This bill amends existing law to require the Health Care Authority (HCA) and the Office of the Insurance Commissioner (OIC) to jointly decide whether to adopt updated versions of the American Society of Addiction Medicine (ASAM) Criteria when those updates are published, and to post their decision on their websites. It directs Medicaid managed care organizations and carriers to begin using the ASAM Criteria, 4th edition, no later than January 1, 2028, unless HCA and OIC jointly determine that the 4th edition should not be used. The ASAM Criteria are described in the bill as treatment criteria for addictive, substance-related, and co-occurring conditions, including adolescent and transition-age youth versions. The change affects HCA, OIC, Medicaid managed care organizations, carriers, and unspecified “other relevant entities.” The bill amends RCW 71.24.619 and RCW 48.43.764, is House Bill 1469 (69th Legislature, 2025 Regular Session), was filed by request of the Office of Financial Management, sponsored by Representatives Macri and Ormsby, and was read for the first time January 21, 2025. This is a procedural statutory change about the adoption and implementation timing of clinical criteria; it does not create a new crime or change penalties. The extracted text does not define “other relevant entities,” does not state what procedures or consequences follow if HCA and OIC decide not to adopt an updated ASAM version, does not provide the full prior text of the amended RCW sections, and does not indicate whether additional sections of the bill exist.

If enacted, the Health Care Authority and the Office of the Insurance Commissioner will be required to jointly decide whether to adopt new editions of the ASAM Criteria, publicly post that decision, and — unless they jointly opt out — Medicaid managed care organizations and health insurers must start using the ASAM Criteria, 4th edition, by January 1, 2028. That creates a clear timeline and a public decision point for when clinical placement and coverage rules based on ASAM will change. The most affected parties are Medicaid managed care organizations and carriers, which will likely need to revise medical necessity criteria, provider agreements, training, and utilization review systems before the 2028 date, creating administrative work and potential short-term costs. The HCA and OIC take on added responsibility to review new ASAM editions and post their determinations, but the law does not specify what happens if they jointly decide not to adopt an update or precisely which other entities must comply, leaving some implementation details unclear.