prior authorization; gold card exemption

SB1227 - prior authorization; gold card exemption

Healthcare

Passed Legislature

This bill passed both chambers and reached final enrollment, even if later executive action is not shown here.

Sponsor: Brian Fernandez
Last action: 2026-01-21
Official status: Senate second read
Effective date: Not listed

Plain English Breakdown

Checked against official source text during the last sync.

SB1227: Gold Card Exemption for Prior Authorization

This law requires health insurers to grant a 'gold card exemption' to providers who get high approval rates on prior authorization requests, allowing them to skip that step for specific services.

What This Bill Does

Requires insurers to grant a gold card exemption if a provider submits at least five requests and gets approved ninety percent of the time in the previous six months for a specific service.
Allows exempted providers to stop asking for prior approval for that specific health care service during their exemption period.
Limits each gold card exemption to no more than six months before it must be reviewed again.
Sets rules that insurers can only remove an exemption after checking a random sample of at least five claims and giving thirty days' written notice with reasons.

Who It Names or Affects

Health care providers who submit prior authorization requests
Disability insurers, health care services organizations, hospital service corporations, and medical service corporations

Terms To Know

Prior Authorization: A rule requiring a provider to get approval from an insurer before giving certain health services.
Gold Card Exemption: A status that lets a trusted provider skip the prior authorization step for specific services they have high approval rates on.

Limits and Unknowns

The law only applies to requests submitted on or after January 1, 2027.
Insurers may review exempted providers every six months to see if they still meet the rules.

Bill History

2026-01-21 Senate
Senate second read
2026-01-20 Senate
Senate Rules: None
2026-01-20 Senate
Senate Finance: None
2026-01-20 Senate
Senate first read

Official Summary Text

SB1227 - prior authorization; gold card exemption

Current Bill Text

Read the full stored bill text

SB1227 - 572R - I Ver

REFERENCE TITLE:
prior authorization; gold card exemption

State of Arizona

Senate

Fifty-seventh Legislature

Second Regular Session

2026

SB 1227

Introduced by

Senator
Fernandez

AN
ACT

amending title 20, chapter 26, article 1,
arizona revised statutes, by adding section 20-3408; relating to prior
authorizations.

(TEXT OF BILL BEGINS ON NEXT PAGE)

Be it enacted by the Legislature of the State of Arizona:

Section 1. Title 20, chapter 26, article 1,
Arizona Revised Statutes, is amended by adding section 20-3408, to read:

START_STATUTE
20-3408.

Prior authorization; gold card exemption; definition

A. If a health care services plan
contains a prior authorization requirement, the health care insurer shall grant
a gold card exemption to a participating provider that submits at least five
prior authorization requests for a specific health care service in the
immediately preceding six-month period and that receives a prior
authorization approval rate of at least ninety percent for that health care
service. A provider that obtains a gold card exemption is not
required to obtain prior authorizations for the specific health care service
for which the gold card exemption is granted.

B. A gold card exemption is valid for
not more than six months.� After each six-month period, the health care
insurer may review the health care services provided by the exempted provider
to determine whether the provider continues to satisfy the requirements
prescribed in subsection A of this section.

C. A health care insurer may rescind
a gold card exemption only if the health care insurer:

1. Determines that the provider does
not satisfy the requirements prescribed in subsection A of this section for the
gold card exemption based on a review of a random sample of not less than five
claims submitted by the provider.

2. Gives at least thirty days'
written notice of the rescission to the provider, including the specific
reasons for the rescission.

3. Gives the provider information on
how to appeal the rescission to an independent review organization.

D. For the purposes of this section,
"health care insurer" means a disability insurer, group disability
insurer, blanket disability insurer, health care services organization,
hospital service corporation or medical service corporation.
END_STATUTE

Sec. 2.
Applicability

This act applies to all prior
authorization requests that are submitted on or after January 1, 2027.