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Federal Groundwork
Federal proposal
Medical Cannabis Equity and Access Act of 2027A BILLTo amend the Controlled Substances Act, the Federal Food, Drug, and Cosmetic Act, and related provisions of the Social SecuritAct and the Internal Revenue Code of 1986 to integrate medical cannabis into standard healthcare practices; to require insurance coverage for cannabis prescriptions and related services; to recognize caregivers and home cooperatives as qualified medical providers eligible for reimbursement; to promote research and standardization; and for other purposes.Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,SECTION 1. SHORT TITLE; TABLE OF CONTENTS.(a) SHORT TITLE.—This Act may be cited as the “Medical Cannabis Equity and Access Act of 2027”.(b) TABLE OF CONTENTS.—The table of contents for this Act is as follows:Sec. 1. Short title; table of contents.
Sec. 2. Findings and purposes.
Sec. 3. Liberal construction.
Sec. 4. Prescribing and integration of medical cannabis.
Sec. 5. Insurance coverage requirements.
Sec. 6. Recognition of caregivers and home cooperatives as qualified medical providers.
Sec. 7. Research and standardization.
Sec. 8. Amendments to tax code.
Sec. 9. Effective date.SECTION 2. FINDINGS AND PURPOSES.Congress finds the following: (1) The rescheduling of cannabis to Schedule III under the Controlled Substances Act acknowledges its accepted medical use for conditions such as chronic pain, nausea, epilepsy, post-traumatic stress disorder, and other debilitating illnesses. (2) Patients, caregivers, and home cooperatives play vital roles in medical cannabis access, administration, and cultivation, but lack federal recognition and insurance eligibility hinders equitable healthcare delivery. (3) Treating medical cannabis as a standard prescription drug will improve patient outcomes, reduce financial barriers, and align with evidence-based medicine, particularly for underserved and rural populations. (4) Liberal construction of this Act is essential to promote broad access, comprehensive coverage, and integration without undue restrictions, ensuring maximum benefit for patients and providers. The purposes of this Act are to— (1) enable physicians and authorized providers to prescribe medical cannabis like other Schedule III substances; (2) mandate insurance coverage for medical cannabis prescriptions, including costs for caregivers and home cooperatives; (3) recognize caregivers and home cooperatives as qualified medical providers eligible for reimbursement and protections; and (4) facilitate research, standardization, and tax equity for medical cannabis users and providers.SECTION 3. LIBERAL CONSTRUCTION.This Act, and any regulations promulgated under it, shall be liberally construed to effectuate its purposes of ensuring broad access to medical cannabis, maximizing insurance coverage, and recognizing the full range of caregiving and cooperative services as integral to healthcare delivery. Any ambiguities shall be resolved in favor of patients, caregivers, cooperatives, and providers.SECTION 4. PRESCRIBING AND INTEGRATION OF MEDICAL CANNABIS.(a) AMENDMENT TO CONTROLLED SUBSTANCES ACT.—Section 303 of the Controlled Substances Act (21 U.S.C. 823) is amended by adding at the end the following: “(k) MEDICAL CANNABIS PRESCRIBING.— “(1) IN GENERAL.—Practitioners registered under this section may prescribe cannabis for medical use in the same manner as other Schedule III substances, including electronic prescribing under section 309. “(2) INTEGRATION INTO HEALTHCARE.—The Secretary of Health and Human Services, in consultation with the Administrator of the Drug Enforcement Administration, shall issue guidelines within 180 days of enactment to integrate medical cannabis into standard treatment protocols, including education on dosing, interactions, and evidence-based applications. Guidelines shall be liberally construed to facilitate access. “(3) STATE COMPLIANCE.—States shall align medical cannabis programs with federal prescribing standards, ensuring no undue restrictions on authorized providers.”. (b) FDA STANDARDIZATION.—The Commissioner of Food and Drugs shall, within 1 year of enactment, establish standards for medical cannabis products, including quality control, labeling, dosage forms, and caregiver/cooperative involvement, to facilitate prescribing and coverage. Standards shall prioritize patient access and be liberally applied.SECTION 5. INSURANCE COVERAGE REQUIREMENTS.(a) MEDICARE AND MEDICAID.