WashingtonHB 17062025-2026 Regular SessionHouseWALLET

Aligning the implementation of application programming interfaces for prior authorization with federal guidelines.

Sponsored By: Tarra Simmons (Democratic)

Became Law

Your PRIA Score

Score Hidden

Personalized for You

How does this bill affect your finances?

Sign up for a PRIA Policy Scan to see your personalized alignment score for this bill and every other piece of legislation we track. We analyze your financial profile against policy provisions to show you exactly what matters to your wallet.

Free to start

Bill Overview

Analyzed Economic Effects

5 provisions identified: 4 benefits, 1 costs, 0 mixed.

Clear, updated rules for prior authorization

Carriers, public employee plans, and Medicaid managed care must explain prior authorization rules in plain language. They must give your provider current written clinical review criteria electronically when asked. The criteria must be peer‑reviewed, evidence‑based, and updated at least once a year. They must consider available evidence for Black and Indigenous people, other people of color, gender, and underserved groups. This applies to commercial and public employee plans issued or renewed on or after January 1, 2024, and to Medicaid managed care beginning January 1, 2024.

Electronic prior authorization for services by 2027

Carriers, public employee plans, and Medicaid managed care must add an electronic tool (API) for prior authorization of services. It follows final federal CMS rules. The state enforces this starting January 1, 2027, even if federal timing changes after February 8, 2024. The tool must mark a denial, or an approval of a less‑intensive service, as an adverse benefit determination you can appeal.

Faster drug prior authorization by 2027

Carriers, public employee plans, and Medicaid managed care must support electronic prior authorization for prescription drugs starting January 1, 2027. The tool shows required documents and covered alternative drugs. It must let your provider send and receive requests from your electronic health record or office system. A denial, or approval of a different drug, is an adverse benefit determination you can appeal.

Faster prior authorization for most health plans

Beginning January 1, 2024, most health plans must answer prior authorization requests faster. For electronic requests, standard decisions come within 3 calendar days and expedited within 1 day. For paper, fax, or phone, standard decisions come within 5 days and expedited within 2 days. Plans must ask for missing information quickly: within 1 day for electronic; within 5 days for standard paper and 1 day for expedited paper. These timelines apply when your provider sends the needed information. This covers commercial and public employee plans issued or renewed on or after January 1, 2024, and Medicaid managed care starting January 1, 2024.

Medicare plans not under these rules

Medicare Part C (Medicare Advantage) and Part D drug plans are not subject to these state prior authorization rules. Your Medicare coverage follows federal rules. Some other prior authorization processes under RCW 71.24.618 and RCW 74.09.490 also stay exempt. These exclusions apply starting January 1, 2024.

Sponsors & Cosponsors

Sponsor

Tarra Simmons
Democratic • House

Cosponsors

There are no cosponsors for this bill.

Roll Call Votes

All Roll Calls

Yes: 146 • No: 0

Senate vote • 3/26/2025

3rd Reading & Final Passage

Yes: 49 • No: 0

House vote • 3/4/2025