The bill seeks to improve access to mental health and substance use disorder services in Washington by revising the state's mental health parity law. It mandates that health insurance coverage for these services aligns with the same standards applied to medical and surgical services, ensuring that medical necessity determinations are based on generally accepted care standards. Key provisions include the requirement for health plans to eliminate stricter criteria for mental health services, prohibit coverage denials based on the assumption of public entitlement program coverage, and ensure that clinical review criteria are evidence-based and regularly updated. The bill also introduces a process for reviewing these criteria and requires carriers to provide necessary clinical protocols to providers upon request.

Additionally, the legislation enhances the dispute resolution process for enrollees, allowing for independent reviews of carrier decisions after the grievance process. It establishes a timeline for prior authorization determinations and mandates the implementation of an interoperable electronic process for prior authorization of prescription drugs by January 1, 2027. The bill includes provisions for the insurance commissioner to adopt rules for compliance and data collection, repeals several existing laws related to mental health 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