Consolidated health care rulemaking (R 2025-12)

The insurance commissioner is considering consolidated health care rulemaking due to the recent passage of insurance-related legislation and other changes in law. Currently, multiple provisions of health care and insurance regulations in the Washington Administrative Code (WAC) may need to be updated by OIC to be consistent with legislation passed and codified in the Revised Code of Washington (RCW) and recent federal law changes. This consolidated rulemaking aims to implement Chapter 25, Laws of 2025, aligning the implementation of application programming interfaces for prior authorization with federal guidelines, Chapter 96, Laws of 2025 concerning coverage requirements for prosthetic limbs and custom orthotic braces, Chapter 336, Laws of 2024 concerning treatment of substance use disorders, Chapter 171, Laws of 2025 increasing access to prescription hormone therapy, Chapter 219, Laws of 2025 ensuring patient choice and access to care by prohibiting unfair and deceptive dental insurance practices, updates to Essential Health Benefits Benchmark Plan, and other related legislation and laws. 

This effort may include, but is not limited to: aligning the WAC code with federal requirements related to prior authorization, updating existing rules to include carrier requirements related to prosthetics and orthotics coverage, adopting language around a standardized form that carriers must use for authorization of substance use disorder treatment, updating rules to include reference to 12-month coverage of prescription hormone therapy, updating rules to include reference to new carrier reporting requirements for dental only plans, and updating various EHB Benchmark Plan rules, and other related legislation and laws.  

This rulemaking may include, but is not limited to, the following authorities: Chapter 284-43 Subchapter D, J, K, and L, WAC 284-43-5937, ​WAC 284-43-5410, ​WAC 284-43-5602, ​WAC 284-43-5622, ​WAC 284-43-5642, ​WAC 284-43-5702, ​and WAC 284-43-5782.