— (1) Section 1860D-2(e) of the Social Security Act (42 U.S.C. 1395w-102(e)) is amended by adding at the end the following new paragraph: “(5) MEDICAL CANNABIS.—The term ‘covered part D drug’ includes medical cannabis prescribed for an accepted medical use, including costs associated with caregivers and home cooperatives as defined in section 6 of the Medical Cannabis Equity and Access Act of 2027. Coverage shall be liberally construed to include all related services.”. (2) Section 1905(a) of the Social Security Act (42 U.S.C. 1396d(a)) is amended by adding at the end the following new paragraph: “(31) medical cannabis prescribed for medical use, including services of caregivers and home cooperatives, with coverage liberally applied to ensure comprehensive reimbursement.”. (b) PRIVATE INSURANCE.—Section 2701 of the Public Health Service Act (42 U.S.C. 300gg) is amended by adding at the end the following: “(k) COVERAGE OF MEDICAL CANNABIS.—A group health plan or health insurance issuer offering group or individual health insurance coverage shall provide coverage for prescribed medical cannabis, including caregiver and cooperative services, on the same terms as other prescription drugs, without exclusions or higher cost-sharing. Coverage shall be liberally construed to maximize patient access.”. (c) ENFORCEMENT.—The Secretary of Health and Human Services shall enforce these requirements, with penalties for noncompliance up to $100,000 per violation. Waivers or exceptions shall be narrowly granted only upon clear demonstration of hardship, favoring coverage.SECTION 6. RECOGNITION OF CAREGIVERS AND HOME COOPERATIVES AS QUALIFIED MEDICAL PROVIDERS.(a) DEFINITIONS.—In this section: (1) CAREGIVER.—The term “caregiver” means an individual designated by a patient to assist with the acquisition, administration, cultivation, or other support for medical cannabis use, including family members or volunteers. (2) HOME COOPERATIVE.—The term “home cooperative” means a group of patients or caregivers sharing resources for the non-commercial production, processing, and distribution of medical cannabis for personal medical use, including shared cultivation sites. (b) RECOGNITION AND QUALIFICATIONS.— (1) FEDERAL RECOGNITION.—Caregivers and home cooperatives are recognized as qualified medical providers for purposes of federal health programs and insurance reimbursement when operating in compliance with state medical cannabis laws or federal guidelines. (2) INSURANCE ELIGIBILITY.—Services provided by caregivers and home cooperatives, including cultivation, processing, administration support, and education, shall be eligible for reimbursement under Medicare, Medicaid, and private insurance as prescribed medical services, with rates comparable to similar healthcare roles. (3) PROTECTIONS.—Caregivers and cooperatives shall receive the same legal protections as other medical providers, including liability limitations under the Federal Tort Claims Act, non-discrimination in licensing, and immunity from federal prosecution for compliant activities. (c) RULEMAKING.—The Secretary of Health and Human Services shall issue regulations within 180 days to define qualification standards, reimbursement rates, and integration protocols, liberally construing to maximize access and include diverse models (e.g., community-based or rural cooperatives).SECTION 7. RESEARCH AND STANDARDIZATION.(a) FUNDING.—The Director of the National Institutes of Health shall allocate at least $50,000,000 annually for research on medical cannabis efficacy, safety, dosing, interactions, and optimal use in caregiver/cooperative settings. Research shall prioritize underserved populations and be liberally funded to accelerate findings.(b) STANDARDIZATION.—The Food and Drug Administration shall develop national standards for medical cannabis products within 1 year, including testing, labeling, and distribution through cooperatives, ensuring accessibility without overly burdensome requirements.SECTION 8. AMENDMENTS TO TAX CODE.Section 280E of the Internal Revenue Code of 1986 is amended by adding at the end the following: “This section shall not apply to expenses related to medical cannabis prescribed or provided through caregivers or home cooperatives, including cultivation and administrative costs.” Deductions shall be liberally allowed to support equitable access.SECTION 9. EFFECTIVE DATE.This Act shall take effect 180 days after the date of enactment, with agencies directed to implement provisions as expeditiously as possible to minimize delays in access.
