Bifurcated

Washington No Surprises Act & IDR Rules

Last verified: July 2026 · For informational purposes only, not legal advice

Quick answer: Washington is a bifurcated state. Some disputes are governed by Washington's own specified state law, while others default to the federal No Surprises Act IDR process depending on the plan type and service involved.

How it works

Washington's specified state law applies to emergency services up to stabilization (including behavioral health emergency services) and non-emergency services by out-of-network providers at in-network facilities. The federal IDR process applies mainly to air ambulance services. Washington is also one of six states that allows self-funded ERISA plans to voluntarily opt into the state process.

Key dates

Federal No Surprises Act protections took effect January 1, 2022. State-specific protections vary — check the official source below for exact effective dates in this state.

Official source: Centers for Medicare & Medicaid Services — Washington enforcement letter and specified state law documentation (cms.gov/nosurprises)

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