Washington State
House of Representatives
Office of Program Research
BILL
ANALYSIS
Health Care & Wellness Committee
HB 1627
Brief Description: Providing enrollees flexibility in obtaining services covered annually or on a multiyear basis.
Sponsors: Representatives Paul, Low, Schmidt, Nance, Shavers and Reed.
Brief Summary of Bill
  • Requires health plans to allow enrollees to obtain covered services offered on an annual or multiyear basis at least one month before the year or multiyear period has elapsed since the enrollee last obtained that service.?
Hearing Date: 2/5/25
Staff: Kim Weidenaar (786-7120).
Background:

The federal Patient Protection and Affordable Care Act requires health plans to cover preventive services to specific populations at certain intervals with no cost sharing based on recommendations from several federal entities.? For example, health plans must cover an annual well-women visit as well as mammograms for women aged 40 to 74 years old every two years.? Colonoscopies are also recommended for adults aged 45 to 74 years old every 10 years.? In addition to preventive services, some other services are generally covered on an annual or biennial basis, such as eye exams.?
Summary of Bill:

Health plans, including plans offered to public employees and dental- and vision-only plans, issued or renewed on or after January 1, 2026, must provide coverage for any covered annual service in a way that allows the enrollee to obtain the covered service at least one month before 12 months have elapsed since the previous service was provided.? Health plans must apply the same cost-sharing requirements that would have been applied if the service occurred after 12 months.? For any covered service that a health carrier covers biennially or at another multiyear frequency, the health carrier must provide coverage to allow an enrollee to obtain the covered service at least one month before that frequency has elapsed since the enrollee's previous covered service.? The health carrier must apply the same cost-sharing requirements that would have been applied if the service occurred after the applicable period.
Appropriation: None.
Fiscal Note: Requested on January 29, 2025.
Effective Date: The bill takes effect 90 days after adjournment of the session in which the bill is passed.