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WashingtonSB 53952025-2026 Regular SessionSenateWALLET

Making improvements to transparency and accountability in the prior authorization determination process.

Sponsored By: Tina Orwall (Democratic)

Signed by Governor

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Bill Overview

Analyzed Economic Effects

3 provisions identified: 3 benefits, 0 costs, 0 mixed.

Clearer health plan rules and tools

Beginning June 11, 2026, covered health plans must post prior authorization rules in one website location and keep them adjustable. Plans must maintain an electronic interface consistent with applicable federal rules, with enforcement required January 1, 2027, regardless of federal rule status. Electronic tools must let in-network providers check drug requirements and, beginning January 1, 2027, exchange requests, decisions, and covered alternatives with their record systems. After December 30, 2030, new health care service authorization applications must be available to providers electronically. Denials and approvals for less intensive care are subject to the plan’s grievance and appeal process.

Patients gain protection for approved care

Beginning June 11, 2026, covered carriers generally cannot later deny approved care or reduce approval to less intensive care. A later change in the medical-necessity decision does not justify reversing approval. Exceptions apply for material misrepresentation or coverage lawfully rescinded, canceled, or terminated retroactively through the service date. If patients or providers show approval was valid under the plan’s written rules, carriers must treat it as approved and payable. Carriers must add 1% monthly interest from the claim submission date and allow independent review without first completing or waiting on their grievance process.

Patients get human review of denials

Beginning June 11, 2026, only a licensed clinician acting within their professional scope can deny prior authorization for medical necessity. The clinician must consider the requested care and the patient’s individual clinical information. Artificial intelligence cannot alone deny, delay, or change care; it must use individual medical information, not just group data. Plans and their contractors using artificial intelligence for these decisions must follow fairness, nondiscrimination, privacy, audit, and regular accuracy-review safeguards. Denial notices must give patients and requesting or referring providers the clinical reviewer’s credentials, board certifications, and specialties.

Sponsors & Cosponsors

Sponsor

  • Tina Orwall

    Democratic • Senate

Cosponsors

  • Bob Hasegawa

    Democratic • Senate

  • Liz Lovelett

    Democratic • Senate

  • Ron Muzzall

    Republican • Senate

  • T'wina Nobles

    Democratic • Senate

  • Vandana Slatter

    Democratic • Senate

Roll Call Votes

All Roll Calls

Yes: 191 • No: 1

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

  1. Effective date 6/11/2026*.

    3/23/2026Senate

  2. Chapter 157, 2026 Laws.

    3/23/2026Senate

  3. Governor signed.

    3/23/2026legislature

  4. Delivered to Governor.

    3/12/2026legislature

  5. Speaker signed.

    3/11/2026legislature

  6. President signed.

    3/10/2026legislature

  7. Passed final passage; yeas, 49; nays, 0; absent, 0; excused, 0.

    3/9/2026Senate

  8. Senate concurred in House amendments.

    3/9/2026House

  9. Rules Committee relieved of further consideration. Placed on second reading.

    3/4/2026Senate

  10. Third reading, passed; yeas, 94; nays, 0; absent, 0; excused, 4.

    3/4/2026Senate

  11. Rules suspended. Placed on Third Reading.

    3/4/2026Senate

  12. Committee amendment(s) adopted with no other amendments.

    3/4/2026Senate

  13. Referred to Rules 2 Review.

    3/2/2026Senate

  14. APP - Majority; do pass with amendment(s) but without amendment(s) by Health Care & Wellness.

    3/2/2026Senate

  15. APP - Executive action taken by committee.

    3/2/2026Senate

  16. HCW - Executive action taken by committee.

    2/25/2026Senate

  17. Minority; without recommendation.

    2/25/2026Senate

  18. HCW - Majority; do pass with amendment(s).

    2/25/2026Senate

  19. Referred to Appropriations.

    2/25/2026Senate

  20. First reading, referred to Health Care & Wellness.

    2/14/2026Senate

  21. Third reading, passed; yeas, 48; nays, 1; absent, 0; excused, 0.

    2/11/2026Senate

  22. Rules suspended. Placed on Third Reading.

    2/11/2026Senate

  23. Floor amendment(s) adopted.

    2/11/2026Senate

  24. 2nd substitute bill substituted.

    2/11/2026Senate

  25. Placed on second reading by Rules Committee.

    2/6/2026Senate

Bill Text

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