In Washington, rulemaking from administrative agencies can occur throughout the year. The state’s 2025 legislative session began on January 13 and will conclude on April 27. Important employee benefit updates recently finalized by the administrative agencies or legislature are chronologically detailed below.
On November 27, 2024, the Washington Office of the Insurance Commissioner (OIC) adopted R2024-01 Implementation of the SSB 5986 and updates to the Balance Billing Protection Act. The rule updates administrative code to include ground ambulance services, which WA SSB 5986 previously added to balance billing protections under the Washington Balance Billing Protection Act (BBPA). Enrollees satisfy their obligation to pay for ground ambulance services if they pay the in-network cost-sharing amount specified in the enrollee's applicable health plan contract and may not be balance billed for more. The amount paid in full by the carrier to the ground ambulance provider is also defined. The rule became effective December 28, 2024.
On November 27, 2024, the Washington OIC also adopted R 2024-05 Consolidated Health Care. The rule clarifies coverage and cost-sharing requirements for preventive services. The rule amends the existing Washington Administrative Code (WAC) to state that a health plan must include in its preventive and wellness services relevant federal rules and guidance related to preventive services in effect on January 8, 2024, and in chapters 284-43 of the WAC. The rule also adds that if a health plan offered by an insurer does not include an in-network provider who can deliver preventive services required under Revised Code of Washington 48.43.047 ‒ such as preventive services recommended by the U.S. Preventive Services Task Force or the HRSA Bright Futures guidelines ‒ the plan must cover the service when provided by an out-of-network provider. In such cases, the plan cannot impose any cost-sharing (like copayments, coinsurance, or deductibles) for that service. The rule became effective December 28, 2024.
On January 27, 2025, the Washington OIC adopted R 2024-03 Prior Authorization Modernization. The regulation updates prior authorization timeframes for healthcare services, drug utilization, and clarifies health plan applicability standards. The rule follows legislative action in Washington on prior authorization and defines notification timeframes for prior authorization decision standard and urgent prior authorization requests in electronic and nonelectronic submission formats. This rule became effective on the date of adoption.
On February 16, 2025, the Washington Employment Security Department finalized CR-103P Definition of “Health Care provider,” Repeal of Pandemic Leave Assistance Rules, Designated Representative, and Other Rules. The implementation plan repeals three pandemic leave assistance rules (WAC 192-500-200, WAC 192-530-100, and WAC 192-610-100) because the program is no longer available due to statutory timelines. These changes became effective immediately.
Employers should be aware of these updates and contact their carrier or service provider, as applicable, for further information.