This bill adds new sections to Washington law (chapter 18.73 RCW and chapter 48.02 RCW), creating a new legal prohibition and an enforcement procedure. It prohibits a ground ambulance service from selling or assigning medical debt tied to ambulance services provided after a motor vehicle accident to any person licensed under chapter 19.16 RCW until at least 120 days after the initial billing statement has been sent to the patient and any other responsible party. The bill defines "motor vehicle accident" to include incidents where a pedestrian or bicyclist is struck or injured by a motor vehicle, defines "initial billing statement" as the first bill sent to a patient and other responsible parties (by mail or electronically), and defines "other responsible party" as any individual or entity other than the patient with legal or contractual responsibility for paying the bills. The bill also creates a procedure for enforcement by adding a section to chapter 48.02 RCW. If the insurance commissioner believes an ambulance service has a pattern of unresolved violations of the new 120-day assignment prohibition, the commissioner may submit information to the Department of Health after first offering the ambulance service an opportunity to cure or explain. If the Department of Health finds a pattern of unresolved violations, it may levy fines or cost recovery up to the applicable statutory amount per violation and take other actions allowed by its authority. The department must notify the commissioner of the results of any review, including whether violations were substantiated and what enforcement action, if any, was taken. This is a new statutory prohibition and a procedural enforcement change rather than the creation of a new crime. It creates a waiting period before certain debt sales or assignments and authorizes administrative referral and civil penalties. The bill text does not specify the numeric fine amounts (it refers to "the applicable statutory amount per violation") and does not define what constitutes a "pattern of unresolved violations," and it does not prohibit sale or assignment to entities that are not licensed under chapter 19.16 RCW. These aspects are therefore unclear from the provided text.

Ambulance companies that bill for care after motor vehicle crashes will have to wait at least 120 days after sending the first bill before selling or assigning that bill to licensed debt buyers, which is likely to mean fewer immediate collection calls to patients and more time for insurance, third‑party liability, or family members to sort out payment. For ambulance providers, especially private or for‑profit services, that delay will tend to slow cash recovery, raise billing and follow‑up work, and could increase short‑term financial pressure or administrative costs as they keep unpaid accounts on their books longer. Regulators can investigate and refer companies that repeatedly ignore the delay rule to the health department, which can fine or take other action, so providers risk penalties and discipline for persistent violations. It is unclear how many violations count as a “pattern,” whether transfers to unlicensed collectors are covered, and how much additional enforcement capacity will be needed, so agencies and small ambulance operators may face uncertain compliance and oversight costs as the rule is implemented.