OIC Begins Rulemaking on Prior Authorizations, Ground Ambulance Balance Billing, and Pharmacy Benefit Managers

June 12, 2024

The Office of the Insurance Commissioner (OIC) has begun the rulemaking process for several bills passed during recent legislative sessions:

  • Prior Authorizations: OIC began rulemaking for provisions of 2023’s House Bill 1357, which reduces the time periods for carriers to respond to prior authorization requests and requires carriers to implement application programming interfaces to standardize and streamline the prior authorization request and response process. The rulemaking will also address certain provisions of Senate Bill 6228 that affect prior authorizations for behavioral health services.
  • Ground Ambulance Balance Billing: OIC began rulemaking related to Senate Bill 5986, which adds ground ambulance services to the state’s existing Balance Billing Protection Act. WSHA is also planning to provide a separate bulletin for this bill.
  • Pharmacy Benefit Managers: OIC began rulemaking for Senate Bill 5213, which creates a regulatory structure for Pharmacy Benefit Managers and adds important protections for pharmacies and patients. WSHA is also planning to provide a separate bulletin for this bill.

WSHA will be participating in each rulemaking process and encourages other interested parties to contact the appropriate person listed in each notice for updates and scheduled hearings.  A comprehensive listing of rulemaking WSHA is participating or monitoring is on our Regulatory Issues page and Top Priority Rules Tracker.

For a listing of existing and planned bulletins and other implementation resources, see our New Law Implementation Guide. (Andrew Busz, andrewb@wsha.org)


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