I 
117TH CONGRESS 
2D SESSION 
H. R. 7995 
To amend title XVIII of the Social Security Act to exempt qualifying physi-
cians from prior authorization requirements under Medicare Advantage 
plans, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 9, 2022 
Mr. BURGESS (for himself, Mr. VICENTE GONZALEZ of Texas, and Mr. JACK-
SON) introduced the following bill; which was referred to the Committee 
on Ways and Means, and in addition to the Committee on Energy and 
Commerce, for a period to be subsequently determined by the Speaker, 
in each case for consideration of such provisions as fall within the juris-
diction of the committee concerned 
A BILL 
To amend title XVIII of the Social Security Act to exempt 
qualifying physicians from prior authorization require-
ments under Medicare Advantage plans, and for other 
purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Getting Over Lengthy 
Delays in Care As Required by Doctors Act of 2022’’ or 
the ‘‘GOLD CARD Act of 2022’’. 
VerDate Sep 11 2014 
06:57 Jun 12, 2022
Jkt 029200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H7995.IH
H7995
kjohnson on DSK79L0C42PROD with BILLS
SEC. 2. EXEMPTION FOR QUALIFYING PHYSICIANS FROM 
PRIOR 
AUTHORIZATION 
REQUIREMENTS 
UNDER MA PLANS. 
(a) IN GENERAL.—Section 1852 of the Social Secu-
rity Act (42 U.S.C. 1395w–22) is amended by adding at 
the end the following new subsection: 
‘‘(o) EXEMPTION
FOR
QUALIFYING
PHYSICIANS 
FROM PRIOR AUTHORIZATION REQUIREMENTS.— 
‘‘(1) IN GENERAL.— 
‘‘(A) EXEMPTION.— 
‘‘(i) IN GENERAL.—In the case of an 
MA organization which utilizes a prior au-
thorization process (as defined in subpara-
graph (B)) with respect to a plan year (be-
ginning with the second plan year begin-
ning after the date of the enactment of 
this subsection), subject to the succeeding 
provisions of this subsection, a physician 
shall be exempt from the prior authoriza-
tion requirements under such process for 
the period of such plan year with respect 
to a specific item, service, or group of simi-
lar services, if during the preceding plan 
year at least 90 percent of prior authoriza-
tion requests submitted to such organiza-
tion by such physician for such item, serv-
VerDate Sep 11 2014 
06:57 Jun 12, 2022
Jkt 029200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H7995.IH
H7995
kjohnson on DSK79L0C42PROD with BILLS
ice, or group were approved by such orga-
nization (including any approval granted 
after an appeal). Such exemption shall con-
tinue to apply with respect to such physi-
cian furnishing such item, service, or group 
of similar services in subsequent plan years 
until the earlier of— 
‘‘(I) the date on which such ex-
emption is revoked under paragraph 
(5); or 
‘‘(II) the date on which such phy-
sician opts out of such exemption 
under paragraph (3)(C). 
‘‘(ii) SPECIAL RULES.—For purposes 
of determining whether a physician quali-
fies for an exemption under clause (i) for 
a plan year for an item, service, or group 
of services, in calculating whether at least 
90 percent of prior authorization requests 
submitted by such physician for such item, 
services, or group during the preceding 
plan year were approved, an MA organiza-
tion shall— 
‘‘(I) subject to subclause (II), 
treat any such claim that was initially 
VerDate Sep 11 2014 
06:57 Jun 12, 2022
Jkt 029200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H7995.IH
H7995
kjohnson on DSK79L0C42PROD with BILLS
denied, subsequently appealed, and 
that remains pending appeal at the 
time of such calculation as having 
been approved if more than 30 days 
have elapsed since the date such ap-
peal was filed; and 
‘‘(II) in the case that, during 
such plan year, such organization 
changed any terms of coverage for 
such item, service, or group of serv-
ices, not take into account any claims 
for such item, service, or group of 
services that were submitted during 
the 90-day period beginning on the 
date of such change. 
‘‘(B) PRIOR
AUTHORIZATION
PROCESS.— 
For purposes of this subsection, the term ‘prior 
authorization process’ means, with respect to 
coverage and payment for items and services 
(other than a covered part D drug) under an 
MA plan offered by an MA organization for a 
plan year, a process under which such organiza-
tion (or a contractor of such organization) de-
termines the medical necessity or medical ap-
propriateness of such items and services prior 
VerDate Sep 11 2014 
06:57 Jun 12, 2022
Jkt 029200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H7995.IH
H7995
kjohnson on DSK79L0C42PROD with BILLS