SB1227 • 2026

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

The bill does not specify what happens if a provider fails to maintain the required approval rate during the exemption period, leaving some uncertainty about the consequences for providers who do not meet these criteria.

Gold Card Exemption for Prior Authorization

The bill allows health insurers in Arizona to grant a 'gold card exemption' to participating providers who meet specific criteria regarding prior authorization approvals.

What This Bill Does

Adds section 20-3408 to the Arizona Revised Statutes, allowing health insurers to grant a gold card exemption to participating providers if they submit at least five prior authorization requests for a particular service and receive approval for at least 90% of them over six months.
Limits the gold card exemption to no more than six months, after which the insurer can review the provider's services again.
Requires health insurers to provide written notice with reasons if they decide to rescind an exemption and give information on how to appeal.

Who It Names or Affects

Health care providers who submit prior authorization requests for specific health care services in Arizona.
Health insurance companies in Arizona.

Terms To Know

Prior Authorization: A requirement by an insurer that a provider get approval before providing certain medical treatments or procedures.
Gold Card Exemption: An exemption from prior authorization requirements granted to health care providers who meet specific criteria.

Limits and Unknowns

The bill applies only to prior authorization requests submitted on or after January 1, 2027.
It does not specify what happens if a provider fails to maintain the required approval rate during the exemption period.

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.