The bill seeks to improve access to mental health and substance use disorder services in Washington by updating the state's mental health parity law. It mandates that health insurance coverage for these services aligns with generally accepted standards of care, ensuring that treatment rules for mental health and substance use disorders are consistent with those for medical and surgical services. Key provisions include prohibiting health carriers from denying coverage based on the assumption that services could be covered by public entitlement programs and requiring that clinical review criteria for these services be evidence-based and regularly updated. The bill also introduces a process for reviewing and updating clinical review criteria, while allowing enrollees to seek independent review of adverse coverage determinations after exhausting the carrier's grievance process.

Additionally, the bill establishes new requirements for health insurance carriers regarding the prior authorization process for prescription drugs, mandating an interoperable electronic system by January 1, 2027, to automate prior authorization determinations. It includes provisions for the insurance commissioner to adopt necessary rules for implementation and emphasizes the importance of compliance with parity requirements through quantitative data collection. The bill also repeals several existing laws related to mental health services coverage effective January 1, 2027, and stipulates that the act will be null and void if specific funding is not provided by June 30, 2025.

Statutes affected:
Original Bill: 48.43.016, 48.43.091, 48.43.410, 48.43.520, 48.43.535, 48.43.761, 48.43.830
Substitute Bill: 48.43.016, 48.43.410, 48.43.520, 48.43.530, 48.43.535, 48.43.600, 48.43.761, 48.43.830
Second Substitute: 48.43.016, 48.43.410, 48.43.520, 48.43.530, 48.43.535, 48.43.600, 48.43.761, 48.43.830
Engrossed Second Substitute: 48.43.016, 48.43.410, 48.43.520, 48.43.530, 48.43.535, 48.43.600, 48.43.830
Bill as Passed Legislature: 48.43.016, 48.43.410, 48.43.520, 48.43.535, 48.43.600, 48.43.830
Session Law: 48.43.016, 48.43.410, 48.43.520, 48.43.535, 48.43.600, 48.43.830