Washington SB 5395 (AI in Health Insurance Prior Authorization)
Effective date
Penalty
Enforcement by Office of the Insurance Commissioner (OIC). AI tools may approve but may not deny prior authorization without human review by a licensed physi…
Obligations mapped
8 obligations
Overview
Enacted as Chapter 157, Laws of 2026; Governor signed March 23, 2026; effective June 11, 2026. AI tools may be used to approve prior authorization requests but may not deny care without human review by a licensed physician or health professional. Where applicable, managed care organizations may need to report the percentage of total denials aided by AI. Periodic performance reviews of AI tools may be required for accuracy and reliability.
This is an AI-specific state law.
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Who this applies to
This regulation applies to the following roles:
- Deployers and users of covered AI systems and tools
- Organizations operating in Washington
This regulation applies to companies that use or deploy AI tools and systems built by other vendors. If your company uses AI-powered products in the areas listed below, this regulation may apply to you.
RCW 48.43.830(1)(e) as amended by Sec. 2; RCW 41.05.845(1)(e) as amended by Sec. 4; parallel provision in reenacted RCW 48.43.830(1)(e) effective 1/1/2027 per Sec. 3 · RCW 48.43.830(2) as amended by Sec. 2 and reenacted by Sec. 3; RCW 41.05.845(2) as amended by Sec. 4 and related sections
AI categories covered
- Healthcare AI
- Insurance
Specific AI use cases:
- Insurance prior authorization
What this requires you to do
8 obligations identified from statutory analysis.
RCW 48.43.0161(1) as amended by Sec. 6
RCW 48.43.525(1) as amended by Sec. 5
RCW 48.43.830(1)(e) as amended by Sec. 2; RCW 41.05.845(1)(e) as amended by Sec. 4; parallel provision in reenacted RCW 48.43.830(1)(e) effective 1/1/2027 per Sec. 3
RCW 48.43.830(3)(b) as amended by Sec. 2 and reenacted by Sec. 3; RCW 41.05.845(3)(b) as amended by Sec. 4
RCW 48.43.525(2) as amended by Sec. 5
Regulation summaries are simplified for readability and may not capture every nuance of the underlying statute. Verify important details against primary sources linked on this page.
Enforcement and penalties
Enforcement by Office of the Insurance Commissioner (OIC). AI tools may approve but may not deny prior authorization without human review by a licensed physician. Where applicable, managed care organizations may need to report percentage of denials aided by AI.
Penalty amounts are based on statutory text and may be subject to adjustment, judicial interpretation, or enforcement discretion.
Legislative history
effective
Takes effect
signed
Signed by Governor; Chapter 157, Laws of 2026
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Washington AI regulation guide lists every tracked rule for this jurisdiction with timelines and obligation tallies.
Regulation summaries are simplified for readability and may not capture every nuance of the underlying statute. Verify important details against primary sources linked on this page.