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 | 2026-07-22 |
| Official source | Final Bill Report, Engrossed Second Substitute Senate Bill 5395 (Washington Legislature) ↗ |
More AI rules in Washington
- WA SB 5982 (Data Center / Clean Energy) · In effect
- Washington HB 2225 (AI chatbot disclosure, minor protections, crisis protocols) · Enacted (not yet in effect)
- Washington HB 1170 (AI content watermarking & provenance metadata) · Enacted (not yet in effect)
- Washington SHB 1672 (employee monitoring notice, ADS restrictions, emotion AI ban) · In effect
- Washington HB 1999 (criminalizes AI/fabricated CSAM and nonconsensual fake intimate images) · In effect
- My Health My Data Act · In effect
Related healthcare AI rules elsewhere
- Missouri AI Therapy Chatbot Ban (SB 1019) · Enacted (not yet in effect)
- PA v. Character.AI (Fake Psychiatrist Chatbot) · Blocked / in litigation
- RI Therapy Chatbot Ban (2026) · In effect
- RI AI Companion Self-Harm Safety (2026) · In effect
- Georgia SB 544 (health insurer AI) · Enacted (not yet in effect)
- Indiana HB 1271 (AI claims downcoding) · In effect
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