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 must be equivalent to that of medical and surgical services, ensuring consistent treatment limitations and financial requirements. The legislation introduces new definitions, such as "clinical review criteria" and "medically necessary," and outlines the obligations of health carriers regarding utilization reviews and coverage approvals. It also prohibits health carriers from denying coverage based on the assumption that services could be covered by public entitlement programs and establishes penalties for non-compliance.

Additionally, the bill outlines a process for independent review of disputes regarding health care coverage decisions and sets specific requirements for prior authorization processes for mental health and substance use disorder treatments. It mandates that clinical review criteria for these services be evidence-based and regularly updated, while also requiring health plans to maintain documented utilization review programs. The bill further requires carriers to develop an application programming interface (API) to automate the prior authorization process, with implementation deadlines set for 2025 and 2027. Overall, the legislation aims to enhance the quality and accessibility of mental health services while providing protections for enrollees.

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