On January 24, 2025, Washington House Bill 1566 was introduced, aiming to address the complexities surrounding health plan compliance with federal regulations and the integration of artificial intelligence in healthcare processes. The bill outlines specific provisions that require health plans to meet certain standards by January 1, 2025, contingent upon the finalization of relevant regulations by the federal Centers for Medicare and Medicaid Services (CMS).

Key provisions of the bill stipulate that if CMS does not finalize these regulations by September 13, 2023, enforcement of the compliance requirements will be postponed until January 1, 2026. Furthermore, health plans unable to meet the requirements by the deadline must submit a narrative justification to the state authority by September 1, 2024. This justification must detail the reasons for noncompliance, the impact on providers and enrollees, and a proposed timeline for achieving compliance.

The bill also introduces a provision allowing the state authority to grant a one-year extension for compliance if it determines that the health plan has made a good faith effort to adhere to the requirements. However, this extension is not applicable if the delay in enforcement is due to the lack of finalized federal regulations.

A notable aspect of HB 1566 is its focus on the use of artificial intelligence in healthcare. The bill defines artificial intelligence and outlines its potential applications, including tasks typically associated with human intelligence, such as natural language processing and forecasting outcomes. Additionally, it addresses expedited prior authorization requests, emphasizing the urgency in cases where delays could jeopardize an enrollee's health or recovery.

The introduction of this bill has sparked discussions among stakeholders, including healthcare providers, insurers, and patient advocacy groups. Proponents argue that the bill could streamline healthcare processes and improve patient outcomes through timely approvals and the integration of advanced technologies. Conversely, some critics express concerns about the feasibility of compliance within the proposed timelines and the potential burden on health plans.

As the legislative process unfolds, the implications of HB 1566 could significantly impact the healthcare landscape in Washington, particularly in how health plans operate and interact with providers and patients. The bill's progress will be closely monitored, as it may set a precedent for future healthcare legislation in the state.