Diabetes and obesity

AN ACT Relating to the diabetes prevention and obesity treatment 1
act; reenacting and amending RCW 41.05.017; adding a new section to 2
chapter 48.43 RCW; and adding a new section to chapter 74.09 RCW.3
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:4
NEW SECTION. Sec. 1. A new section is added to chapter 48.43 5
RCW to read as follows: 6
(1) For health plans issued or renewed on or after January 1, 7
2026, a health carrier shall include coverage for the diagnosis and 8
treatment of the chronic disease of obesity including, but not 9
limited to: 10
(a) Intensive health behavioral and lifestyle treatment;11
(b) Metabolic and bariatric surgery; and 12
(c) Food and drug administration-approved obesity medication.13
(2) Coverage criteria for food and drug administration-approved 14
obesity medications may not be more restrictive than the food and 15
drug administration-approved indications for those treatments.16
(3) Coverage under this section may not be different or separate 17
from coverage for any other illness, condition, or disorder for 18
purposes of determining deductibles, copayment, and coinsurance 19
factors, and benefit year maximums for deductibles, copayment, and 20
coinsurance factors. 21
H-0494.1
HOUSE BILL 1326
State of Washington 69th Legislature 2025 Regular Session
By Representatives Thai, Ormsby, Salahuddin, Parshley, Taylor, Hill,
Doglio, Pollet, Nance, Callan, and Fosse
Read first time 01/16/25. Referred to Committee on Health Care &
Wellness.
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(4) This section does not prohibit a health carrier from applying 1
utilization management to determine the medical necessity for 2
treatment of the chronic disease of obesity under this section if 3
appropriateness and medical necessity determinations are made in the 4
same manner as those determinations are made for the treatment of any 5
other illness, condition, or disorder covered by a contract.6
(5) Intensive health behavior and lifestyle treatment may include 7
interventions certified by or recognized by the centers for disease 8
control and prevention or recommended by current clinical standards 9
of care. 10
(6) For purposes of this section: 11
(a) "Intensive health behavior and lifestyle treatment" means an 12
evidence-based, intensive, multicomponent behavioral or lifestyle 13
modification intervention that supports healthy weight management and 14
is delivered in-person or through telemedicine as defined in RCW 15
48.43.735. 16
(b) "Food and drug administration-approved obesity medication" 17
means any medication approved by the United States food and drug 18
administration with an indication for chronic weight management in 19
patients with an obesity diagnosis. 20
(c) "Metabolic and bariatric surgery" means any surgical 21
intervention included in the most current American society for 22
metabolic and bariatric surgery and international federation for the 23
surgery of obesity and metabolic disorders guidelines on indications 24
for metabolic and bariatric surgery. 25
Sec. 2. RCW 41.05.017 and 2024 c 251 s 5 and 2024 c 242 s 10 are 26
each reenacted and amended to read as follows: 27
Each health plan that provides medical insurance offered under 28
this chapter, including plans created by insuring entities, plans not 29
subject to the provisions of Title 48 RCW, and plans created under 30
RCW 41.05.140, are subject to the provisions of RCW 48.43.500, 31
70.02.045, 48.43.505 through 48.43.535, 48.43.537, 48.43.545, 32
48.43.550, 70.02.110, 70.02.900, 48.43.190, 48.43.083, 48.43.0128, 33
48.43.780, 48.43.435, 48.43.815, 48.200.020 through 48.200.280, 34
48.200.300 through 48.200.320, 48.43.440, section 1 of this act, and 35
chapter 48.49 RCW. 36
NEW SECTION. Sec. 3. A new section is added to chapter 74.09 37
RCW to read as follows: 38
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(1) By November 1, 2025, the authority shall apply for 1
authorization from the federal centers for medicare and medicaid 2
services to receive matching federal funds for providing the services 3
covered under this section. 4
(2) Upon federal authorization, the authority and all managed 5
care organizations shall provide coverage to provide treatment of the 6
chronic disease of obesity including, but not limited to:7
(a) Intensive health behavioral and lifestyle treatment;8
(b) Metabolic and bariatric surgery; and 9
(c) Food and drug administration-approved obesity medication.10
(3) Coverage criteria for food and drug administration-approved 11
obesity medications may not be more restrictive than the food and 12
drug administration-approved indications for those treatments.13
(4) This section does not prohibit the authority and managed care 14
organizations from applying utilization management to determine the 15
medical necessity for treatment of the chronic disease of obesity 16
under this section if appropriateness and medical necessity 17
determinations are made in the same manner as those determinations 18
are made for the treatment of any other illness, condition, or 19
disorder covered by a contract. 20
(5) Intensive health behavior and lifestyle treatment may include 21
interventions certified by or recognized by the centers for disease 22
control and prevention or recommended by current clinical standards 23
of care. 24
(6) For purposes of this section: 25
(a) "Intensive health behavior and lifestyle treatment" means an 26
evidence-based, intensive, multicomponent behavioral or lifestyle 27
modification intervention that supports healthy weight management and 28
is delivered in-person or through telemedicine as defined in RCW 29
74.09.325. 30
(b) "Food and drug administration-approved obesity medication" 31
means any medication approved by the United States food and drug 32
administration with an indication for chronic weight management in 33
patients with an obesity diagnosis. 34
(c) "Metabolic and bariatric surgery" means any surgical 35
intervention included in the most current American society for 36
metabolic and bariatric surgery and international federation for the 37
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surgery of obesity and metabolic disorders guidelines on indications 1
for metabolic and bariatric surgery. 2
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