Learn More
- Medical Cannabis Equity and Access Act of 2027: A groundbreaking federal bill to treat medical cannabis like any other prescription drug, ensuring fair access for all Americans.
- Prescribing Like Schedule III Drugs: Doctors can now prescribe medical cannabis just like other controlled substances, with clear guidelines for dosing, safety, and integration into treatment plans—no more "recommendations" only.
- Mandatory Insurance Coverage: Requires Medicare, Medicaid, and private insurers to cover medical cannabis prescriptions, including costs for products, consultations, and related services, removing financial barriers for patients.
- Recognition of Caregivers and Home Cooperatives: Officially recognizes caregivers (family or volunteers) and home cooperatives (patient groups for non-commercial growing) as qualified medical providers, making their services eligible for insurance reimbursement.
- Boosts Research and Standards: Allocates $50 million annually for NIH research on cannabis efficacy and safety; FDA sets national standards for products to ensure quality and consistency.
- Tax Relief for Medical Use: Ends IRS Section 280E restrictions for medical cannabis expenses, allowing deductions for patients, caregivers, and cooperatives.
- Liberal Construction for Maximum Access: The bill mandates broad interpretation to prioritize patient needs, resolving ambiguities in favor of easier access and coverage.
- Effective 180 Days After Passage: Quick implementation to help patients sooner, building on recent rescheduling for real reform.
Medical Cannabis Reform Act
Full draft state level
- ACT Relating to the integration of medical cannabis into standard healthcare and insurance practices; amending RCW 69.51A.010, 69.51A.030, 48.43.005, and 48.43.715; adding new sections to chapter 69.51A RCW and chapter 48.43 RCW; creating new sections; and providing an effective date.
- BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:NEW SECTION. Sec. 1. (1) The legislature finds that: (a) Medical cannabis has been recognized for its therapeutic benefits, particularly following the federal rescheduling to Schedule III under the Controlled Substances Act, acknowledging its accepted medical use; (b) Patients in Washington rely on medical cannabis for conditions such as chronic pain, nausea, epilepsy, and post-traumatic stress disorder, yet barriers to access, including lack of insurance coverage and standardized prescribing, persist; (c) Caregivers and home cooperatives play essential roles in supporting patients, but lack formal recognition and insurance eligibility hinders their effectiveness; (d) Treating medical cannabis like other prescription drugs will improve patient outcomes, reduce costs, and align with evidence-based medicine. (2) This act shall be liberally construed to effectuate its purposes of ensuring equitable access, insurance coverage, and integration into healthcare systems.Sec. 2. RCW 69.51A.010 and 2015 2nd sp.s. c 4 s 201 are each amended to read as follows: The definitions in this section apply throughout this chapter unless the context clearly requires otherwise. (1) "Authorization" means a form developed by the department that is completed and signed by a qualifying patient's health care professional and printed on tamper-resistant paper. (2) "Cannabis" or "marijuana" means all parts of the plant Cannabis, whether growing or not, with a THC concentration greater than 0.3 percent on a dry weight basis; the seeds thereof; the resin extracted from any part of the plant; and every compound, manufacture, salt, derivative, mixture, or preparation of the plant, its seeds or resin. The term does not include: (a) The mature stalks of the plant, fiber produced from the stalks, oil or cake made from the seeds of the plant, any other compound, manufacture, salt, derivative, mixture, or preparation of the mature stalks (except the resin extracted therefrom), fiber, oil, or cake, or the sterilized seed of the plant which is incapable of germination; or (b) Industrial hemp as defined in RCW 15.140.020. (3) "Cannabis concentrates" means products consisting wholly or in part of the resin extracted from any part of the plant Cannabis and having a THC concentration greater than ten percent. (4) "Cannabis processor" means a person licensed by the board to process cannabis into cannabis concentrates, useable cannabis, and cannabis-infused products, package and label cannabis concentrates, useable cannabis, and cannabis-infused products for sale in retail outlets, and sell cannabis concentrates, useable cannabis, and cannabis-infused products at wholesale to cannabis retailers. (5) "Cannabis producer" means a person licensed by the board to produce and sell cannabis at wholesale to cannabis processors and other cannabis producers. (6) "Cannabis products" means useable cannabis, cannabis concentrates, and cannabis-infused products as defined in