Consolidated health care rulemaking (R 2025-12)

Effective Date

January 19, 2026

Date adopted

December 19, 2025

Date proposed

July 22, 2025

Recently adopted

Consumers

Insurers and regulated entities

Providers

The commissioner adopted the consolidated health care rule R 2025-12 on December 19, 2025. The rule takes effect on January 19, 2025.

This rulemaking updates existing rules to align with changes in state and federal laws. It clarifies rights and obligations for affected entities and Essential Health Benefit plan coverage requirements. Finally, it clarifies reporting responsibilities for locally set ground ambulance rates.

The rule updates include Chapter 284-43 WAC Subchapter D Prior Authorization and Utilization Review, Chapter 284-43 WAC Subchapter H Health Plan Benefits, Chapter 284-43 Subchapter L Reproductive Health Care and Contraception, WAC 284-43-7010, and WAC 284-43B-029.

Amended laws & rules:

WAC 284-43-2050 - Prior Authorization Processes

WAC 284-43-5151, 284-43-5410, 284-43-5602, 24-43-5622, 284-43-5642, 284-43-5702, 284-43-5782, 284-43-5937 - Health Plan Benefits

WAC 284-43-7010, 284-43-7210 - Mental Health and Substance Use Disorder

WAC 284-43B-029 - Local Governmental Entity Rate Reporting to the Insurance Commissioner

New laws & rules:

WAC 284-43-2070 - Prior Authorization and Utilization Review

WAC 284-43-5604, 284-43-5624, 284-43-5644, 284-43-5704, 284-43-5784, 284-43-5939 - Health Plan Benefits

Repealed laws & rules:

WAC 284-43-5600, 284-43-5620, 284-43-5640, 284-43-5700, 284-43-5780 - Health Plan Benefits