Washington § 48.43.520 Requirement to maintain a documented utilization review program description and written utilization review criteria—Rules.(Effective until January 1, 2027.)

Washington Statutes

§ 48.43.520 — Requirement to maintain a documented utilization review program description and written utilization review criteria—Rules.(Effective until January 1, 2027.)

Washington § 48.43.520

Title 48INSURANCE

Ch. 48.43INSURANCE REFORM

This text of Washington § 48.43.520 (Requirement to maintain a documented utilization review program description and written utilization review criteria—Rules.(Effective until January 1, 2027.)) is published on Counsel Stack Legal Research, covering Washington primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook

Wash. Rev. Code § 48.43.520 (2026).

Text

(1)Carriers that offer a health plan shall maintain a documented utilization review program description and written utilization review criteria based on reasonable medical evidence. The program must include a method for reviewing and updating criteria. Carriers shall make clinical protocols, medical management standards, and other review criteria available upon request to participating providers.

(2)The commissioner shall adopt, in rule, standards for this section after considering relevant standards adopted by national managed care accreditation organizations and state agencies that purchase managed health care services.

(3)A carrier shall not be required to use medical evidence or standards in its utilization review of religious nonmedical treatment or religious nonmedical nursing c

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(1) Carriers that offer a health plan shall maintain a documented utilization review program description and written utilization review criteria based on reasonable medical evidence. The program must include a method for reviewing and updating criteria. Carriers shall make clinical protocols, medical management standards, and other review criteria available upon request to participating providers.

(2) The commissioner shall adopt, in rule, standards for this section after considering relevant standards adopted by national managed care accreditation organizations and state agencies that purchase managed health care services.

(3) A carrier shall not be required to use medical evidence or standards in its utilization review of religious nonmedical treatment or religious nonmedical nursing care.

Application — Short title — Captions not law — Construction — Severability — Application to contracts — Effective dates — 2000 c 5: See notes following RCW 48.43.500 .

(1) Carriers that offer a health plan shall maintain a documented utilization review program description and written utilization review and clinical review criteria based on reasonable medical evidence. For mental health and substance use disorder services, as defined in RCW 48.43.766 , clinical review criteria must meet the requirements of RCW 48.43.766 . The program must include a method for reviewing and updating criteria. Carriers shall make clinical protocols, medical management standards, clinical review criteria as defined in RCW 48.43.766 , and other review criteria available upon request to participating providers.

(2) The commissioner shall adopt, in rule, standards for this section after considering relevant standards adopted by national managed care accreditation organizations and state agencies that purchase managed health care services.

(3) A carrier shall not be required to use medical evidence or standards in its utilization review of religious nonmedical treatment or religious nonmedical nursing care.

Effective date — 2025 c 227 ss 1-8: See note following RCW 48.43.766 .

Findings — Intent — Rules — 2025 c 227: See notes following RCW 48.43.766 .

Application — Short title — Captions not law — Construction — Severability — Application to contracts — Effective dates — 2000 c 5: See notes following RCW 48.43.500 .