this section. (7) "Cannabis retailer" means a person licensed by the board to sell cannabis concentrates, useable cannabis, and cannabis-infused products in a retail outlet. (8) "Cannabis-infused products" means products that contain cannabis or cannabis extracts, are intended for human use, are derived from cannabis as defined in subsection (2) of this section, and have a THC concentration no greater than ten percent. The term "cannabis-infused products" does not include either useable cannabis or cannabis concentrates. (9) "Cooperative" means a group of qualifying patients or designated providers who share responsibility for acquiring and supplying the resources needed to produce and process cannabis for medical use of the members of the cooperative, such as a location for a collective garden; equipment, supplies, and labor necessary to plant, grow, and harvest cannabis plants; cannabis plants, seeds, and cuttings; and equipment, supplies, and labor necessary for proper construction, plumbing, wiring, and ventilation of a garden of cannabis plants. (10) "Designated provider" means a person who is twenty-one years of age or older and: (a)(i) Is the parent or guardian of a qualifying patient who is under the age of eighteen and holds a recognition card; or (ii) Has been designated in writing by a qualifying patient to serve as the designated provider for that patient; (b)(i) Has an authorization from the qualifying patient's health care professional; or (ii) Beginning July 1, 2016, has been entered into the medical cannabis authorization database as being the designated provider to a qualifying patient; and (c) Is prohibited from consuming cannabis obtained for the personal, medical use of the qualifying patient for whom the individual is acting as designated provider; and (d) Meets the requirements of RCW 69.51A.030(4); and (e) Is the designated provider to only one patient at any one time. (11) "Health care professional," for purposes of this chapter only, means a physician licensed under chapter 18.71 RCW, a physician assistant licensed under chapter 18.71A RCW, an osteopathic physician licensed under chapter 18.57 RCW, an ((osteopathic physician's assistant)) advanced practice registered nurse licensed under chapter 18.57A RCW, a naturopathic physician licensed under chapter 18.36A RCW, or an advanced registered nurse practitioner licensed under chapter 18.79 RCW. (12) "Housing unit" means a house, an apartment, a mobile home, a group of rooms, or a single room that is occupied as separate living quarters, or if vacant, is intended for occupancy as separate living quarters. Separate living quarters are those in which the occupants live and eat separately from any other persons in the building and which have direct access from the outside of the building or through a common hall. (13) "Low THC, high CBD" means products with less than 0.3 percent THC on a dry weight basis and at least forty times more cannabidiol than THC by weight. (14) "Medical use of cannabis" means the manufacture, production, possession, transportation, delivery, ingestion, application, or administration of cannabis to treat or alleviate a qualifying patient's symptoms, or to mitigate the side effects of the qualifying patient's medical treatments or terminal or debilitating medical condition. (15) "Plant" means a cannabis plant. (16) "Public place" has the same meaning as defined in RCW 66.04.010, but the exclusions in RCW 66.04.010 do not apply. (17) "Qualifying patient" means a person who: (a)(i) Is a patient of a health care professional; (ii) Has been diagnosed by that health care professional as having a terminal or debilitating medical condition; (iii) Is a resident of the state of Washington at the time of such diagnosis; (iv) Has been advised by that health care professional about the risks and benefits of the medical use of cannabis; (v) Has been advised by that health care professional that they may benefit from the medical use of cannabis; (vi)(A) Has an authorization from the patient's health care professional; or (B) Beginning July 1, 2016, has been entered into the medical cannabis authorization database and has been provided proof of registration; and (vii) Is otherwise in compliance with the terms and conditions established in this chapter; or (b) Is a person enrolled in a research program pursuant to section 6 of this act. (18) "Recognition card" means a card issued to qualifying patients and designated providers by a cannabis retailer with a medical cannabis endorsement that has entered the patient or provider into the medical cannabis authorization database. (19) "Retail outlet" means a location licensed by the board for the retail sale of cannabis concentrates, useable cannabis, and cannabis-infused products. (20) "Secretary" means the secretary of the department of health. (21) "Tamper-resistant paper" means paper that meets one or more of the following