Bill > SB5324

This bill revises existing laws related to prior authorization processes for health care services and prescription drugs, applying to carriers, public employee health plans, and managed care organizations. The bill establishes specific time frames for prior authorization determinations, requiring organizations to make decisions and notify providers within set calendar day limits depending on whether the request is standard or expedited, and whether it is submitted electronically or non-electronically. For example, electronic standard prior authorization requests must be decided within three calendar days, while electronic expedited requests must be decided within one calendar day. If insufficient information is provided, the organization must request additional details within one to five calendar days, depending on the request type. The bill also mandates that prior authorization requirements be written in clear language, based on peer-reviewed clinical review criteria that are evidence-based and accommodate emerging information about clinical appropriateness for diverse populations. Notably, the bill removes previous language requiring organizations to build and maintain a specific prior authorization application programming interface (API), which appears to be a modification of previously planned technical requirements.

Health and Social Services

https://app.leg.wa.gov/billsummary?BillNumber=5324&Year=2025&Initiative=false