All Roll Calls
Yes: 191 • No: 1
WashingtonSB 53952025-2026 Regular SessionSenateWALLET
Making improvements to transparency and accountability in the prior authorization determination process.
Sponsored By: Member 14205
Became Law
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Bill Overview
Analyzed Economic Effects
8 provisions identified: 7 benefits, 0 costs, 1 mixed.
No retroactive take-backs on approvals
If your plan approved prior authorization under its rules, the insurer cannot later deny or cut it back, except for fraud or a lawful retroactive loss of coverage. If money is owed, the carrier must pay with 1% interest per month from the claim submission date. You or your provider can seek an independent review without waiting through grievance timelines.
Clearer prior-authorization rules and notices
Starting January 1, 2024, insurers and public plans must write prior-authorization rules in plain language and share current clinical criteria electronically on request. The criteria must be peer‑reviewed, evidence‑based, updated at least yearly, and consider impacts by race, gender, and underserved groups when appropriate. Denial notices must list the reviewing clinician’s credentials, board certifications, and specialty. Plans must post all prior-authorization policy changes in one spot on their website. After December 30, 2030, any new prior-authorization requirement must also be available through the electronic prior-authorization system or an API.
Electronic prior-authorization APIs by 2027
By January 1, 2027, insurers and public plans must run a prior-authorization API that follows federal CMS rules. They must also support an electronic process or API that lets in‑network providers check if a covered prescription drug needs prior authorization and send and receive decisions, including alternatives. The state enforces these API rules starting January 1, 2027, even if federal rules change.
Faster prior-authorization decisions for patients
Beginning January 1, 2024, insurers must decide electronic standard prior-authorizations in 3 calendar days and expedited in 1 day. Paper standard requests must be decided in 5 days and paper expedited in 2 days. If information is missing, the insurer must ask for it within 1 day for electronic (and expedited paper) or within 5 days for standard paper. These same timelines apply to public-employee and retiree health plans.
Human review required; no AI-only denials
Starting January 1, 2024, insurers and public plans cannot let AI alone deny, delay, or change care for medical-necessity reasons. A licensed doctor or other licensed health professional must make or oversee those denials. Any AI used must rely on your medical history, avoid discrimination, be open to audit, be checked for accuracy over time, and protect patient data.
Independent external review with firm timelines
You can ask a certified independent reviewer after finishing the plan’s grievance process or if the plan missed its deadline. Until January 1, 2027, carriers must send records to the reviewer within 3 business days; you get at least 5 business days to add information; expedited decisions come in 72 hours; carriers must keep services going during review when requested and must follow the decision. Beginning January 1, 2027, these external review protections continue on a permanent basis with the same key timelines and carrier duties.
Annual public reports on prior authorizations
By October 1, 2026, and every year after, large insurers must file deidentified reports on prior authorizations. Reports include totals, approvals, denials (including AI‑aided denials), late decisions, nonelectronic counts, top‑10 affected services and drugs, and average response times in hours. The insurance commissioner combines and anonymizes the data and publishes a public report, and may request more data and set rules.
Temporary rules end, new rules start 2027
Some temporary sections of the law end on January 1, 2027. Replacement sections take effect the same day. This sets when older rules give way to permanent rules.
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Sponsors & Cosponsors
Sponsor
Member 14205
House
Cosponsors
Bob Hasegawa
Democratic • Senate
Liz Lovelett
Democratic • Senate
Ron Muzzall
Republican • Senate
T'wina Nobles
Democratic • Senate
Member 27504
House
Roll Call Votes
Senate vote • 3/9/2026
Final Passage as Amended by the House
Yes: 49 • No: 0
House vote • 3/4/2026
Final Passage as Amended by the House
Yes: 94 • No: 0 • Other: 4
Senate vote • 2/11/2026
3rd Reading & Final Passage
Yes: 48 • No: 1
Actions Timeline
Effective date 6/11/2026*.
3/23/2026SenateChapter 157, 2026 Laws.
3/23/2026SenateGovernor signed.
3/23/2026legislatureDelivered to Governor.
3/12/2026legislatureSpeaker signed.
3/11/2026legislaturePresident signed.
3/10/2026legislaturePassed final passage; yeas, 49; nays, 0; absent, 0; excused, 0.
3/9/2026SenateSenate concurred in House amendments.
3/9/2026HouseRules Committee relieved of further consideration. Placed on second reading.
3/4/2026SenateThird reading, passed; yeas, 94; nays, 0; absent, 0; excused, 4.
3/4/2026SenateRules suspended. Placed on Third Reading.
3/4/2026SenateCommittee amendment(s) adopted with no other amendments.
3/4/2026SenateReferred to Rules 2 Review.
3/2/2026SenateAPP - Majority; do pass with amendment(s) but without amendment(s) by Health Care & Wellness.
3/2/2026SenateAPP - Executive action taken by committee.
3/2/2026SenateHCW - Executive action taken by committee.
2/25/2026SenateMinority; without recommendation.
2/25/2026SenateHCW - Majority; do pass with amendment(s).
2/25/2026SenateReferred to Appropriations.
2/25/2026SenateFirst reading, referred to Health Care & Wellness.
2/14/2026SenateThird reading, passed; yeas, 48; nays, 1; absent, 0; excused, 0.
2/11/2026SenateRules suspended. Placed on Third Reading.
2/11/2026SenateFloor amendment(s) adopted.
2/11/2026Senate2nd substitute bill substituted.
2/11/2026SenatePlaced on second reading by Rules Committee.
2/6/2026Senate
Bill Text
Session Law
3/26/2026
Bill as Passed Legislature
3/12/2026
Engrossed Second Substitute
2/11/2026
Second Substitute
1/29/2026
Substitute Bill
2/21/2025
Original Bill
1/21/2025
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