Get Full Government Meeting Transcripts, Videos, & Alerts Forever!
Get email alerts on the Gold Card Transparency topic
No spam. Unsubscribe anytime.
Bill would require centralized reporting of 'gold card' prior-authorization exemptions; insurers warn of duplicate reporting costs
Summary
Sen. Menendez introduced SB 547 to require plans to notify the Texas Department of Insurance of physician gold-card status to create a centralized database. Supporters said the change would reduce delays and confusion; payers flagged potential duplicative reporting costs and administrative burdens.
Sen. Menendez laid out Senate Bill 5-47, which would require health plans to notify the Texas Department of Insurance (TDI) within 10 days of a change to a physician’s prior-authorization exemption (the "gold card" status), and would direct TDI to create and maintain a centralized database and publish an annual report summarizing exemptions and insurer behavior.
"The Gold Card Act passed in 2021, but the results by almost any standard have been underwhelming," Menendez said. He told the committee that only about 3 percent of doctors have been granted exemptions based on available voluntary reporting and that physicians face inconsistent notifications from multiple plans and products.
Physician witnesses, including Dr. Zeke Silva (chair of the TMA Council on Legislation), supported the bill, saying a single source for status would reduce confusion and help the state evaluate whether the program was working as intended. "It matters to us to have a single source to understand the status related to the gold card," Silva said.
Insurer witnesses testified that the bill could create duplicative administrative reporting because plans already send notices to providers, and that the department estimated a database build and maintenance cost. Jamie Dudensingh, CEO of the Texas Association of Health Plans, said payers were neutral on providing data to TDI but worried about duplicate reporting and cost.
TDI told the committee it envisions a secure portal to receive data and provide information to providers on request; the department estimated a one-time database cost and annual maintenance that it characterized as substantial given plans, providers and service granularity.
Senators discussed possible options including directing TDI to receive reports rather than replacing payer notices, or adjusting the statute to address the "math problem" in how exemptions are calculated across plan products. The committee left SB 5-47 pending.
Supporters said the bill is a targeted fix to improve transparency and compliance; payers asked for statutory clarity to avoid duplicative reporting and to limit the administrative burden.
