Committee hears broad bill to tighten prior authorization, limit AI sole‑use denials

The Washington House Health Care & Wellness Committee on Feb. 5 heard extensive testimony on House Bill 1566, a multi‑part proposal to reform prior authorization for medical procedures, imaging and medications.

Emily Poole, committee staff, opened the briefing by describing the bill's principal elements, including new notification requirements that would force carriers, health plans and managed care organizations (MCOs) to identify the individual reviewer and the supervising physician (by national provider ID) when issuing prior authorization determinations; mandatory peer‑to‑peer review opportunities for adverse determinations; and limits on when plans may change prior authorization policies to once per year, effective Jan. 1 of each year beginning after Aug. 1, 2025.

Poole also summarized the bill's protections for the use of artificial intelligence and related software tools: "only a licensed physician or health professional may make determinations of medical necessity," and an AI algorithm "may not be the sole means used to deny, delay,…