Committee reviews and recommends approval of four Medicaid 'gold‑card' prior‑authorization policies

Four provider‑led managed‑care organizations appeared before the Public Health, Welfare and Labor Committee to present policies aimed at reducing prior‑authorization burden under Act 575, the 2023 law that created a gold‑card exemption for high‑performing providers.

Mitch Morris, CEO of Empower Healthcare Solutions, said provider‑led plans were exempt from the statute only if they submit a plan to reduce prior authorizations, and described a gold‑card approach tied to provider performance. "We were exempted from Act 575 as long as we prepare a policy designed to reduce and in some cases lessen prior authorizations for our network of providers," he said.

Speakers from Summit Community Care, CareSource and Arkansas Total Care said they tried to align policy approaches while preserving necessary authorizations for complex, long‑term or high‑risk services. Brad Nye of Summit said the company will maintain a committee to review claims data quarterly and consider expanding gold‑carded services. David Donahue of CareSource said his organization would default to the statutory rescission/appeal process if a provider’s gold card were rescinded and emphasized a process of proactive outreach.

Lawmakers asked for more clarity and comparability. Representative Johnson asked each plan to provide both the procedural approach to gold‑carding and a clear list of services that historically did not require prior authorization so the committee could "compare apples to apples." Representative Johnson also queried whether plans had an internal appeals process for rescission; CareSource indicated it would default to the appeals process described in statute and provide more detail.

Senator Hammer and others pressed plans on retrospective review and on whether community reinvestment dollars would be affected by gold‑carding. Plan representatives said clawbacks are rare, retrospective reviews are usually concurrent in long admissions, and they do not expect community reinvestment dollars to be tied to these policy changes.

After discussion, the chair asked for motions to recommend approval of the four submitted policies (exhibits D2–D5). Each recommendation was moved, seconded and approved by voice vote; no roll‑call tallies were recorded in the transcript. The committee asked plans to provide clearer lists showing what was preexisting and what was changed in response to the legislation.

What’s next: Plans agreed to send clearer documentation — lists of gold‑carded services (what was previously gold‑carded vs. what was added to comply with Act 575) and an outline of rescission/appeal procedures for committee staff to review.