For Consumers

Streamlining prior authorization for health care services (R 2016-02)

In 2014, the legislature passed SB 6511 (leg.wa.gov) requiring the Office of the Insurance Commissioner (OIC) to adopt recommendations of a OneHealthPort (PDF, 148KB) (www.onehealthport.com) work group dedicated to streamlining the prior authorization process. Previous rulemaking (R 2014-13) codified most of the work group recommendations but additional rulemaking is necessary to adopt the remaining recommendation. This rulemaking will adjust the approval timeframes for prior authorization of medical benefits to allow for additional time if insufficient information has been provided for an issuer to make a decision. The rulemaking is limited in scope to fulfilling the mandate of SB 6511.

Rule adopted May 16, 2016

Proposal filed March 29, 2016

Stakeholder draft released on February 10, 2016

Preproposal filed January 27, 2016