The bill seeks to improve access to mental health and substance use disorder services in Washington by amending the state's mental health parity law. It emphasizes the necessity for health insurance coverage for these services, ensuring that medical necessity determinations align with accepted care standards. Key provisions include requiring health plans to cover mental health services and prescription drugs on par with other medical services, establishing a single out-of-pocket limit for all services, and mandating that health carriers provide meaningful benefits for mental health conditions. The bill also introduces penalties for non-compliance and requires health carriers to analyze treatment limitation parity upon request, aiming to eliminate barriers to care.

Additionally, the bill introduces several amendments to existing laws governing health carriers, such as prohibiting refund requests for mental health service payments after 180 days, except in cases of fraud. It mandates that clinical review criteria for prescription drugs treating mental health or substance use disorders be evidence-based and regularly updated. The legislation also ensures that health plans issued or renewed after January 1, 2026, cannot require prior authorization for certain inpatient or residential treatment services. Furthermore, it establishes a structured process for independent review of coverage disputes and mandates timely communication of prior authorization requirements based on peer-reviewed clinical criteria. The bill will take effect on January 1, 2026, and repeals several existing laws related to mental health service coverage.

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