SB5395 – Prior Authorization Determination Process

WALawState

Date Passed

3/23/2026

Effective Date

6/11/2026

Summary

Strengthens Washington’s prior-authorization framework for private health insurance by adding transparency, reporting, and patient-protection requirements, including guardrails on the use of artificial intelligence in medical-necessity determinations and prohibitions on AI-only denials, delays, or modifications of care.

Healthcare Implications

Directly constrains payer and utilization-management use of AI in coverage decisions by requiring human clinical review for denials based on medical necessity, auditability of AI policies, periodic performance review, and reporting on AI-aided denials. This is a high-salience health-AI governance law for payers, providers, and patients.

Impact Level

High

Keywords

Safety & Risk; Transparency & Governance; Privacy & Data

Stakeholders

Payers & Purchasers; Providers & Health Systems; Patients & Public; Regulators & Government