68th Legislative Assembly in Action
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Weekly Update: 2023
QUICK LINK REFERENCE
April 29
It's a Wrap!
In the race to the finish line, lawmakers spent a number of late - or early hours - working the final bills. The session officially ended on Sunday morning with a few minutes to spare before the 3:00 a.m. hour.
Legislators met for a total of 75 days, leaving 5 days in reserve. The reserve days can be put to use to reconvene at a later date should any issue arise that needs legislative attention.
Legislators approved a record $19.6 billion two-year budget and managed to vet 990 bills. From this total, NDMA tracked 177 bills and five resolutions. From this list, 125 bills passed and 57 failed. It's important to know that there are times when a failed bill is a success, as this session produced a stream of aggressive bills that were not health-care friendly.
For NDMA, the last week of the session focused on the two priority bills:
Success
Medicaid & Medicaid Expansion
Passed: Senate 35-11, House 60-32
SB 2012 - a budget bill for the North Dakota Department of Health and Human Services proved to keep NDMA and the ND Hospital Association on its toes. The budget impacts Medicaid and Medicaid Expansion payment rates among other funding priorities.
For North Dakota physicians and health care facilities, the Medicaid and Medicaid Expansion payment rates are important to keep health care providers and facilities operating without needing to absorb a loss.
When it comes to Medicaid Expansion payment reimbursements, it's important to keep in mind that 90% of the funds are federal funds. To receive the federal dollars, the state needs to come up with a 10% match. This means that for every nine dollars North Dakota accepts in federal funds, North Dakota needs to come up with the final dollar.
Here is how the bill tracked through the legislative process: The Senate passed the bill without any cuts. However, when the bill crossed over and was vetted by the House, the House Appropriations reduced Medicaid Expansion payments from 160% of Medicaid rates to a drastic drop of 125%.
This proposal would have saved the state $17 million but would have resulted in a substantial over-all loss of $171 million for health care providers across the state - a huge financial loss for health care.
Since the Senate did not concur with the House's choice, a conference committee was appointed from members of both the Senate and House. This committee worked long hours batting proposals back and forth. Eventually a settlement was reached. Here is the outcome:
- Medicaid Expansion reimbursement will be reduced from 160% of Medicare rates to 145%. This will take effect beginning January 2025.
- This overall impact to providers is $29 million.
Another factor besides the reimbursement percentage for Medicaid Expansion is the inflation adjustment rate for Medicaid. Inflators adjust fee schedules each year to compensate for the effects of inflation, which is adjusted July 1 of each year. Here is how the inflator fees settled:
- Physicians and other medical providers: PASSED with a 3% inflator increase for each year.
- Hospitals (Prospective Payment Systems): PASSED with no increase for the first year; and 2% for the second year.
Overall, this compromise is considered a success. Thanks to all NDMA members who reached out and contacted legislators to preserve physician reimbursement.
UND School of Medicine & Health Sciences Budget Passed: house 69-23, Sente 45-2
HB 1003 - is the UND School of Medicine budget bill. NDMA supports the UND School of Medicine budget, including adjustments made for the challenge grants. Here is how the budget settled:
- Successfully passed a needs-based budget in the higher education budget.
Challenge Grants
- UND SMHS was awarded $2.2 million in Challenge grant opportunities.
- Challenge grants require matching funds 2 to 1 from state educational institutions. This is a big win.
April 24 - 28
If you listen close, you can hear the clock ticking. At the close of Thursday, legislators will have completed 73 days of the 80-day limit. This leaves legislators with 7 gavel-in days to complete the rest of the work. Some heavy budget bills are still pending.
The intent of finishing prior to the 80-day deadline is to preserve some time to be used later, should an issue arise that needs legislator attention.
One pending issue is SB 2012 - This bill impacts Medicaid and Medicaid Expansion funding and will determine how much health care facilities and physicians will be reimbursed to provide service to this sector of the population. It has been an arduous process. The House wants to cut payments, while the Senate is choosing to hold the line and keep payments at the existing rates.
Success
Parental Consent for Medical Treatment
Failed House 39-51.
SB 2260 is a parental rights bill that relates to parental involvement in education, and parental right to consent to medical treatment of the parent's child. This bill would require written consent from the parent or guardian prior to providing a child with any medical care.
NDMA opposed this bill for these reasons:
Under long-standing policies and procedures, all hospitals, clinics and physicians obtain consent from the parent when treating a minor. However, the consent is not always written. Many times, the parent is not the person bringing the child to the appointment.
