Bill > SB1227

This bill establishes a "gold card exemption" for healthcare providers in Arizona, meaning that if a healthcare insurer, which includes various types of insurance companies and health service organizations, requires prior authorization for certain medical services, they must exempt providers who have a strong track record of successful requests. Specifically, a provider can earn this exemption if they have submitted at least five prior authorization requests for a particular service in the last six months and have had at least 90% of those requests approved. Once granted, this exemption means the provider no longer needs to get prior authorization for that specific service, simplifying their administrative process. However, the exemption is not permanent; it lasts for six months and can be reviewed by the insurer to ensure the provider still meets the criteria. An insurer can only revoke this exemption if they find the provider no longer meets the requirements after reviewing a sample of their claims, and they must provide the provider with at least 30 days' written notice explaining the reasons and offering a way to appeal the decision. This new rule will apply to all prior authorization requests made on or after January 1, 2027.

Budget and Finance

https://apps.azleg.gov/BillStatus/BillOverview/84544