Washington Insurance Commissioner rulemaking (insurers and regulated entities) · January 19, 2026 · Primary source
Consolidated health care rulemaking (R 2025-12)
Summary
Washington State's Office of the Insurance Commissioner adopted consolidated health care rulemaking R 2025-12 on December 19, 2025, effective January 19, 2026, updating multiple chapters of the Washington Administrative Code to align with recent state and federal law changes. The rulemaking amends WAC 284-43 provisions governing prior authorization and utilization review, health plan benefits, mental health and substance use disorder coverage, reproductive health care, and local ground ambulance rate reporting. New WAC sections on prior authorization (284-43-2070) and additional health plan benefit provisions were added, while several existing health plan benefit WACs were repealed.
What this may mean
Washington health insurers and regulated entities are subject to updated prior authorization and utilization review standards under amended WAC 284-43-2050 and new WAC 284-43-2070, effective January 19, 2026. The rule amends WAC 284-43-7010 and 284-43-7210 governing mental health and substance use disorder coverage, directly affecting parity compliance obligations for health plans in Washington. Essential Health Benefit plan coverage requirements and reproductive health coverage rules are also revised, affecting plan design and compliance for carriers offering individual and small-group products.
Informational only. Not legal, medical, financial, or other professional advice. Always consult a qualified professional familiar with your specific facts before relying on any item.
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