Washington hospitals must meet the federal machine-readable file (MRF) requirement under 45 CFR 180.50 — and Washington layers its own rules on top: Washington State's hospital transparency rules (RCW 70. With ~95 hospitals in the state, CMS's 2026 AI-enabled audit ramp means non-compliant files in Washington are more likely than ever to convert a warning letter into a $5,500/day fine.
Washington adds a state-level standard-charge posting requirement on top of the federal MRF; dual-compliance means two separate audit tracks for every hospital.
Federal baseline: 45 CFR Part 180 still applies to every Washington hospital regardless of state rules. Missing either track is an exposure.
| Hospitals in Washington | ~95 |
| State law | WA RCW 70.41.210 — Hospital Pricing Transparency |
| Federal exposure | $5,500/day per violation under 45 CFR 180.50 |
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