industry-recognized features: (a) One or more features designed to prevent copying of the paper; (b) One or more features designed to prevent the erasure or modification of information written on the paper; or (c) One or more features designed to prevent the use of counterfeit authorization. (22) "Terminal or debilitating medical condition" means a condition severe enough to significantly interfere with the patient's activities of daily living and ability to function, which can be objectively assessed and evaluated and limited to the following: (a) Cancer, human immunodeficiency virus (HIV), multiple sclerosis, epilepsy or other seizure disorder, or spasticity disorders; (b) Intractable pain, limited for the purpose of this chapter to mean pain unrelieved by standard medical treatments and medications; (c) Glaucoma, either acute or chronic, limited for the purpose of this chapter to mean increased intraocular pressure unrelieved by standard treatments and medications; (d) Crohn's disease with debilitating symptoms unrelieved by standard treatments or medications; (e) Hepatitis C with debilitating nausea or intractable pain unrelieved by standard treatments or medications; (f) Diseases, including anorexia, which result in nausea, vomiting, wasting, appetite loss, cramping, seizures, muscle spasms, or spasticity, when these symptoms are unrelieved by standard treatments or medications; (g) Posttraumatic stress disorder; or (h) Traumatic brain injury. (23) "THC concentration" means percent of tetrahydrocannabinol content per dry weight of any part of the plant Cannabis, or per volume or weight of cannabis product, or the combined percent of tetrahydrocannabinol and tetrahydrocannabinolic acid in any part of the plant Cannabis regardless of moisture content. (24) "Useable cannabis" means dried cannabis flowers. The term "useable cannabis" does not include either cannabis-infused products or cannabis concentrates. (25) "Youth access" means the ability of individuals under the age of twenty-one years to access cannabis, cannabis concentrates, useable cannabis, cannabis-infused products, or cannabis paraphernalia in a manner other than that provided in this chapter.Sec. 3. RCW 69.51A.030 and 2022 c 16 s 114 are each amended to read as follows: (1) This chapter may not be construed to require any health insurance provider to be liable for any claim for reimbursement for the medical use of cannabis. For the purposes of this section, "health insurance provider" has the same meaning as "health care carrier" or "carrier" as defined in RCW 48.43.005. (2) Unless otherwise specified, health care professionals may authorize the medical use of cannabis for qualifying patients who are under the age of eighteen if: (a) The minor and the minor's parent or legal guardian actively participate in the development and agree with the minor's medical treatment plan; (b) The parent or legal guardian acts as the minor's designated provider; (c) The minor, parent, or legal guardian complies with the requirements in the treatment plan; (d) The parent or legal guardian meets requirements for a designated provider under this chapter; (e) The authorizations are issued by two separate health care professionals if the initial authorizing health care professional is not the minor's primary care provider; and (f) The health care professional has assessed the minor at least quarterly, or more frequently as needed, to confirm the minor is responding to treatment. If the minor no longer benefits from the medical use of cannabis, the authorization must be revoked. (3) Qualifying patients who are under the age of eighteen with a recognition card may not purchase cannabis products from a cannabis retailer with a medical cannabis endorsement. The designated provider must purchase the cannabis products for a qualifying patient who is under the age of eighteen. (4) Notwithstanding any other provision of this chapter, qualifying patients under the age of eighteen may not participate in cooperatives authorized under RCW 69.51A.250. (5) A health care professional who authorizes the medical use of cannabis by a qualifying patient who is under the age of eighteen must comply with all requirements in this chapter that apply to the authorization of cannabis for medical use. (6) The board must adopt rules pertaining to products that are appropriate for qualifying patients who are under the age of eighteen. (7) Health care professionals may authorize the medical use of cannabis for qualifying patients who are under the age of eighteen in accordance with this chapter and in compliance with rules adopted by their disciplinary authority. Health care professionals must comply with the standard of care in their respective fields, including maintaining records of patient encounters and treatment plans.NEW SECTION. Sec. 4. A new section is added to chapter 69.51A RCW to read as follows: (1) Health care