ESHB 1430
In CommitteeHouse
APRN & PA reimbursement
Concerning advanced practice registered nurse and physician assistant reimbursement.
This status may be delayed. See Action History below for the latest updates.
How does a bill become law?
- Introduced: The bill is filed and assigned a number.
- Committee: A subject-matter committee holds hearings, takes public testimony, and decides whether to advance the bill.
- Floor Vote: The full chamber (House or Senate) debates and votes on the bill.
- Opposite Chamber: The bill repeats the committee and floor vote process in the other chamber.
- Governor: The Governor reviews the bill and decides whether to sign or veto it.
- Signed: The bill has been signed into law.
AI Analysis
This bill requires health insurance companies to pay advanced practice registered nurses (APRNs) and physician assistants (PAs) the same amount as physicians for the same services, aiming to support provider availability—especially in rural and underserved areas—by improving compensation. It also bans insurers from cutting physician payments *just* to fund the higher APRN/PA rates and mandates data reporting on the law’s impact.
- Requires health carriers (insurance companies) to pay APRNs and PAs the same amount as physicians for the same services, starting with health plans issued or renewed on or after January 1, 2026.
- Prohibits health carriers from reducing physician reimbursement rates *solely* to fund increased payments to APRNs and PAs.
- Requires the Office of the Insurance Commissioner to collect and report data to the legislature by July 1, 2027, including how many providers saw rate changes and what costs insurers incurred.
- Excludes APRNs and PAs who are direct employees of health maintenance organizations (HMOs) from the equal-reimbursement requirement.
Who is affected
- Advanced practice registered nurses (APRNs) and physician assistants (PAs) — Advanced practice registered nurses (APRNs) and physician assistants (PAs) who provide covered services may see increased reimbursement rates to match physician rates for the same services, improving their compensation and potentially supporting retention and recruitment in underserved areas.
- Physicians — Physicians may face reduced reimbursement rates in some cases to offset the increased payments to APRNs and PAs, though the bill prohibits reducing physician rates solely to comply with this requirement—meaning any reduction would need to be part of broader rate adjustments unrelated to this law.
- Health insurance companies (health carriers) — Health insurance companies (health carriers) must adjust their payment schedules to ensure equal reimbursement for the same services regardless of provider type, and must report implementation data to the state.
- Residents of rural and underserved communities — Residents in rural and underserved areas may benefit from improved access to care, as higher reimbursement for APRNs and PAs could encourage more providers to work in these areas.
Pro/Con Analysis
Stronger case for benefits
Potential Benefits (5)
Equalizing reimbursement for APRNs and PAs with physicians is likely to increase their income—particularly in rural and underserved areas where these providers already constitute a larger share of the workforce—potentially improving retention, recruitment, and continuity of care for vulnerable populations. APRNs and PAs are disproportionately women and people of color, and many work in community health centers and rural clinics; higher pay may help address long-standing pay inequities in the health workforce.
HealthcarePeopleRef: Sec. 2(1)By improving compensation for APRNs and PAs, the bill may expand access to care in areas with provider shortages—especially in Eastern Washington and rural counties—where physician recruitment is difficult. APRNs and PAs often fill critical gaps in primary care, behavioral health, and chronic disease management, and higher pay could encourage more to work in these underserved settings.
HealthcarePeopleRef: Sec. 2(1)The data collection and reporting requirement creates transparency around reimbursement practices and provider compensation, enabling future policymakers and researchers to assess whether the policy achieves its goals and whether unintended consequences (e.g., reduced physician participation) emerge. This evidence base is critical for informed policy adjustments.
HealthcarePeopleRef: Sec. 2(3)The prohibition on reducing physician reimbursement *solely* to fund APRN/PA increases protects against zero-sum shifts in provider compensation and preserves physician participation in insurance networks—helping maintain continuity of care and preventing provider flight, especially among specialists who already face reimbursement pressures.
HealthcarePeopleRef: Sec. 2(2)By aligning reimbursement rates, the bill supports the full scope of practice for APRNs and PAs—allowing them to provide high-quality, cost-effective care without financial disincentives—potentially lowering overall system costs through more efficient care delivery, especially for preventive and chronic disease management.
HealthcarePeopleRef: Sec. 2(1)
Potential Concerns (5)
The requirement to pay APRNs and PAs equal reimbursement to physicians for identical services may increase health plan costs, which could be passed through to consumers in the form of higher premiums, deductibles, or out-of-pocket costs—especially for employer-sponsored and individual-market plans. While the bill prohibits insurers from cutting physician rates *solely* to fund the increase, broader rate restructuring could still occur, and insurers may adjust overall pricing to offset the new liability.
HealthcarePeopleRef: Sec. 2(1)The exclusion of APRNs and PAs who are direct employees of HMOs from the equal-reimbursement requirement creates a two-tiered system: those in HMOs (often large, integrated systems like Kaiser) are left out, while those in fee-for-service or independent practice arrangements benefit. This undermines the bill’s stated goal of improving access and equity across care delivery models and may reduce the policy’s overall impact on provider availability in HMO-dominated markets.
HealthcarePeopleRef: Sec. 2(4)The data reporting mandate places administrative burden on health carriers, which may pass some costs to providers or insurers—but the state’s Office of the Insurance Commissioner will also incur costs to collect, analyze, and report on the data. While not a large fiscal impact, this diverts state resources toward monitoring a policy whose long-term effectiveness remains unproven.
Local GovernmentLean peopleRef: Sec. 2(3)While the bill prohibits reducing physician reimbursement *solely* to fund APRN/PA increases, it does not prevent broader reimbursement reductions that *include* physician cuts as part of a larger cost-containment strategy. Insurers or employers may use this as cover to reduce physician payments more broadly under the guise of “value-based” or “efficiency” adjustments, indirectly harming physician incomes and potentially discouraging participation in insurance networks.
HealthcareLean peopleRef: Sec. 2(2)The policy may incentivize health systems to shift service delivery toward APRNs and PAs—potentially at the expense of physician availability—especially in high-cost urban areas where salaries and overhead are already high. This could fragment care, reduce continuity, and increase patient confusion, especially for complex or chronic conditions requiring coordinated physician oversight.
HealthcareLean peopleRef: Sec. 2(1)
Who Is Most Affected
APRNs and PAs—especially those in rural clinics, community health centers, and independent practices—are likely to see meaningful income gains, particularly if they were previously underpaid relative to physicians. This may improve workforce stability and attract more to high-need areas.
Physicians—especially primary care and specialists in private practice—may face indirect pressure if insurers adjust overall payment structures, though the explicit ban on rate cuts *solely* to fund APRN/PA increases offers some protection. HMO-employed physicians are less affected due to the HMO exclusion.
Health insurers will face administrative and potential reimbursement-cost burdens, but the impact may be modest since the law only applies to new/renewed plans after 2026 and excludes HMO employees. Some insurers may already reimburse APRNs and PAs at or near physician rates, limiting net change.
Rural and low-income residents—particularly in Eastern WA and tribal communities—may benefit from improved access to care if more APRNs/PAs enter or remain in underserved areas. However, if physician participation declines, access to specialists could suffer.
Employers and consumers in the individual and small-group insurance markets may face modest premium increases if insurers pass on higher provider reimbursement costs, though the fiscal impact is likely small given the delayed implementation and data-driven oversight.