June 03, 2025
In April and May 2025, Gov. Ferguson signed the following healthcare bills into law:
- HB 1669: Concerning coverage requirements for prosthetic limbs and custom orthotic braces. The legislation states that a health plan offered in the large group or small group market that is issued or renewed on or after January 1, 2026, must include coverage for one or more prostheses per limb and custom orthotic braces per limb when medically necessary unless exceptions apply. Coverage under this mandate also includes the replacement or repair of a prosthetic limb or custom orthotic brace (or for the replacement or repair of any part of the device). Health plans are permitted to apply normal utilization management and prior authorization practices.
- HB 1971: Increasing access to prescription hormone therapy. The legislation requires health plans issued or renewed on or after January 1, 2026, to cover a 12-month supply of prescription hormone therapy in a single refill unless the patient or provider requests a smaller amount or the medication is a controlled substance. The bill applies to prescription hormone therapy patients of all ages.
- SB 5557: Codifying emergency rules to protect the right of a pregnant person to access treatment for emergency medical conditions in hospital emergency departments. The legislation requires hospitals to provide emergency care as defined in the law to pregnant individuals consistent with the standard of care, including termination of pregnancy if medically necessary. The legislation also establishes when hospitals may transfer patients and reasonable procedures and confirms acceptance by the receiving hospital. The law took immediate effect on April 29, 2025.
- SB 5351: (Approved in part, vetoed in part) ensuring patient choice and access to care by prohibiting unfair and deceptive dental insurance practices. The legislation states that dental-only plans cannot deny coverage for procedures solely because they were performed on the same day unless certain exceptions apply. The law also creates credit card reimbursement rules for payers and requires dental-only plan providers to annually report metrics, including average premiums, dental loss ratio, and revenue/payments. The bill’s effective date was the reason for the partial veto, but it was otherwise approved and returned to the legislature.
- SB 5262: Insurance statute. The legislation requires health plans issued or renewed on or after January 1, 2026, to provide coverage for hearing instruments, including non-over-the-counter bone conduction hearing devices. Coverage of these hearing instruments is provided every 36 months per ear with hearing loss. Lifetime and annual limits on dollar coverage are prohibited, whether provided in or out of network. Prior authorization or other utilization controls when approving coverage for medically necessary hearing instruments are permitted.
- HB 1432: Mental health and substance use disorder services, health carrier coverage, and various provisions. The legislation adds new language to the utilization review criteria used by carriers, including for mental health and substance use disorder services. Further, the legislation requires that if a health carrier provides any benefits for a mental health condition or substance use disorder in any classification of benefits, it must provide meaningful benefits for that mental health condition or substance use disorder in every classification in which medical or surgical benefits are provided. Interestingly, the legislation also incorporates in its entirety provisions of the federal mental health parity rule published in September 2024 and any related guidance issued by federal departments. However, the DOL, HHS, and IRS issued a statement indicating they will not enforce the MHPAEA 2024 final rule (the 2024 final rule) while they reconsider whether to rescind or modify it. These provisions in the Washington law take effect July 1, 2027. To learn more about the federal mental health parity law, check out the NFP articles on the recent MHPAEA 2024 Final Rule Nonenforcement Policy and, separately, MHPAEA Compliance in an Uncertain Regulatory Environment.
Employers with plans governed by state laws should be aware of these mandates and can contact their carrier for further details.
- HB 1669 Concerning coverage requirements for prosthetic limbs and custom orthotic braces
- HB 1971 Increasing access to prescription hormone therapy
- SB 5557 Codifying emergency rules to protect the right of a pregnant person to access treatment for emergency medical conditions in hospital emergency departments
- SB 5351 Ensuring patient choice and access to care by prohibiting unfair and deceptive dental insurance practices
- SB 5262 Insurance Statutes—Various Provisions
- HB 1432 Mental Health and Substance Use Disorder Services—Health Carrier Coverage—Various Provisions