Apr. 3, 2026

WSMA's Latest Prior Authorization Reform Bill Signed Into Law

Legislation sets parameters on AI use and determination timelines

Last week, WSMA priority legislation Senate Bill 5395 was signed into law by Gov. Bob Ferguson. The bill, developed in partnership by the WSMA, the Washington State Hospital Association, and Proliance Surgeons, is the third prior authorization reform bill the WSMA has helped advance through the legislative process since 2020, working to address a top priority issue for our state's physician community and patients.

Aligning with recent WSMA House of Delegates policy, SB 5395 prohibits insurance carriers from solely using artificial intelligence to deny prior authorizations, ensuring that a licensed health care practitioner makes such determinations. The bill also clarifies a prohibition in state law around retroactive denials of prior authorizations and requires insurance carriers to post policy updates on a single site.

SB 5395 builds on legislation from 2023 that requires integration of prior authorization processes into electronic health records to help streamline and expedite determinations. That law goes into effect Jan. 1, 2027, dovetailing with a similar federal law that was put in place subsequent to WSMA's legislation. The federal law applies to prior authorizations for physical health care services, while the state law goes further and also applies to prescription drug authorizations.

In 2020, the WSMA and WSHA successfully advocated for a bill requiring tracking of insurance carriers' utilization of prior authorization, directing annual reports from the Office of the Insurance Commissioner. As expected, the reports have found the vast majority of prior authorizations are approved, underscoring frustration that the process primarily serves to drive up costs for practices and cause delays for patients accessing care.

While we're proud of our work to help reform prior authorization processes and our state's standing as a leader on this issue, we know there's more to be done. We’ll continue to work at the state and federal levels to advance WSMA policies on prior authorization and mitigate its administrative and financial burdens.