The bill in its original form stated that a physician would need a written consent form from a parent before examining a child, or prescribing medication to a child, even though the parent brought the child to the appointment or was picking up the prescription for the child. This was an unnecessary additional requirement in an environment that is already highly regulated and monitored.
Here is how the bill tracked through the legislative process: the bill PASSED through the Senate 40-6; when it reached the House, NDMA, along with champion legislators, successfully removed references to "medical consent". In addition, more modifications were made to the bill as it pertained to the education sector. The amendment was adopted, however, when the bill was voted on the House floor, the bill FAILED 39-51.
April 17 - 21
Time is quickly moving along and at the close of Thursday, legislators will have completed 68 days of the 80-day limit. If you are doing the math, that leaves legislators with 12 days to complete the rest of the work. Typically, legislators prefer to hold back some of the 80 day maximum, pending it is necessary for legislators to organize at a later date to tend to more business. RUMOR HAS IT that the assembly is targeting to finish up with the session at the end of next week.
This week, Legislators chose to not gavel in on Tuesday. When the assembly chooses to not gavel in, the committee work continues, but the day does not count toward the 80-day limit. It's a way to strategically get to the end of the session with reserved days.
Success
Patient Choice or Any Willing Provider
Governor's veto overridden.
HB 1416 Freedom of Choice for Health Care, or otherwise known as the Patient Choice bill took an interesting turn of events. The bill received a GOVERNOR'S VETO on Friday, April 14. When a bill is vetoed, it is returned to the chambers to once again be voted on by the assembly. A governor's veto can be overridden with a 2/3 vote by both chambers. The bill officially overcame the veto on Thursday when the Senate voted 36 yeas and 11 nays. This means the bill now becomes law on August 1.
HB 1416 provides for patients to choose a health care provider outside of network, pending the provider is willing and fully qualified to meet the terms and conditions of participation, as established by the health insurer. Here is the status of how the bill worked its way through the session:
PASSED HOUSE 84-9. PASSED SENATE 27-20. CONCURRED AND PASSED HOUSE 89-3. Governor vetoed 4/13. House consideration of veto; passed over veto (yeas 90, nays 0); Senate consideration of veto; passed over veto (yeas 36, nays 11). Law becomes effective August 1.
Challenges
Criminalization of Transgender
In early April HB 1254 - a bill that criminalizes physicians for science-based transgender care to minors was passed. Advocates continued to reach out to the governor asking for a veto. Unfortunately, the governor chose to sign the bill on April 19. This bill was passed with an emergency clause, which means it goes into effective immediately.
NDMA opposes bills that criminalize physicians for providing patient care using highly researched and approved standard practices. HB 1254 was opposed by NDMA since the bill makes it a Class B felony for physicians to treat a minor with surgery and a misdemeanor for medication treatment.
The bill does contain a grandfather clause that states minors already undergoing gender-affirming care are allowed to continue treatment.
Abortion Law Fix
Officially passed both chambers.
SB 2150 Abortion Law Fix - many advocates worked tirelessly to fix North Dakota's abortion law that did not allow for adequate exemptions to protect the health and life of the pregnant woman. Although not optimal, the bill does make it palatable to provide health care when it comes to serious issues that arise during a pregnancy. In addition, the affirmative defense stipulations on physicians are removed. NDMA considers these gains a big win for health care. Here is the status of the bill:
PASSED SENATE 43-4. PASSED HOUSE with Amendments 76-14. CONCURRED AND PASSED SENATE 42-5. Emergency clause carried, meaning the law becomes effective upon Governor’s signature.
It's important to know that NDMA will be closely monitoring how SB 2150 is impacted by the State Supreme Court ruling Wrigley v. Romanick et al.
April 10 - 14
Time is quickly moving along and at the close of Thursday, legislators will have completed 65 days of the 80-day limit. Legislators chose to not gavel in on Friday, so upon gaveling in on Monday, it will be the 66th day of session. Here is a summary of this week's activity:
Success
Truth in Advertising
Signed by Governor on April 10 - bill officially becomes law August 1.
HB 1221 Truth in Advertising: Otherwise known as the Health Care Transparency Act, this bill is an important issue to NDMA members to ensure patients are aware of what kind of health care professional is providing their care. The Truth in Advertising policy requires clear statements on health care providers’ educational background, training, and licensing credentials through communication mediums such as advertising and name badges. This bill was submitted by NDMA.
