Washington, D.C. – Congressman Michael C. Burgess, M.D. (R-TX) and Congressman Vicente Gonzalez (D-TX) introduced H.R. 4698, the GOLD Card Act of 2023. This legislation will exempt qualifying providers from prior authorization requirements under Medicare Advantage plans. 

"Having practiced medicine for nearly three decades before entering Congress, I empathize with the frustration of waiting on the government's approval to administer necessary treatments to my Medicare patients," said Congressman Michael Burgess, MD "I want to extend my gratitude to my fellow Texan, Congressman Vincente Gonzalez, for collaborating with me on introducing this vital legislation. By streamlining the prior authorization process for physicians, this bill will enable patients to receive timely and high-quality care. Witnessing the overwhelming support for this policy in my home state, I am optimistic that the GOLD Card Act will effectively enhance clinical outcomes." 

“This commonsense bill will pass at the federal level what many states, including Texas, have already enacted,” said Congressman Gonzalez. “Bureaucratic red-tape should not hinder patients’ ability to receive attention or our medical professionals’ ability to perform preventative or even life-saving care. This bill will increase provider efficiency and improve care for South Texans.” 

What others are saying: 

“The more we can remove barriers to our patients’ access to care, the better their care can be. Legislation like this bill to empower physicians and their patients to quickly access the medical treatments they need will cut delays in care and increase quality,” said Rick W. Snyder II, MD, President of the Texas Medical Association (TMA).“We thank Congressman Burgess for recognizing how onerous prior authorization delays can harm patients, and for his leadership in crafting a solution to remove unnecessary bureaucratic burdens to help America’s patients.”

“Prior authorization takes away from the critical time orthopaedic surgeons could be spending with patients and can sometimes delay or deny medically necessary care," said  American Association of Orthopaedic Surgeons (AAOS) First Vice President Paul Tornetta III, MD, PhD, FAAOS."We are long-time advocates who strongly support the GOLD CARD Act and look forward to advancing this bipartisan bill.”

“Prior authorization requirements often delay or deter patient access to necessary care,” said Christopher S. Kang, MD, FACEP, president of the American College of Emergency Physicians (ACEP). "Patients should not be constrained by their insurer to postpone medical attention until their condition becomes debilitating, life-threatening, or the emergency department becomes their only option for care. The bipartisan GOLD CARD Act of 2023 takes important steps to remove perfunctory barriers to medical care while improving the prior authorization process for physicians and patients alike.”

“Prior authorization often results in delays in care, which causes needless pain, delays in treatment, and suffering for patients and is a significant problem in today’s delivery of health care,” said Terrence A. Cronin, Jr., MD, FAAD, President of the American Academy of Dermatology Association. “The GOLD Card Act would exempt qualifying providers from prior authorization delays for Medicare Advantage patients. The American Academy of Dermatology Association thanks Congressman Michael Burgess, MD, for leading this critical issue.”

“Our patients cannot afford to wait or jump through unnecessary hoops to get care for painful, debilitating and life-threatening neurologic conditions. The GOLD Card Act is a commonsense approach to addressing the unnecessary burdens and delays caused by the widespread use of prior authorization, and America’s neurosurgeons thank Reps. Burgess and Gonzalez for introducing legislation to expedite this process so our nation’s seniors get timely access to care,” said Russell R. Lonser MD, FAANS, chair of the department of neurosurgery at The Ohio State University and chair of the American Association of Neurological Surgeons/Congress of Neurological Surgeons Washington Committee.

“The GOLD Card Act is a necessary response to the over utilization of prior authorization in Medicare Advantage plans that have created needless barriers between patients and the care they need,” said Michael X. Repka, MD, American Academy of Ophthalmology, Medical Director for Governmental Affairs. “Ophthalmology’s patients come to us to save their sight and preserve their quality of life. In some cases, putting off a procedure will lead to further complications. It is unfair to make those same patients get preapproval for procedures that are widely approved anyway, and further delay that sight saving care. The GOLD Card Act will remove this barrier and allow patients to get the care they need when they need it, not later. The American Academy of Ophthalmology is proud to support this commonsense solution.”  

Background:  
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. 

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