WA HB1566

Prior authorization policy changes by carriers and managed care organizations can only be made quarterly (effective January 1st, April 1st, July 1st, or October 1st) starting August 1, 2025, with at least 45 days advance notice to in-network providers

Only licensed physicians or licensed health professionals may deny prior authorization requests based on medical necessity; artificial intelligence tools cannot be the sole means used to deny, delay, or modify health care services

Carriers using AI for prior authorization must ensure the tool considers individual patient clinical history, does not discriminate, is open to audit, and is periodically reviewed for accuracy and reliability

Prior authorization denials must include the credentials, board certifications, and specialty training of the provider who had clinical oversight over the determination

Carriers are prohibited from retrospectively denying or modifying to less intensive services care that had prior authorization, unless based on material misrepresentation or lawful plan termination