Prior Authorization
Signed by Governor on April 10 - bill officially becomes law August 1.
SB 2389 Prior Authorization: North Dakota does not have a prior authorization law in place and NDMA supports efforts to reduce prior authorization restrictions when it comes to prescribing medical procedures and prescription drugs.
NDMA worked with partners to develop parameters, including time limits for responding to prior authorization requests. In the Senate, this bill was vigorously opposed by the payors. Payors claimed that they had no prior authorization complaints. The Senate amended the bill to a study, which passed the Senate. The bill passed the House with 88 yeas and 3 nays.
The next step is to lobby to get the bill selected for a study. The selection process typically begins in June.
Vaccines
SB 2274 This bill would have prohibited all vaccine requirements for health care facilities. Fortunately, the bill was successfully amended to be similar to HB 1200 which exempts health care facilities from the bill; furthermore, the vaccines were amended to include only Covid 19 vaccines and Emergency Use Authorized drugs. Another amendment in the House removed the sunset clause, which means it will remain permanently in the law (North Dakota Century Code).
The bill passed the House with 87 yeas and 3 nays; it made its way back to the Senate for concurrence, and was concurred by the Senate with 29 yeas and 17 nays.
NDMA considers this bill a success. Although we were not able to kill the bill, we successfully lobbied legislators to remove the most harmful aspects of the bill. It's a negotiated win for sure.
April 3 - 7
Time is quickly moving along and at the close of today, legislators will have completed 61 days of the 80-day limit. Here is a summary of this week's activity:
Success
Truth in Advertising
Concurred on April 3
HB 1221 Truth in Advertising: Otherwise known as the Health Care Transparency Act, this bill is an important issue to NDMA members to ensure patients are aware of what kind of health care professional is providing their care. The Truth in Advertising policy requires clear statements on health care providers’ educational background, training, and licensing credentials through communication mediums such as advertising and name badges. This bill was submitted by NDMA.
This bill successfully passed both chambers, but since some minor house-keeping amendments were made in the Senate the bill went back to the House to concur - or otherwise agree with - the amendments. The House voted to accept the amendments by voting 68 yeas, and 21 nays.
The next step is to have the bill move onto the Governor's office for a final signature. Once signed, the bill becomes law on August 1.
Freedom of Choice
Concurred on April 6
HB 1416 Freedom of Choice for Health Care: This bill is about having the freedom of choice for health care services. It provides for patients to choose a health care provider, pending the provider is willing and fully qualified to meet the terms and conditions of participation, as established by the health insurer.
An amendment made by the Senate limits the option to an integrated delivery network, which means it applies only to a system of health care providers and facilities that offer both health care services and health benefit plans.
This bill successfully passed the Senate floor with the amendment with 27 yeas and 20 nays. The bill was returned to the House for concurrence. The House concurred with 89 yeas and 3 nays.
Vaccines
This week, a few vaccine bills that had the potential to impact health care and the practice of medicine were heard on the floor, which were successfully defeated.
HB 1200 School Required Vaccines: This bill initially placed restrictions on the use of COVID-19 vaccinations and experimental vaccines for students at higher education institutions and changed school and day-care immunization laws. The definition of experimental vaccination eliminates all requirements for vaccination. In the House, the bill was amended to apply only to covid and emergency-use authorized vaccines. In summary, this bill reauthorizes the Covid-19 vaccination rules passed during special session for employers, with an exemption for healthcare employers.
This bill was successfully defeated in the Senate: 6 yeas and 41 nays.
SB 2384 mRNA Vaccines: This bill would have prohibited the use of vaccines developed using messenger ribonucleic acid technology in the state; and to provide a penalty. Class A misdemeanor. This was amended to a study.
This bill was successfully defeated in the Senate: 38 yeas and 53 nays.
Challenges
Transgender Care
HB 1254 This bill makes it a Class B felony to treat a minor with surgery, or with medication for transgender care. The House amended the bill to lower the penalty to a misdemeanor for medication. The Senate Human Services committee attempted to remove treatment with hormone blockers an exemption, but the floor did not accept the amendment. A great deal of work was done by many caring physicians who testified against the bill, but the Senate stood against all reasoning. Unfortunately, the bill passed with 37 yeas and 10 nays.
NDMA takes a position against bills that criminalize physicians for using scientifically-proven best standards of care.
