Preventive health services

AN ACT Relating to preserving access to preventive services by 1
clarifying state authority and definitions; amending RCW 48.43.047, 2
70.290.010, and 70.290.040; adding a new section to chapter 43.70 3
RCW; creating a new section; and declaring an emergency.4
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:5
NEW SECTION. Sec. 1. (1) It is the intent of the legislature to 6
preserve access to evidence-based preventive health services for 7
people residing in Washington state who choose to use such services.8
(2) The legislature does not intend to establish new requirements 9
that any individual receive any immunization or other preventive 10
health service, nor does the legislature intend to modify, limit, or 11
expand existing laws related to informed consent for health care 12
decisions for minors or adults. 13
NEW SECTION. Sec. 2. A new section is added to chapter 43.70 14
RCW to read as follows: 15
The department may issue immunization recommendations and related 16
guidance. In developing its recommendations, the department must 17
consider the recommendations of the advisory committee on 18
immunization practices of the United States centers for disease 19
control and prevention and experts and expert organizations that the 20
Z-0590.2
HOUSE BILL 2242
State of Washington 69th Legislature 2026 Regular Session
By Representatives Bronoske, Doglio, Parshley, Simmons, Berry, Ramel,
Thomas, Ormsby, Thai, Macri, Fosse, Hill, Pollet, Obras, Wylie, and
Zahn; by request of Governor Ferguson and Insurance Commissioner
Prefiled 01/02/26. Read first time 01/12/26. Referred to Committee
on Health Care & Wellness.
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department in its discretion deems relevant and based on reasonable 1
scientific evidence and judgment. Any recommendations or guidance 2
issued by the department under this section shall be posted on the 3
department's website. Any recommendations or guidance issued by the 4
department under this section are not subject to the rule-making 5
requirements of chapter 34.05 RCW. 6
Sec. 3. RCW 48.43.047 and 2024 c 314 s 1 are each amended to 7
read as follows: 8
(1) A nongrandfathered health plan issued on or after ((June 6, 9
2024,)) April 1, 2026, must, at a minimum, provide coverage for the 10
following preventive services ((as the recommendations or guidelines 11
existed on January 8, 2024)): 12
(a) Evidence-based items or services that have a rating of A or B 13
in the ((current)) recommendations of the United States preventive 14
services task force in effect on June 30, 2025, and items and 15
services included in rules adopted by the insurance commissioner 16
under this section with respect to the enrollee; 17
(b) ((Immunizations for routine use in children, adolescents, and 18
adults that have in effect a recommendation from the advisory 19
committee on immunization practices of the centers for disease 20
control and prevention with respect to the enrollee. For purposes of 21
this subsection, a recommendation from the advisory committee on 22
immunization practices of the centers for disease control and 23
prevention is considered in effect after the recommendation has been 24
adopted by the director of the centers for disease control and 25
prevention, and a recommendation is considered to be for routine use 26
if the recommendation is listed on the immunization schedules of the 27
centers for disease control and prevention;28
(c))) With respect to infants, children, and adolescents, 29
evidence-informed preventive care and screenings provided for in 30
comprehensive guidelines supported by the health resources and 31
services administration in effect on June 30, 2025, and preventive 32
care and screenings included in rules adopted by the insurance 33
commissioner under this section; ((and34
(d))) (c) With respect to women, additional preventive care and 35
screenings that are not listed with a rating of A or B by the United 36
States preventive services task force but that are provided for in 37
comprehensive guidelines supported by the health resources and 38
services administration in effect on June 30, 2025, and preventive 39
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care and screenings included in rules adopted by the insurance 1
commissioner under this section; and 2
(d) Immunizations that have in effect a recommendation from the 3
department of health under section 2 of this act. 4
(2) A nongrandfathered health plan must provide coverage for 5
((the)):6
(a) The preventive services required to be covered under 7
subsection (1)(a) through (c) of this section consistent with federal 8
rules and guidance related to coverage of such preventive services in 9
effect on ((January 8, 2024)) June 30, 2025, and rules adopted by the 10
insurance commissioner under this section; and11
(b) Immunizations required to be covered under subsection (1)(d) 12
of this section consistent with department of health guidance issued 13
under section 2 of this act. 14
(3) A nongrandfathered health plan must provide coverage for the 15
preventive services required to be covered under subsection s (1) and 16
(2) of this section for plan years that begin on or after the date 17
that is one year after the date the recommendation or guideline is 18
issued. 19
(4) ((A nongrandfathered health plan is no longer required to 20
provide coverage for particular items or services specified in the 21
recommendations or guidelines described in subsection (1) of this 22
section if such a recommendation or guideline is revised by the 23
recommending entities described in subsection (1) of this section to 24
no longer include the preventive item or service as defined in 25
subsection (1) of this section.26
(5) Annually, a health carrier shall determine whether any 27
additional items or services must be covered without cost-sharing 28