professionals shall treat medical cannabis as a standard prescription drug, including: (a) Issuing prescriptions rather than recommendations where permissible under federal law; (b) Integrating medical cannabis into patient treatment plans with the same documentation and follow-up as other controlled substances; (c) Providing education on dosing, interactions, and risks, consistent with evidence from research facilitated by federal rescheduling. (2) The department shall adopt rules to standardize prescribing protocols, ensuring liberal construction to promote patient access.NEW SECTION. Sec. 5. A new section is added to chapter 69.51A RCW to read as follows: (1) Designated providers (caregivers) and home cooperatives are recognized as essential components of the medical cannabis program and shall be eligible for insurance reimbursement for services related to patient care, including acquisition, administration, and cultivation support. (2) Insurance carriers must cover costs associated with designated providers and cooperatives, including supplies, labor, and facility expenses, when prescribed by a health care professional as part of a patient's treatment plan. (3) The insurance commissioner shall adopt rules to implement this section, ensuring liberal construction to qualify such services under standard health plans, subject to federal compliance.Sec. 6. RCW 48.43.005 and 2024 c 244 s 4 are each amended to read as follows: Unless otherwise specifically provided, the definitions in this section apply throughout this chapter. (1) "Adjusted community rate" means the rating method used to establish the premium for health plans adjusted to reflect actuarially demonstrated differences in utilization or cost attributable to geographic region, age, family size, and use of wellness activities. (2) "Adverse benefit determination" means a denial, reduction, or termination of, or a failure to provide or make payment, in whole or in part, for a benefit, including a denial, reduction, termination, or failure to provide or make payment that is based on a determination of a participant's or beneficiary's eligibility to participate in a plan, and including, with respect to group health plans, a denial, reduction, or termination of, or a failure to provide or make payment, in whole or in part, for, a benefit resulting from the application of any utilization review, as well as a failure to cover an item or service for which benefits are otherwise provided because it is determined to be experimental or investigational or not medically necessary or appropriate. (3) "Allowed amount" means the maximum portion of a billed charge a health carrier will pay, including any applicable enrollee cost-sharing responsibilities, for a covered health care service or item rendered by a participating provider or facility or by a nonparticipating provider or facility. (4) "Balance bill" means a bill sent to an enrollee by a nonparticipating provider or facility for health care services provided to the enrollee after the provider or facility's billed amount is not fully reimbursed by the carrier, exclusive of permitted cost-sharing. (5) "Behavioral health agency" means an agency licensed or certified under chapter 71.24 RCW. (6) "Carrier" or "health carrier" means a disability insurer regulated under chapter 48.20 or 48.21 RCW, a health care service contractor as defined in RCW 48.44.010, or a health maintenance organization as defined in RCW 48.46.020, and includes "issuers" as that term is used in the patient protection and affordable care act (P.L. 111-148). (7) "Covered health care service" means a health care service or item as defined in the health plan for which reimbursement is available under the enrollee's health plan contract or for which coverage is required under this title or other state or federal law. (8) "Covered person" or "enrollee" means a person covered by a health plan including an enrollee, subscriber, policyholder, beneficiary of a group plan, or individual covered by any other health plan. (9) "Emergency medical condition" means a medical, mental health, or substance use disorder condition manifesting itself by acute symptoms of sufficient severity including, but not limited to, severe pain or emotional distress, such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical, mental health, or substance use disorder treatment attention to result in a condition (a) placing the health of the individual, or with respect to a pregnant person, the health of the person or their unborn child, in serious jeopardy; (b) serious impairment to bodily functions; or (c) serious dysfunction of any bodily organ or part. (10) "Emergency services" means a medical screening examination that is within the capability of the emergency department of a hospital, including ancillary services routinely available to the emergency department to evaluate that emergency medical condition, and