March 27 - 31
This was a busy week at the legislature for NDMA's priority bills. Time is quickly moving along and at the close of today, legislators will have completed 56 days of the 80-day limit. NDMA and its members addressed several bills considered priority bills. Here is a summary:
Success
Non-Profit Employment of Physicians
It's Officially Signed and Set to Become a Law on August 1.
SB 2148 Non-Profit Employment of Physicians: North Dakota’s corporate practice of medicine law limits non-profit employment of physicians to hospitals, and non-profit hyperbaric clinics. NDMA proposed policy to expand non-profit employment of physicians to include all non-profits, which would allow more flexibility for physician employment.
This NDMA sponsored bill successfully passed both the House and Senate and was signed by the Governor on March 27.
Prior Authorization
SB 2389 Prior Authorization: North Dakota does not have a prior authorization law in place and NDMA supports efforts to reduce prior authorization restrictions when it comes to prescribing medical procedures and prescription drugs.
As mentioned last week, the Senate amended the bill to a study, which passed the Senate. The House considered bringing it back into its original form, but the committee voted to keep it a study. The bill passed the House floor with 88 yeas and 3 nays.
The bill does not guarantee a study, but NDMA will be in full force to work the committee when it comes time to choosing which studies are selected to move forward for an interim report.
It will be good to have a study to review all the issues facing prior authorization and make the bill more palatable for the next session, pending study outcomes.
Safety Belt Requirements
SB 2362 Safety Belt Usage: Relating to safety belt usage; to repeal section 39-21-41.5 of the North Dakota Century Code, relating to secondary enforcement of safety belt requirements; and to provide a penalty.
This bill requires all passengers to buckle up, not just front seat passengers, and makes the violation a primary offense. Many police officers provided testimony on how seat belts save lives. This bill was supported by NDMA and successfully passed the House floor: 53 yeas and 38 nays.
White Bagging
SB 2378 White Bagging: Relating to clinician-administered drugs. Restrictions on pharmacy benefit managers. This is referenced as “white bagging”.
The practice involves insurance companies forcing medications that are administered in a clinic to be purchased through an insurer's exclusive pharmacy of choice. The medications, specifically for one patient, are then sent to a physician's office or a hospital where they are administered to patients. This new practice is being used for chemotherapy medications, certain ophthalmologic medications, and other physician administered drugs. The practice adds unnecessary complexity to the physician/patient relationship, raises patient safety issues, and may cause delays in patient care.
The required use of “white bagging” replaces the current system where a clinic has a supply of needed medications in stock that can be used to address the patient’s needs. When the insurer requires the drug to be ordered for the patient from their pharmacy, it limits the physician’s ability to adjust the medications as needed when treating the patient.
The bill prohibits pharmacy benefit managers (PBM) to require patients to purchase prescription drugs exclusively through mail order pharmacy. The PBM may not interfere with a patient's right to obtain clinician administered drugs from the patient's provider of choice.
This bill was supported by NDMA and successfully passed the House floor: 86 yeas and 4 nays.
Challenges
Assault Against Healthcare Workers
HB 1121 Assault Against a Health Care Worker: This bill increases the simple assault penalty to Class C felony for all health care workers. Currently, only emergency room workers have the higher level of penalty. This expands that category to all health care workers.
This bill received a DO NOT PASS recommendation. NDMA and partners worked the floor hard, but unfortunately, it was defeated by one vote: 23 yeas, and 24 nays. NDMA worked the Senate floor to reconsider the bill, but did not get the votes needed to reconsider the bill. So close, but yet so far.
March 20 - 24
This was a busy week at the legislature for NDMA's priority bills. Time is quickly moving along and at the close of today, legislators will have completed 51 days of the 80-day limit. NDMA and its members addressed several bills considered priority bills. Here is a summary:
Success
Non-Profit Employment of Physicians
HB 2148 - North Dakota’s corporate practice of medicine law limits non-profit employment of physicians to hospitals, and non-profit hyperbaric clinics. NDMA proposed policy to expand non-profit employment of physicians to include all non-profits, which would allow more flexibility for physician employment.
This NDMA sponsored bill successfully passed on the House floor with 91 yeas and 1 nay.
The bill now will make its way back to the Senate for signatures and will become official after it is signed by Governor Burgum. All bills that pass without an emergency clause go into effect on August 1. Laws that have emergency clauses go into effect after being signed by the Governor. This law will go into effect August 1.
This new law will allow non-profit health care facilities like the Anne Carlsen Center to directly employ physicians to provide care to patients.
