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)
Became Law
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Bill Overview
Analyzed Economic Effects
8 provisions identified: 7 benefits, 0 costs, 1 mixed.
Clear prior authorization rules and 120‑day notice
Plans must post prior authorization rules and clinical criteria online in plain language. A plan cannot use a new rule until it updates its website. Contracted providers must get written notice at least 120 days before a new or changed rule starts. This begins January 1, 2026.
Faster prior authorization decisions and auto-approval
For urgent care, the reviewer must decide within 72 hours after getting all needed information. For nonurgent care, the reviewer must decide within seven calendar days after it has all information. You and your provider have 14 business days after a nonurgent event or service to notify the reviewer. If the reviewer misses a required deadline or rule, the services are treated as approved. These rules start January 1, 2026.
Keep care when plans or rules change
When you start a new plan, it must honor your old plan’s prior authorization for at least 60 days. The new plan can review it during those 60 days. If your plan changes approval rules mid‑year, authorizations you already received stay valid for the rest of your plan year. Exception: drugs or devices deemed unsafe by the FDA or withdrawn by the maker. Plans must also honor authorizations if you switch products within the same insurer. These protections start January 1, 2026.
Longer approvals and fewer surprise reversals
A prior authorization stays valid for six months from the date your provider got it. For chronic or long‑term care, it lasts 12 months. If care happens within 45 business days after your provider got the authorization, the plan cannot revoke or limit it unless there is evidence of fraud. These protections start January 1, 2026.
No prior authorization for emergency care
Plans cannot require prior authorization for ambulance transport or emergency services. You or your provider must notify the reviewer within two business days after an emergency admission. If your provider certifies within 72 hours that it was an emergency, the care is presumed medically necessary unless clear and convincing evidence shows otherwise. Decisions cannot depend on whether the provider is in‑network or out‑of‑network. If post‑stabilization care needs approval, the reviewer must decide in two business days or it is approved. These rules start January 1, 2026.
No prior authorization for opioid treatment medications
Plans cannot require prior authorization for medication‑assisted treatment for opioid use disorder. This removes a paperwork barrier to starting or continuing these medicines. This rule starts January 1, 2026.
Stronger review and appeal protections
A licensed doctor, dentist, or pharmacist in the same or a similar specialty must review denials under a medical director. On appeal, an independent doctor or dentist with a valid license and at least five years of active practice in a similar specialty must review. Drug appeals go to a qualified pharmacist or doctor. Before a denial, your doctor must be allowed to discuss the case by phone. You and your doctor can appeal, see the information used, and give evidence. Your coverage continues during the appeal. If a denial is reversed and a different company pays claims, the reviewer must notify the claims administrator. These protections start January 1, 2026.
Study of public employee plan authorizations
During 2025–26, lawmakers study prior authorization rules in public employee group plans and their impact on care and costs. Insurers must send prior‑year data by July 1, 2025. The insurance commissioner reports by November 1, 2025. Results go to the 70th Legislative Assembly. The law takes effect January 1, 2026.
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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