further medical examination and treatment to stabilize the patient to the extent they are within the capabilities of the staff and facilities available at the hospital. With respect to an emergency medical condition related to a behavioral health disorder, "emergency services" includes care coordination, triage, and facilitation of appropriate care transitions, regardless of setting. (11) "Enrollee point-of-service cost-sharing" or "cost-sharing" means amounts paid to health carriers directly providing services, health care providers, or health care facilities by enrollees and may include copayments, coinsurance, or deductibles. (12) "Essential community provider" has the same meaning as in 45 C.F.R. Sec. 156.235. (13) "Facility" means an institution providing health care services or a health care setting, including hospitals or other licensed inpatient centers; ambulatory surgical or treatment centers; skilled nursing centers; residential treatment centers; diagnostic, laboratory, and imaging centers; and rehabilitation and other therapeutic health settings. (14) "Grandfathered health plan" means a group health plan or an individual health plan that under section 1251 of the patient protection and affordable care act, P.L. 111-148 and implementing regulations, is not subject to subtitles A or C of Title I of the act as amended. (15) "Grievance" means a written complaint submitted by or on behalf of an enrollee regarding service delivery issues other than denial of payment for medical services or nonprovision of medical services, including dissatisfaction with medical care, waiting time for medical services, provider or staff attitude or demeanor, or dissatisfaction with service provided by the health carrier. (16) "Health care facility" or "facility" means hospices licensed under chapter 70.127 RCW, hospitals licensed under chapter 70.41 RCW, rural health care facilities as defined in RCW 70.175.020, psychiatric hospitals licensed under chapter 71.12 RCW, nursing homes licensed under chapter 18.51 RCW, community mental health centers licensed under chapter 71.24 RCW, kidney disease treatment centers licensed under chapter 70.41 RCW, ambulatory diagnostic, treatment, or surgical facilities licensed under chapter 70.41 RCW, drug and alcohol treatment facilities licensed under chapter 70.96A RCW, and home health agencies licensed under chapter 70.127 RCW, and includes such facilities if owned and operated by a political subdivision or instrumentality of the state and such other facilities as required by federal law and implementing regulations. (17) "Health care provider" or "provider" means: (a) A person regulated under Title 18 or chapter 70.127 RCW, to practice health or health-related services or otherwise practicing health care services in this state consistent with state law; or (b) An employee or agent of a person described in (a) of this subsection, acting in the course and scope of his or her employment. (18) "Health care service" means that service offered or provided by health care facilities and health care providers relating to the prevention, cure, or treatment of illness, injury, or disease. (19) "Health plan" or "health benefit plan" means any policy, contract, or agreement offered by a health carrier to provide, arrange, reimburse, or pay for health care services except the following: (a) Long-term care insurance governed by chapter 48.84 or 48.83 RCW; (b) Medicare supplemental health insurance governed by chapter 48.66 RCW; (c) Coverage supplemental to liability insurance; (d) Workers' compensation insurance; (e) Automobile medical payment insurance; (f) Insurance under which beneficiaries are payable without regard to fault and which is statutorily required to be contained in any liability insurance policy or equivalent self-insurance; (g) Property insurance, casualty insurance, or other insurance other than health insurance as defined in RCW 48.01.040 in which loss of time benefits are incidental; (h) Disability income insurance; and (i) Coverage for on-site medical clinics operated by an employer described in section 816 of the employee retirement income security act of 1974, as amended. (20) "In-network" or "participating" means a provider or facility that has contracted with a carrier or a carrier's contractor or subcontractor to provide health care services to enrollees and be reimbursed by the carrier at a contracted rate as payment in full for the health care services, including applicable cost-sharing obligations. (21) "Managed care plan" means a health plan that coordinates the provision of covered health care services to a covered person through the use of a primary care provider or a case management program. (22) "Medical cannabis" means cannabis products authorized for medical use under this title, treated as prescription drugs for purposes of prescribing, coverage, and regulation. (23) "Nonparticipating" means a provider