Priority Updates
Prior Authorization
Dr. Chad Carlson provides testimony for SB 2389
SB 2389 Prior Authorization: North Dakota does not have a prior authorization law in place and NDMA supports efforts to reduce prior authorization restrictions when it comes to prescribing medical procedures and prescription drugs.
NDMA worked with partners to develop parameters, including time limits for responding to prior authorization requests. In the Senate, this bill was vigorously opposed by the payors. Payors claimed that they had no prior authorization complaints. The Senate amended the bill to a study, which passed the Senate.
On Monday, the bill was heard in the House Industry Business and Labor Committee. Dr. Chad Carlson presented testimony on behalf of NDMA.
NDMA was in good company with support from the North Dakota Hospital Association, NDMA member Dr. Gabriela Balf, and Essentia Health. The hearing took a surprise turn when several members of the committee felt it was worth taking a deeper dive into the details by further analyzing the testimony and perhaps making amendments to bring some portion of the original bill back. The committee will be addressing the bill next week. Stay tuned.
Assault Against Healthcare Workers
HB 1121 Assault Against a Health Care Worker: This bill increases the simple assault penalty to Class C felony for all health care workers. Currently, only emergency room workers have the higher level of penalty. This expands that category to all health care workers.
The bill was heard by the Senate Judiciary on Tuesday. There was a great deal of support, but the committee gave it a DO NOT PASS. NDMA sent out an alert on Thursday morning to help encourage Senate members to vote against the recommendation. Stay tuned for more information.
Parental Consent for Minor's Health Care
SB 2260 Relating to fundamental parental rights, parental involvement in education, and parental right to consent to medical treatment of the parent's child.
This bill was contentiously debated. NDMA opposes this bill because when it comes to providing timely health care, it interferes with the patient and physician relationship. Furthermore, under long-standing policies and procedures, all hospitals, clinics and physicians obtain consent from the parent when treating a minor, with exceptions that are set forth in North Dakota Century Code. Stay tuned for more information.
MARCH 13 - 17
This was a busy week at the legislature for NDMA's priority bills. Time is quickly moving along and at the close of today, legislators will have completed 46 days of the 80-day limit. NDMA and its members addressed several bills considered priority bills. Here is a summary:
Success
Healthcare Transparency
HB 1221 - is a bill that relates to professional transparency for health care practitioners, otherwise known as the Health Care Transparency Act. The bill addresses the need for all health care providers to clearly state their level of training, education, and licensing in marketing and other communications to the public.
This NDMA sponsored bill successfully passed on the Senate floor with 32 yeas and 15 nays.
The bill now will make its way back to the house for signatures and will become official after it is signed by Governor Burgum. The effective date for new laws is August 1.
This consumer safety legislation will assist patients in making informed decisions when choosing a healthcare professional.
Priority Updates
Aborption Trigger Law Amendments: Protecting the Health and Life of Patients
Dr. Ana Tobiasz
The abortion trigger law amendments contained within HB 2150 received a hearing on Tuesday in front of the House Human Services Committee. Dr. Ana Tobiasz presented testimony on behalf of NDMA in support of the amendments.
Although the bill protects the health and life of the mother, it falls short in providing relief to rape and incest victims due to the six week ban. Many victims do not realize they are pregnant until well past the six week mark. On a more positive note, the bill removes the affirmative defense as a penalty, which is a win for physicians.
The bill passed out of the committee with 12 yeas and two nays. In normal circumstances, HB 2150 would be making its way to the floor today, but a North Dakota Supreme Court ruling on the temporary block of North Dakota's trigger law could cause delays. Read on for more information.
ND Supreme Court Ruling on Trigger Ban Injunction
On Thursday, the North Dakota Supreme Court issued an opinion in Wrigley v. Romanick, ruling on North Dakota’s trigger law regarding abortion. At issue was a preliminary injunction issued by District Court Judge Bruce Romanick enjoining enforcement of the trigger law pending the litigation. The Supreme Court declined to lift the injunction and it remains in place.
In the opinion, Chief Justice Jon Jensen stated, “While the regulation of abortion is within the authority of the legislature under the North Dakota Constitution, the plaintiff has demonstrated likely success on the merits that there is a fundamental right to an abortion in the limited instances of life-saving and health-preserving circumstances, and the statute is not narrowly tailored to satisfy strict scrutiny.”
The Court further stated that “because we hold the North Dakota Constitution provides a fundamental right to receive an abortion to preserve a pregnant woman’s life or health, the constitutionality of N.D.C.C. § 12.1-31-12 must be analyzed under the strict scrutiny standard.” The Court analyzed the statute and found it did not meet that strict scrutiny.
