Making improvements to transparency and accountability in the prior authorization determination process.

Removed redundant references to 'health plans' and 'managed care organizations' from the legislative findings to focus specifically on 'health carriers.'

Clarified that clinical review criteria must be evaluated and updated at least annually, with specific attention to equity for Black and Indigenous people, other people of color, gender, and underserved populations.

Removed the requirement to include 'expertise and training' in notifications when denying prior authorization, keeping only credentials, board certifications, and areas of specialty.

Updated the data reporting requirement to specify that trend data must be reported separately for each carrier and each delegated health care benefit manager.

Added a new requirement that clinical review criteria for mental health and substance use disorder services must meet the specific standards outlined in RCW 48.43.766.

Added a requirement that the electronic prior authorization system referenced in subsection (2) must be the specific one mentioned in subsection (4) of the section.

Changed the frequency of prior authorization policy updates from once annually to quarterly, with specific effective dates allowed in January, April, July, and October.

Replaced the requirement to include a unique identifier for the reviewer with a requirement to include the credentials, board certifications, and specialty expertise of the provider who had clinical oversight over the determination.

Added a strict prohibition on using artificial intelligence as the sole means to deny, delay, or modify health care services, requiring human review for all denial decisions.

Added new requirements for AI systems to include demographic data in their determinations and to not base decisions solely on group data sets.

Added a requirement that patient data used by AI systems must not be used beyond its intended purpose.

Expanded the reporting requirements for carriers to include the total number of nonelectronic prior authorization requests and to separate reports for carrier-made versus benefit manager-made decisions.

Added a new requirement for managed care organizations to publish a list specifying when prior authorization is required, prohibited, or has uniform application for Medicaid services.

Strengthened protections against retrospective denials by explicitly prohibiting retrospective modifications to a service less intensive than the original request.

Added a requirement for carriers to allow providers to query prior authorization documentation requirements through their electronic health records.

Added specific definitions for 'generative artificial intelligence' and 'machine learning' to clarify the technologies covered by the bill.

The legislative session changed from the 2025 Regular Session to the 2026 Regular Session, and the bill was renumbered from S-1767.1 to S-3711.2.

The deadline for enforcing federal interoperability standards for prior authorization was moved from January 1, 2025, to January 1, 2027.

The bill was transferred from the Senate Health & Long-Term Care committee to the Senate Ways & Means committee.

Separate provisions for managed care organizations were removed and consolidated into the general carrier requirements, meaning they no longer have a distinct section in the bill.

A new expiration date was added, requiring Section 2 (AI transparency and human review requirements) to expire on January 1, 2027.

The requirement for carriers to post policy changes on their websites was simplified, removing the specific 45-day notice requirement and the temporary website-only rule ending in 2028.

The reporting deadline for prior authorization data was extended from January 1, 2026, to January 1, 2027.