Subject of Possible Rule Making: Implementation of SHB 1706 (2025), SHB 1669 (2025), 2SSB 6228 (2024), ESHB 1971 (2025), SSB 5351 (2025), 2SSB 5313 (2021), various updates to the essential health benefit (EHB) benchmark plan, and other related legislation and state or federal laws incorporated as consolidated health care rule making.

Reasons Why Rules on this Subject may be Needed and What They Might Accomplish: The insurance commissioner's office (OIC) is considering consolidated health care rule making due to the recent passage of insurance-related legislation and other changes in state or federal law. Multiple provisions of health care and insurance regulations in WAC may need to be updated by OIC to be consistent with the legislation passed and codified in RCW and other recent state or federal law changes. These rules will facilitate implementation of the new laws by ensuring that all affected health care providers and health carriers understand their legal rights and obligations under the enacted legislation and law changes.

This effort may include, but is not limited to: Aligning WAC with federal requirements related to prior authorization; updating existing rules to include carrier requirements related to prosthetics and orthotics coverage; adopting language around a standardized form that carriers must use for authorization of substance use disorder treatment; updating rules to include reference to 12-month coverage of prescription hormone therapy; updating rules to include reference to new carrier reporting requirements for dental only plans; and updating various EHB benchmark plan rules. This rule making may include, but is not limited to, the following authorities: Chapter 284-43 WAC, Subchapters D, J, K, and L; WAC 284-43-5151, 284-43-5937, 284-43-5410, 284-43-5602, 284-43-5622, 284-43-5642, 284-43-5702, and 284-43-5782.

Other Federal and State Agencies that Regulate this Subject and the Process Coordinating the Rule with These Agencies: OIC is promulgating administrative rules related to the commercial plans it regulates. However, there are other state agencies who may be affected by this rule making.

The health care authority (HCA) and OIC have similar statutory authority for EHB updates regarding hearing aids. Therefore, OIC will coordinate on this rule making with other agencies, including HCA, by offering notices and opportunities for written comment or feedback with multiple participation forums.

Interested parties can participate in the decision to adopt the new rule and formulation of the proposed rule before publication by contacting Rules Coordinator, 302 Sid Snyder Avenue S.W., Olympia, WA 98504, phone 360-725-7171, fax 360-586-3109, TTY 360-586-0241, email rulescoordinator@oic.wa.gov, website www.insurance.wa.gov.