Washington Engrossed Second Substitute Senate Bill 5395 — Transparency and Accountability in Prior Authorization Determinations
Washington · Engrossed Second Substitute S.B. 5395, 2025-26 Reg. Sess. (Wash.)
Washington bars health carriers from using AI to deny, delay, or modify health care services on its own; a denial based on medical necessity must be made by a licensed health professional. Where AI is used in prior authorization, it must be applied fairly, comply with anti-discrimination law, and base determinations on the individual enrollee's medical history, clinical circumstances, and relevant demographic data rather than broad group data. AI tools must be reviewed for accuracy, AI policies are subject to audit by the Insurance Commissioner, and carriers must report the share of denials aided by AI.
Technical detail
Engrossed Second Substitute SB 5395 (2025-26) amends Washington's insurance prior-authorization statutes to prohibit AI from being the sole basis for denying/delaying/modifying covered services, to require licensed-professional review of medical-necessity denials, and to impose equity, individualized-basis, accuracy-review, audit, and reporting requirements.
Who is protected: Enrollees and patients covered by Washington-regulated health carriers and benefit managers.
Who must comply: Health carriers and health care benefit managers operating in Washington.
Key facts
| Jurisdiction | Washington |
|---|---|
| Level | State |
| Status | In effect |
| Protection strength | Limited protection |
| Effective date | 2026-06-11 |
| Enacted | 2026-03-23 |
| Citation | Engrossed Second Substitute S.B. 5395, 2025-26 Reg. Sess. (Wash.) |
| Enforced by | Washington Office of the Insurance Commissioner. |
| Penalties | Subject to the existing enforcement and penalty provisions of Washington's insurance code as amended; no new standalone penalty. |
| Topics | healthcare AI · insurance AI · automated decision-making |
| Last verified | 2026-06-16 |
| Official source | Final Bill Report, Engrossed Second Substitute Senate Bill 5395 (Washington Legislature) ↗ |
More AI rules in Washington
- My Health My Data Act · In effect
- SB 5152 (Election Synthetic Media) · In effect
- SSB 5886 (WA Digital Likeness Rights) · In effect
- HB 2225 (WA Chatbot Safety) · Enacted (not yet in effect)
- HB 1170 (WA AI Content Disclosure) · Enacted (not yet in effect)
- Washington HB 1999 (criminalizes AI/fabricated CSAM and nonconsensual fake intimate images) · In effect
Related healthcare AI rules elsewhere
- ACA § 1557 (AI in patient care) · In effect
- FDA AI/ML SaMD Action Plan · In effect
- FDA GMLP Principles · In effect
- Colorado AI Act (repealed) · Repealed / replaced
- SB 26-189 (Colorado ADMT Law) · Enacted (not yet in effect)
- AI Companion Safeguards Law · In effect
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