Committee weighs prior‑authorization overhaul that limits AI‑only denials
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Summary
The Health Care and Wellness Committee heard testimony on SB 5395, which would tighten timelines and require clinician oversight of prior‑authorization denials, limit standalone AI decisions, and require carriers to publish changes and report AI‑aided denial rates beginning in 2027.
The Health Care and Wellness Committee on Feb. 18 considered Senate Bill 53‑95, a measure to reform prior‑authorization practices used by health carriers and plans. Committee staff said the bill sets timing requirements for decisions, requires carriers to post policy changes in a single online location and to include the provider who had clinical oversight when issuing a denial.
"AI may not be the sole means used to deny, delay, or modify healthcare services," committee staff told members as staff summarized the bill. Prime sponsor Sen. Tina Orwell said the measure grew from two years of stakeholder work and removed Medicaid coverage from the bill because of budget constraints.
Supporters — including hospitals, physician groups and patient advocates — urged limits on automated decision making and stronger accountability. Sean Graham of the Washington State Medical Association told the committee that prior authorization drives costs and delays care and that clinicians should review denials: "We do want a human to continue to be involved in circumstances where an authorization is being denied." Providers described cases of retrospective denials after care was delivered, which can trigger lengthy appeals and financial uncertainty.
Insurers and carriers broadly said they back efforts to streamline prior authorization but requested targeted technical amendments; Premera Blue Cross asked for a narrow change to a section the company said could limit appropriate post‑claim reviews.
If enacted, the bill would also require carriers to report on the percentage of denials aided by AI beginning Jan. 1, 2027. Proponents say the changes will increase transparency and reduce inappropriate denials; critics cautioned about unintended operational consequences and asked for clarifying language on appeals and provider‑response timelines.
The committee did not vote on the bill on Feb. 18 and suspended the public hearing to take further testimony at a later date.