requirements or whether any items or services are no longer required 29
to be covered as provided in subsections (2) and (3) of this section. 30
The carrier's determination must be included in its health plan 31
filings submitted to the commissioner.32
(6)))(a) Except as provided in (b) of this subsection, the health 33
plan may not impose cost-sharing requirements for the preventive 34
services required to be covered under subsection s (1) and (2) of this 35
section when the services are provided by an in-network provider. If 36
a plan does not have in its network a provider who can provide an 37
item or service described in subsection s (1) and (2) of this section, 38
the plan must cover the item or service when performed by an out-of-39
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network provider and may not impose cost sharing with respect to the 1
item or service. 2
(b) ((If any portion of 42 U.S.C. Sec. 300gg-13 is found invalid, 3
for)) For a health plan offered as a qualifying health plan for a 4
health savings account, the carrier may apply cost sharing to 5
coverage of the services ((that have been invalidated )) required to 6
be covered under subsections (1) and (2) of this section only at the 7
minimum level necessary to preserve the enrollee's ability to claim 8
tax exempt contributions and withdrawals from the enrollee's health 9
savings account under internal revenue service laws and regulations.10
(((7))) (5) A carrier may use reasonable medical management 11
techniques to determine the frequency, method, treatment, or setting 12
for an item or service described in subsection s (1) and (2) of this 13
section to the extent not specified in the relevant recommendation or 14
guideline, federal rules and guidance related to the coverage of 15
preventive services in effect on ((January 8, 2024, )) June 30, 2025, 16
department of health guidance issued under section 2 of this act, and 17
any rules adopted by the insurance commissioner. 18
(((8) The insurance commissioner shall enforce this section 19
consistent with federal rules and guidance in effect on January 8, 20
2024.21
(9))) (6) The insurance commissioner may adopt rules necessary to 22
implement the requirements of this section, ((consistent with federal 23
statutes, rules, and guidance in effect on January 8, 2024. The 24
insurance commissioner may also adopt rules related to any future 25
preventive services recommendations and guidelines issued by the 26
United States preventive services task force, the advisory committee 27
on immunization practices of the centers for disease control and 28
prevention, and the health resources and services administration or 29
related federal rules or guidance )) including rules modifying 30
coverage requirements for preventive services under subsection (1)(a) 31
through (c) of this section based on the addition of preventive 32
services or other changes to the recommendations and guidelines 33
referenced in subsection (1)(a) through (c) of this section that are 34
made after June 30, 2025. Any rules adopted by the insurance 35
commissioner must be as or more favorable to enrollees with respect 36
to coverage of preventive services than the recommendations and 37
guidelines in effect on June 30, 2025. In adopting any rules under 38
this subsection, the insurance commissioner must:39
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(a) Consult with the health care authority and department of 1
health; and2
(b) Consider the recommendations of the department of health 3
issued under section 2 of this act and recommendations issued by the 4
United States preventive services task force, the health resources 5
and services administration, and experts and expert organizations 6
that the commissioner in their discretion deems relevant and based on 7
reasonable scientific evidence and judgment. 8
Sec. 4. RCW 70.290.010 and 2024 c 41 s 1 are each amended to 9
read as follows: 10
The definitions in this section apply throughout this chapter 11
unless the context clearly requires otherwise. 12
(1) "Association" means the Washington vaccine association.13
(2) "Covered lives" means all persons under the age of nineteen 14
in Washington state who are: 15
(a) Covered under an individual or group health benefit plan 16
issued or delivered in Washington state or an individual or group 17
health benefit plan that otherwise provides benefits to Washington 18
residents; or 19
(b) Enrolled in a group health benefit plan administered by a 20
third-party administrator. Persons under the age of nineteen for whom 21
federal funding is used to purchase vaccines or who are enrolled in 22
state purchased health care programs covering low-income children 23
including, but not limited to, apple health for kids under RCW 24
74.09.470 and the basic health plan under chapter 70.47 RCW are not 25
considered "covered lives" under this chapter. 26
(3) "Estimated vaccine cost" means the estimated cost to the 27
state over the course of a state fiscal year for the purchase and 28
distribution of vaccines purchased ((at the federal discount rate )) 29
by the department of health. 30
(4) "Health benefit plan" has the same meaning as defined in RCW 31
48.43.005 and also includes health benefit plans administered by a 32
third-party administrator. 33
(5) "Health carrier" has the same meaning as defined in RCW 34
48.43.005. 35
(6) "Secretary" means the secretary of the department of health.36
(7) "State supplied vaccine" means vaccine purchased by the state 37
department of health for covered lives for whom the state is 38
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purchasing vaccine using state funds raised via assessments on health 1
carriers and third-party administrators as provided in this chapter.2
(8) "Third-party administrator" means any person or entity who, 3