or facility that has not contracted with a carrier or a carrier's contractor or subcontractor to provide health care services to enrollees. (24) "Out-of-pocket maximum" or "maximum out-of-pocket" means the maximum amount an enrollee is required to pay in the form of cost-sharing for covered benefits in a plan year, after which the carrier covers the entirety of the allowed amount of covered benefits costs for that year. (25) "Participating provider" and "participating facility" mean a provider or facility that is contracted with a health carrier or a health carrier's contractor or subcontractor to provide health care services to enrollees. (26) "Person" means an individual, a corporation, a partnership, an association, a joint venture, a joint stock company, a trust, an unincorporated organization, any similar entity, or any combination of the foregoing. (27) "Premium" means all sums charged, received, or deposited by a health carrier as consideration for a health plan or the continuance of a health plan. Any assessment, or any "membership," "policy," "contract," "endorsement," or "rider" fees or charges made as consideration for a health plan must be considered part of the premium. (28)(a) "Protected individual" means: (i) An individual who is enrolled in a health plan in which enrollment is restricted to individuals who qualify as protected individuals under a certificate of creditable coverage issued by the carrier; or (ii) An individual who is eligible for and elects continuation coverage under RCW 48.21.250, 48.44.460, or 48.46.535. (b) For a grandfathered individual health plan sold or renewed on or after January 1, 2014, "protected individual" also includes individuals enrolled in the plan who have one or more of the following risk factors: (i) The individual has had a significant break in creditable coverage but had coverage under a group health plan or health insurance coverage that covered a large number of individuals before the break in coverage; (ii) The individual has reached a lifetime limit on the payment of benefits (whether or not the limit is allowed under this chapter) under all health care services or health insurance plans that covered large numbers of people in which the individual was previously enrolled; (iii) The individual is ineligible for group coverage available through an employment relationship, association membership, or other group that would otherwise be available to individuals with similar medical conditions or risk factors; (iv) The individual's cost for coverage under available group health plans would be at least fifteen percent more than the cost paid by an individual with no health status-related factors or medical conditions; or (v) The individual has a medical condition that, absent health coverage, could reasonably be expected to require medical care costing in excess of three percent of the individual's annual income. (29) "Service area" means the geographic area served by a health plan. (30) "Small group plan" means a health plan issued to a small employer as defined under RCW 48.43.005(34) comprising from one to fifty eligible employees. (31) "Utilization review" means the prospective, concurrent, or retrospective assessment of the necessity and appropriateness of the allocation of health care resources and services of a provider or facility, given or proposed to be given to an enrollee or group of enrollees.Sec. 7. RCW 48.43.715 and 2019 c 33 s 3 are each amended to read as follows: (1) A health carrier offering a health plan may not deny enrollment to an eligible individual based on the individual's medical history or risk factors if the plan is a grandfathered individual health plan or if the individual is a protected individual. (2) A health carrier offering a health plan may not cancel or nonrenew an individual's enrollment in a health plan based solely on the individual's medical history or risk factors if the plan is a grandfathered individual health plan or if the individual is a protected individual. (3) A health carrier offering a health plan may not deny coverage for a health care service or item that is otherwise covered under the health plan based solely on the individual's medical history or risk factors if the plan is a grandfathered individual health plan or if the individual is a protected individual. (4) For medical cannabis authorized under chapter 69.51A RCW, health carriers must provide coverage equivalent to other prescription drugs, including reimbursement for consultations, products, and related services such as caregivers and cooperatives. (5) The insurance commissioner shall adopt rules to implement this section, ensuring liberal construction to promote access and coverage.NEW SECTION. Sec. 8. The insurance commissioner and department of health shall adopt rules as necessary to implement this act by December 1, 2026.NEW SECTION. Sec. 9. This act takes effect July 1, 2026.
