The bill amends Washington state laws to enhance the prior authorization processes for health care services and prescription drugs, aligning them with federal guidelines. Effective January 1, 2024, health carriers and health plans are required to make prior authorization determinations within specific time frames: three calendar days for standard electronic requests and one calendar day for expedited requests. Additionally, the bill mandates the establishment of a prior authorization application programming interface (API) that complies with federal standards, ensuring that any prior authorization denial is treated as an adverse benefit determination, subject to grievance and appeal processes. The implementation of the API for prescription drugs is set to begin on January 1, 2027.

Furthermore, the bill emphasizes the importance of clear communication regarding prior authorization requirements, mandating that these be presented in understandable language and made available electronically to providers. It also requires that clinical review criteria be evidence-based and inclusive of diverse populations. Health plans and managed care organizations must implement interoperable electronic processes to facilitate the exchange of prior authorization requests and determinations, with specific deadlines for compliance. The bill ensures that these processes remain in line with federal regulations, regardless of any potential changes or delays from federal authorities.

Statutes affected:
Original Bill: 48.43.830, 41.05.845, 74.09.840
Substitute Bill: 48.43.830, 41.05.845, 74.09.840
Bill as Passed Legislature: 48.43.830, 41.05.845, 74.09.840
Session Law: 48.43.830, 41.05.845, 74.09.840