on behalf of a health insurer or health care purchaser, receives or 4
collects charges, contributions, or premiums for, or adjusts or 5
settles claims on or for, residents of Washington state or Washington 6
health care providers and facilities. 7
(9) "Total nonfederal program cost" means the estimated vaccine 8
cost less the amount of federal revenue available to the state for 9
the purchase and distribution of vaccines. 10
(10) "Vaccine" means an immunization recommended by the 11
department of health under section 2 of this act for administration 12
to persons under the age of 19 years and approved by the federal food 13
and drug administration as safe and effective ((and recommended by 14
the advisory committee on immunization practices of the centers for 15
disease control and prevention for administration to children under 16
the age of nineteen years)) in any manner. 17
Sec. 5. RCW 70.290.040 and 2010 c 174 s 4 are each amended to 18
read as follows: 19
(1) The secretary shall estimate the total nonfederal program 20
cost for the upcoming calendar year by October 1, 2010, and October 21
1st of each year thereafter , prioritizing purchasing at the federal 22
discount rate or, if not available, at the most cost-effective rate . 23
Additionally, the secretary shall subtract any amounts needed to 24
serve children enrolled in state purchased health care programs 25
covering low-income children for whom federal vaccine funding is not 26
available, and report the final amount to the association. In 27
addition, the secretary shall perform such calculation for the period 28
of May 1st through December 31st, 2010, as soon as feasible but in no 29
event later than April 1, 2010. The estimates shall be timely 30
communicated to the association. 31
(2) The board of directors of the association shall determine the 32
method and timing of assessment collection in consultation with the 33
department of health. The board shall use a formula designed by the 34
board to ensure the total anticipated nonfederal program cost, minus 35
costs for other children served through state purchased health care 36
programs covering low-income children, calculated under subsection 37
(1) of this section, is collected and transmitted to the universal 38
vaccine purchase account created in RCW 43.70.720 in order to ensure 39
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adequacy of state funds to order state-supplied vaccine ((from 1
federal centers for disease control and prevention)).2
(3) Each licensed health carrier and each third-party 3
administrator on behalf of its clients' health benefit plans must be 4
assessed and is required to timely remit payment for its share of the 5
total amount needed to fund nonfederal program costs calculated by 6
the department of health. Such an assessment includes additional 7
funds as determined necessary by the board to cover the reasonable 8
costs for the association's administration. The board shall determine 9
the assessment methodology, with the intent of ensuring that the 10
nonfederal costs are based on actual usage of vaccine for a health 11
carrier or third-party administrator's covered lives. State and local 12
governments and school districts must pay their portion of vaccine 13
expense for covered lives under this chapter. 14
(4) The board of the association shall develop a mechanism 15
through which the number and cost of doses of vaccine purchased under 16
this chapter that have been administered to children covered by each 17
health carrier, and each third-party administrator's clients health 18
benefit plans, are attributed to each such health carrier and third-19
party administrator. Except as otherwise permitted by the board, this 20
mechanism must include at least the following: Date of service; 21
patient name; vaccine received; and health benefit plan eligibility. 22
The data must be collected and maintained in a manner consistent with 23
applicable state and federal health information privacy laws. 24
Beginning November 1, 2011, and each November 1st thereafter, the 25
board shall factor the results of this mechanism for the previous 26
year into the determination of the appropriate assessment amount for 27
each health carrier and third-party administrator for the upcoming 28
year. 29
(5) For any year in which the total calculated cost to be 30
received from association members through assessments is less than 31
the total nonfederal program cost, the association must pay the 32
difference to the state for deposit into the universal vaccine 33
purchase account established in RCW 43.70.720. The board may assess, 34
and the health carrier and third-party administrators are obligated 35
to pay, their proportionate share of such costs and appropriate 36
reserves as determined by the board. 37
(6) The aggregate amount to be raised by the association in any 38
year may be reduced by any surpluses remaining from prior years.39
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(7) In order to generate sufficient start-up funding, the 1
association may accept prepayment from member health carriers and 2
third-party administrators, subject to offset of future amounts 3
otherwise owing or other repayment method as determined by the board. 4
The initial deposit of start-up funding must be deposited into the 5
universal vaccine purchase account on or before April 30, 2010.6
NEW SECTION. Sec. 6. If any provision of this act or its 7
application to any person or circumstance is held invalid, the 8
remainder of the act or the application of the provision to other 9
persons or circumstances is not affected.10
NEW SECTION. Sec. 7. This act is necessary for the immediate 11
preservation of the public peace, health, or safety, or support of 12
the state government and its existing public institutions, and takes 13
effect immediately.14
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