Washington SB 5395 (limits AI in health-insurance prior-auth denials)
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.)
- Status
- In effect
- Took effect
- June 11, 2026
- Applies to
- Health carriers and health care benefit managers operating in Washington.
- Enforced by
- Washington Office of the Insurance Commissioner.
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.
Who is protected: Enrollees and patients covered by Washington-regulated health carriers and benefit managers.
Legal 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.
Key facts
| Jurisdiction | Washington |
|---|---|
| Level | State |
| Strength | Limited |
| Enacted | March 23, 2026 |
| Citation | Engrossed Second Substitute S.B. 5395, 2025-26 Reg. Sess. (Wash.) |
| 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 |
| Bill text | 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 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
- SB 5152 (Election Synthetic Media) · In effect
- SSB 5886 (WA Digital Likeness Rights) · In effect
Related healthcare AI rules elsewhere
- Missouri AI Therapy Chatbot Ban (SB 1019) · 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) · Enacted (not yet in effect)
- California AB 489 (AI healthcare chatbot misrepresentation ban) · In effect
- AZ HB 2175 (AI Insurance Denial — Physician Review) · In effect
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