Missouri committee hears bill to 'gold‑card' high‑performing providers and curb prior‑authorization burden

The Missouri House Insurance Committee on Wednesday heard testimony on House Bill 618, a proposal to create a “gold carding” system that would exempt providers or provider organizations from certain prior‑authorization requirements if they meet a high approval threshold.

Representative Melanie Stinnett, the bill sponsor, told the committee the bill “creates what we call a gold carding system for prior authorization” and would not eliminate prior authorization but would exempt providers or organizations that “achieve at least 90% authorization approval” during an evaluation period.

The bill’s proponents — including hospitals, physicians and nurses — said prior authorization causes delays and administrative burdens that can harm patients and drive up costs. Andrew Wheeler of the Missouri Hospital Association told the committee that “the problem is that this healthy friction has become unhealthy,” and cited a national report showing millions of prior‑authorization requests for Medicare Advantage plans as evidence the system consumes substantial clinician and hospital time.

Physicians gave multiple patient‑level examples of delays. Dr. Briceno Kinney, a hematologist‑oncologist, said roughly 85% of his orders now require prior authorization and estimated that 5%–15% of those are denied; he and other clinicians said denials and lengthy appeals can keep patients from timely treatment. A family‑medicine doctor described a patient whose MRI was denied despite “red‑flag” symptoms, and a pediatric case‑manager said a child who needed an outpatient infusion had to be readmitted after insurance had not approved home treatment in time.

Opponents — primarily insurers and managed‑care representatives — said the bill is too narrow and could remove necessary utilization safeguards. Hampton Williams, general counsel for the Missouri Insurance Coalition, argued the proposal relies on a single metric and lacks quality or outcome measures, saying the bill “is only based off that one metric” and that other programs consider factors such as type of patient, dollar value of claims and clinical outcomes.

Representatives of managed‑care plans and Blue Cross Blue Shield urged the committee to examine how prior authorization processes operate under current Missouri law and said Missouri already has strict timeframes. David Willis of the Missouri Health Plan Association and Shannon Cooper, representing insurers, said some carriers already run gold‑card programs and that the market — not a one‑size statute — may be the appropriate place to refine those programs. Several industry witnesses warned the proposal could increase costs, citing industry analyses that restrict utilization management and step‑therapy programs can raise drug spending.

Committee members asked how the 90% threshold would be calculated, how long an evaluation period would last, and whether an organizational exemption might allow poorly performing individual clinicians to “coattail” on a high‑performing group. Supporters said the measure can be tuned in rules or by amendment; opponents said the bill as written lacks needed flexibility and regulatory authority for implementation.

No committee action was recorded at the hearing. Representative Stinnett told the committee that a prior version of the measure reportedly passed the House floor last year by a 146‑6 vote, but the committee did not take a vote at this session.

The hearing drew dozens of witnesses on both sides: hospital executives, primary‑care and specialty physicians, nurses and managers recounted administrative hours spent on prior authorizations and gave examples of delayed or foregone care; representatives of insurers and managed‑care plans outlined concerns about fraud, costs and the need for utilization controls.

The committee indicated it would gather additional information, including fiscal‑note details and how carriers and state regulators implement existing prior‑authorization timelines, before moving the bill. Several members suggested follow‑up with the Department of Insurance for a clear flowchart of timelines and parties’ responsibilities under current law.

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Notes: the hearing record includes competing factual claims about costs and time spent on prior authorization (witness estimates varied). The bill as presented would create a provider‑level and an organization‑level exemption based on approval rates; it does not remove prior authorization for all providers.