Bill > HB1566

This bill aims to improve transparency and accountability in the prior authorization process for health insurance carriers, health plans, and managed care organizations. The bill introduces several key provisions, including requiring carriers to make prior authorization decisions within specific timeframes, mandate clear and easily understandable language for authorization requirements, and most notably, place significant restrictions on the use of artificial intelligence (AI) in making medical coverage decisions. Health plans must now ensure that only licensed physicians or health professionals can deny prior authorization requests based on medical necessity, and AI tools cannot be the sole means of denying, delaying, or modifying health care services. The bill requires AI tools to base determinations on individual patient medical history and circumstances, prohibits discrimination, mandates periodic review of AI performance, and ensures patient data is used only for its intended purpose. Additionally, carriers must provide more detailed information when denying prior authorization, such as the credentials of the provider who made the determination, and can only make policy changes quarterly with proper notification to providers. The legislation aims to maintain human oversight in medical decision-making while promoting transparency and preventing potential algorithmic biases in healthcare coverage determinations.

Budget and Finance, Health and Social Services

https://app.leg.wa.gov/billsummary?BillNumber=1566&Year=2025&Initiative=false