Bill > SB2280

This bill establishes comprehensive regulations for prior authorization in health insurance, creating a new chapter in North Dakota law that defines key terms and sets standards for how health insurers review and approve medical services. The bill requires prior authorization review organizations to make their requirements transparent by publishing detailed clinical criteria online, ensure that adverse determinations and appeals are reviewed by licensed physicians or pharmacists with relevant medical expertise, and establish specific timelines for reviewing medical service requests. For non-urgent services, insurers must make decisions within seven calendar days, while urgent services must be reviewed within 72 hours. The bill prohibits prior authorization for emergency medical services and medication-assisted treatment for opioid use disorder, and mandates that approved prior authorizations remain valid for at least six months. Additionally, the bill requires insurers to submit annual reports to the insurance commissioner detailing their prior authorization request statistics and includes provisions for legislative management studies on prior authorization requirements and electronic health record submissions. The studies will examine the impact of prior authorization on patient care and healthcare costs, with findings to be reported to the 70th legislative assembly. The act is set to become effective on January 1, 2026.

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https://ndlegis.gov/assembly/69-2025/regular/bill-overview/bo2280.html