Washington SB 5395 - AI in Health Insurance Prior Authorization
Effective
Overview
Regulates use of AI in health insurance prior authorization decisions. Requires human review of AI-generated denials.
This is an AI-specific state law.
Who this applies to
This regulation applies to companies that use or deploy AI tools and systems built by other vendors. If your company uses AI-powered products in the areas listed below, this regulation may apply to you.
AI categories covered
- Healthcare AI
- Insurance
Specific AI use cases:
- Insurance prior authorization
What this requires you to do
Human oversight required
Ensure human oversight. A human must be able to review and override AI-driven decisions.
Transparency notice required
Provide transparency notices. Inform affected individuals that AI is being used and how it influences decisions.
Record-keeping required
Maintain records. Keep documentation of your AI systems, decisions made, and compliance activities.
Enforcement and penalties
Enforced by Washington Office of Insurance Commissioner.
Source
Read the full text
https://app.leg.wa.gov/billsummary?BillNumber=5395&Year=2025
Always verify current language and amendments at the official source.
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