medical Association physician survey,34 percent of respondents reported that prior authorization led to a serious event -- such as hospitalization -- for a patient in their care. This bill incorporates the common-sense reforms that will benefit Medicare Advantage patients and reduce burnout among physicians, including exempting physicians with high prior authorization approval rates from these utilization management requirements. We went to medical school to provide the best care possible for our patients, not to waste time checking boxes. Not only does this bill help streamline prior authorization, the GOLD CARD Act provides physicians with ample opportunities to appeal attempts by Medicare Advantage plans to rescind this exemption. We commend Reps. Michael Burgess, M.D. (R-TX) and Vicente Gonzalez (D-TX) for introducing this bipartisan bill that will lead to higher quality care, better health care outcomes, and improved physician and patient satisfaction.”
“Prior authorizations too often result in unnecessary administrative delays in care, which are detrimental to patients and frustrating for providers,” said John Hawkins, President and CEO of the Texas Hospital Association. “The Gold Card Act will preserve program integrity and encourage a more efficient health care system by streamlining approval for care. THA applauds Congressman Michael Burgess, MD, Congressman Vicente Gonzalez, and Congressman Ronny Jackson, MD, for their leadership on this important issue.
Other sponsors of this legislation include Ronny Jackson (R-TX).
If enacted this legislation will:
- Exempt providers from requiring prior authorization for a Medicare Advantage plan year if the provider had at least 90% of prior authorization requests approved the preceding year. No later than 30 days prior to the first day of each plan year, an MA organization would be required to notify each provider who qualifies.
- Reviews for a Gold Card are limited to no more than once every 12 months
- The 90% threshold includes approvals granted after appeal
- Allow a Medicare Advantage plan to revoke a providers' Gold Card status during such plan year if;
- less than 90% of claims submitted would have been approved for prior authorization or
- in the case of less than 10 claims being submitted, less than 90% of the last 10 claims submitted would have been approved for prior authorization.
- Allow physicians to appeal Gold Card revocations they believe were wrongly decided.
- Require the Secretary of HHS to issue a rule on the use of prior authorization by Medicare Advantage plans to ensure continuity of care for individuals transitioning to, or between, coverage to minimize disruption of ongoing treatments in previous plans.