PA laws vary significantly state to state. Find your state's turnaround mandates, gold card laws, reform legislation, and Medicaid PA rules.
51
States + DC
7
Gold Card States
20
PA Reform States
Standard: 15 business days | Urgent: 72 hours
Standard: 15 business days | Urgent: 72 hours
Standard: 14 calendar days | Urgent: 48 hours
Standard: 15 business days | Urgent: 72 hours
Standard: 14 calendar days | Urgent: 24 hours
Standard: 14 calendar days | Urgent: 48 hours
Standard: 15 business days | Urgent: 72 hours
Standard: 14 calendar days | Urgent: 48 hours
Standard: 3 business days | Urgent: 24 hours (prescriptions: 24 hours)
Standard: 15 business days | Urgent: 48 hours
Standard: 14 calendar days | Urgent: 72 hours
Standard: 14 calendar days | Urgent: 72 hours
Standard: 15 business days | Urgent: 72 hours
Standard: 15 business days | Urgent: 72 hours
Standard: 14 calendar days | Urgent: 72 hours
Standard: 14 calendar days | Urgent: 72 hours
Standard: 14 calendar days | Urgent: 72 hours
Standard: 15 business days | Urgent: 72 hours
Standard: 15 business days | Urgent: 72 hours
Standard: 14 calendar days | Urgent: 72 hours
Standard: 14 calendar days | Urgent: 72 hours
Standard: 14 calendar days | Urgent: 72 hours
Standard: 14 calendar days | Urgent: 24 hours
Standard: 14 calendar days | Urgent: 72 hours
Standard: 15 business days | Urgent: 24 hours
Standard: 14 calendar days | Urgent: 72 hours
Standard: 15 business days | Urgent: 72 hours
Standard: 14 calendar days | Urgent: 72 hours
Standard: 14 calendar days | Urgent: 72 hours
Standard: 10 business days | Urgent: 72 hours
Standard: 14 calendar days | Urgent: 72 hours
Standard: 15 business days | Urgent: 72 hours
Standard: 15 business days | Urgent: 72 hours
Standard: 14 calendar days | Urgent: 48 hours
Standard: 15 business days | Urgent: 72 hours
Standard: 14 calendar days | Urgent: 72 hours
Standard: 14 calendar days | Urgent: 72 hours
Standard: 14 calendar days | Urgent: 72 hours
Standard: 15 business days | Urgent: 72 hours
Standard: 3 business days (HMOs), 15 business days (other) | Urgent: 24 hours (life-threatening)
Standard: 15 business days | Urgent: 72 hours
Standard: 5 business days | Urgent: 72 hours
Standard: 10 business days | Urgent: 48 hours
Standard: 15 business days | Urgent: 72 hours
Standard: 15 business days | Urgent: 72 hours
Standard: 15 business days | Urgent: 72 hours
Standard: 14 calendar days | Urgent: 72 hours
Standard: 14 calendar days | Urgent: 72 hours
Standard: 14 calendar days | Urgent: 72 hours
Standard: 14 calendar days | Urgent: 72 hours
Standard: 15 business days | Urgent: 72 hours
Prior authorization regulation is primarily a state-level matter, which means the rules your practice follows depend on where you operate.
Gold card laws exempt high-performing providers from PA requirements. Typically, a provider must demonstrate a 90% or higher PA approval rate over a 12-month period. Texas was the first state to enact a gold card law (HB 3459, 2021), and several states have followed.
Every state sets maximum turnaround times for PA decisions. Standard requests range from 3 business days (New York) to 15 business days. Urgent requests are typically 24-72 hours. Some states have faster requirements for HMOs than PPOs.
A growing number of states have enacted PA reform legislation that limits unnecessary PA requirements, mandates transparency, and requires electronic submission capabilities. These laws are driven by physician advocacy groups and patient complaints about care delays.
CMS has finalized the Interoperability and Prior Authorization Rule requiring Medicare Advantage, Medicaid, and CHIP plans to implement electronic PA APIs. This is expected to significantly speed up PA processing for government-sponsored plans starting in 2026.