All Roll Calls
Yes: 179 • No: 7
North DakotaSB 22802025 Regular SessionSenateWALLET
AN ACT to create and enact chapter 26.1-36.12 of the North Dakota Century Code, relating to prior authorization for health insurance; to provide for a legislative management study; to provide for a legislative management report; and to provide an effective date.
Sponsored By: Scott Meyer (Republican)
Signed by Governor
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Bill Overview
Analyzed Economic Effects
6 provisions identified: 5 benefits, 0 costs, 1 mixed.
Emergency patients need no advance approval
Beginning January 1, 2026, covered North Dakota plans cannot require advance approval for prehospital transport or emergency care. An emergency means symptoms a reasonable person would expect to seriously threaten health or bodily function without care. Reviewers must allow at least 2 business days for notice after emergency admission or services. They cannot base medical necessity or appropriateness on whether the provider is in the plan's network. Requests for immediate services after evaluation or stabilization must be decided within 2 business days or are automatically approved. Medicaid and the Public Employees Retirement System uniform group insurance program are excluded.
Longer approvals protect patients' ongoing care
Beginning January 1, 2026, covered North Dakota plans must keep approvals valid at least 6 months after providers receive them. Approvals for chronic or long-term conditions must last at least 12 months. Reviewers cannot revoke, limit, condition, or restrict approval for care provided within 45 business days after the provider receives approval, except for fraud. A new plan must honor documented existing approval for at least the first 60 days if it covers the service. Patients or providers must submit records through the new plan's procedures. Approval must also be honored when switching products within one insurer, if the new policy covers the service. Midyear coverage or approval-rule changes cannot affect already-approved patients for the rest of that plan year. The coverage-term protection excludes drugs or devices deemed unsafe by the FDA or withdrawn by the FDA or manufacturer. Medicaid and the Public Employees Retirement System uniform group insurance program are excluded.
Opioid treatment needs no advance approval
Beginning January 1, 2026, covered North Dakota plans cannot require prior approval for medication-assisted treatment for opioid use disorder. This treatment combines FDA-approved medicines with counseling and behavioral therapies. Medicaid and the Public Employees Retirement System uniform group insurance program are excluded.
Faster health approval decisions for patients
Beginning January 1, 2026, covered North Dakota plans must decide routine requests within 7 calendar days and urgent requests within 72 hours. Both deadlines start after reviewers receive all needed information, including any required exam or second opinion. Reviewers must notify the patient and provider. Urgency requires a health professional familiar with the patient to find that waiting risks health, recovery, or adequate pain control. Services are automatically authorized if reviewers miss a deadline or another legal requirement. Reviewers may deny requests if necessary information is not supplied within 14 calendar days after a written request. Patients or providers get at least 14 business days to request updated approval after unforeseen changes in nonurgent care needs. Medicaid and the Public Employees Retirement System uniform group insurance program are excluded.
Clearer health approval rules for patients
Beginning January 1, 2026, covered North Dakota plans' review organizations must post approval requirements, restrictions, and clinical criteria online. The information must be detailed, in plain language, and accessible to patients, providers, and the public. Reviewers must update the website before implementing new or changed requirements or restrictions. Contracted providers must receive at least 60 days' written notice before those changes. Medicaid and the Public Employees Retirement System uniform group insurance program are excluded.
Patients gain stronger health denial appeals
Beginning January 1, 2026, covered North Dakota plans must offer written appeal procedures to patients and their attending providers. Patients can review information used, present evidence and testimony, and receive continued coverage while an appeal is pending. Initial denials must come from a licensed doctor or pharmacist experienced with the condition, under a medical director's clinical direction. Most appeals require a different doctor with an unrestricted license and at least 5 consecutive years practicing a related specialty. Reviewers must know the services involved and consider relevant clinical information, records, and medical literature provided. Drug appeals may use a qualified doctor or pharmacist. Appeal reviewers cannot receive incentives based on denial counts, except for incentives established between health plans and providers. The appeal-reviewer rule excludes reviews under North Dakota Century Code sections 26.1-36-44 and 26.1-36-46. Separate review organizations must tell claims administrators when an appeal reverses a denial. Medicaid and the Public Employees Retirement System uniform group insurance program are excluded.
Sponsors & Cosponsors
Sponsor
Scott Meyer
Republican • Senate
Cosponsors
Jon O. Nelson
Republican • House
Jonathan Warrey
Republican • House
Jeff Barta
Republican • Senate
Brad Bekkedahl
Republican • Senate
Sean Cleary
Republican • Senate
Roll Call Votes
Senate vote • 4/15/2025
Second reading, passed, yeas 43 nays 3
Yes: 43 • No: 3
House vote • 4/8/2025
Second reading, passed as amended, yeas 93 nays 0
Yes: 93 • No: 0
Senate vote • 2/19/2025
Second reading, passed, yeas 43 nays 4
Yes: 43 • No: 4
Actions Timeline
Filed with Secretary Of State 04/22
4/24/2025HouseSigned by Governor 04/21
4/23/2025SenateSent to Governor
4/18/2025SenateSigned by President
4/18/2025SenateSigned by Speaker
4/18/2025HouseSecond reading, passed, yeas 43 nays 3
4/15/2025SenateConcurred
4/15/2025SenateReturned to Senate (12)
4/9/2025SenateSecond reading, passed as amended, yeas 93 nays 0
4/8/2025HouseAmendment adopted, placed on calendar
4/3/2025HouseReported back amended, do pass, amendment placed on calendar 10 0 4
4/1/2025HouseCommittee Hearing 09:45
3/24/2025HouseCommittee Hearing 02:30
3/17/2025HouseIntroduced, first reading, referred Industry, Business and Labor Committee
2/21/2025HouseReceived from Senate
2/20/2025HouseSecond reading, passed, yeas 43 nays 4
2/19/2025SenateAmendment adopted, placed on calendar
2/17/2025SenateReported back amended, do pass, amendment placed on calendar 5 0 0
2/14/2025SenateCommittee Hearing 02:30
2/5/2025SenateIntroduced, first reading, referred Industry and Business Committee
1/20/2025Senate
Bill Text
Adopted by the House Industry, Business and Labor Committee
Adopted by the Senate Industry and Business Committee
Enrollment
FIRST ENGROSSMENT
FIRST ENGROSSMENT with House Amendments
INTRODUCED
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