This bill amends RCW 43.71.065 and adds new sections to chapter 43.71 RCW and chapter 42.56 RCW to allow the Washington health benefit exchange to adopt market factor certification criteria for qualified health plans sold through the exchange. It requires exchange-certified plans to meet existing state insurance law and applicable federal law, to meet the new market factor criteria addressing access and affordability, and to include tribal clinics and urban Indian clinics as essential community providers consistent with federal law (with an exemption for integrated delivery systems if allowed by federal law). The exchange must annually review market conditions, may adopt criteria for the next plan year, may require carriers to submit specified plan and rate information, and must consider factors such as cost sharing, benefits, premiums, provider networks, quality, carrier participation, and maximizing federal and state premium assistance. Carriers may request waivers of the criteria within a specified window, and carriers may still offer noncertified plans off the exchange in the individual or small group market. The bill creates a detailed multi-step timeline for developing and adopting criteria for plan year 2028 and later, with specific dates for preliminary criteria (Dec. 15 two years before the plan year), objection windows for the insurance commissioner and the governor (by Jan. 15 one year before the plan year), exchange responses and public notice, public hearings, and final criteria publication by March 1 one year before the plan year; criteria may be modified after March 1 only for legal changes or with commissioner agreement if they affect carrier filings. Information and data carriers submit to the exchange under the market factor criteria are made confidential and exempt from public disclosure under chapter 42.56 RCW. The bill also limits the market factor criteria from directly imposing network participation requirements or reimbursement limits on hospitals or providers except as required by law. The act contains an emergency clause and takes effect immediately. The text does not define the referenced entity called "the authority," does not specify the detailed content of the market factor certification criteria, and does not provide the exchange’s specific procedures for plan year 2027 beyond delegating them to the exchange. The bill also references applicable federal requirements without specifying those federal provisions.

If enacted, the health benefit exchange would gain a formal tool to require that plans sold on the exchange meet new access and affordability standards, which will likely change which plans are allowed on the exchange and push carriers to adjust premiums, benefits, network design, or cost-sharing to meet those standards. Carriers that want to sell on the exchange will face new reporting and timing requirements, potential compliance costs, and the need to seek waivers if they cannot meet the criteria; they can still sell nonconforming plans off-exchange. Consumers could see plan choices on the exchange shift toward offerings that the exchange judges better for access and affordability, but the actual content of the criteria and how strict they will be is not specified here, leaving some uncertainty about concrete effects. State agencies, the insurance commissioner, the governor, tribes, and other stakeholders will have defined roles in developing, reviewing, and responding to the criteria; agencies must provide requested information within 60 days and will be reimbursed for compilation costs within 180 days, creating a new administrative task and limited budget impact. Provider and hospital operations are largely protected from direct new participation or reimbursement mandates by the criteria, and carrier submissions to the exchange are confidential; the act takes effect immediately, so these processes and timelines would start right away once the law is enacted, though the exact standards and 2027 procedures are not detailed in the provided text.