In doing so, the Court noted that “the statute requires a physician who performs a life-preserving abortion to face prosecution of a class C felony, and if prosecuted prove by a preponderance of the evidence the abortion was necessary to save the life of the woman. This is not narrowly tailored to achieve the State’s interests in women’s health and protecting unborn human life.” The Court determined that the trigger law criminalized life-preserving abortions.
NDMA is still weighing how the ruling will impact HB 2150 and if additional amendments will be made. Stay tuned for more information.
Read the opinion here.
Freedom of Choice
Dr. Duncan Ackerman
Dr. Joshua Ranum
HB 1416 - is a bill that gives patients the option to choose a healthcare provider outside of network, pending the provider is willing and fully qualified to meet the terms and conditions of participation by the health insurer. This bill was heard in the Senate Human Services Committee
In the House, the bill was amended to provide focus on the integrated delivery network, meaning that a health insurer that is part of an integrated delivery network may not obstruct patient choice by excluding a health care provider. The Senate Human Services Committee has not voted on the bill. Stay tuned for more information.
Gender Care
Presenting testimony in opposition are from left to right: Danial Sturgill, PhD, Amanda Dahl, MD, Luis Casas, MD, and Gabriela Balf, MD.
HB 1254 - this bill makes evidence-based medical decision making and treatment of transgender individuals a violation of law. NDMA opposes this bill. The NDMA Policy Forum recently passed a policy opposing the criminalization of medical practice.
NDMA proposed an amendment that would make the bill more palatable to allow physicians to continue prescribing puberty blockers and hormone treatment to transgender adolescents after the onset of puberty. A ban on surgeries for minors would remain.
The testimony presented by the physicians shared evidence-based treatments that are critical to patients' mental health.
The Senate Human Services Committee outcome is still pending. Stay tuned.
MARCH 6 - 10
At the close of today, legislators will have completed the 41st day of the 80-day mark. NDMA and its members addressed several bills this that are considered priority bills. Here is a summary:
UND SMHS School Budget
Dr. Josh Wynne
UND School of Medicine and Health Sciences Dean and Vice President for Health Affairs Dr. Josh Wynne provided testimony that supports the schools budget to the Senate Appropriations Education and Environment Division. Dr. Wynne shared UND SMHS accomplishments over the past two years and shared why it is important to keep the school funded at the requested level. The bill, HB 1003 entails education trends, funding of severance agreements, academic program approval, and the school's budget.
Corporate Practice of Medicine
Dr. William Noyes
Dr. Myra Quanrud
SB 2148 - a bill spearheaded by NDMA that addresses the corporate practice of medicine to include nonprofits was heard in the House Human Services Committee on Wednesday. Presenting testimony in support of the bill were two NDMA members, Dr. William Noyes and Dr. Myra Quanrud. There was no opposition to the bill. A decision on how the committee will vote is pending. Stay tuned.
Truth in Advertising
Dr. Joan Connell
HB 1221 - another bill spearheaded by NDMA addresses professional transparency for health care practitioners, also known as Truth in Advertising. NDMA member Dr. Joan Connell provided testimony in support of the bill to the Senate Workforce Development Committee. The committee voted unanimously to pass the bill. The next step is for this bill to be carried to the Senate floor for a vote.
February 27 - MARCH 3
Legislators had a late start reconvening due to winter weather conditions. The Wednesday morning committee meetings were postponed, leaving legislators with a half day to meet. There were no floor sessions held on Wednesday and Thursday, so technically day 36 of the session only begins when the floor sessions gavel in on Friday, March 3.
Three bills were heard. NDMA member Dr. Joan Connell provided written testimony to oppose HB 1229 - a bill that would allow businesses to open public cigar lounges.
This bill would weaken North Dakota's smoke free law by once again allowing indoor smoking. Historically, NDMA has adopted resolutions and has taken positions to oppose legislation that encourages tobacco use. During the hearing there was a great deal of opposition to the bill. Stay tuned for more outcomes.
Two other bills on NDMA's bill tracker that received hearings this week were:
SB 2153 - a bill relating to the core functions of public health units.
SB 2302 - a bill prohibiting discrimination in the organ transplant process.
February 20-24
Challenges
Prior Authorization
SB 2389 - is a bill supported by NDMA that attempts to reduce prior authorization restrictions when it comes to prescribing medical procedures and prescription drugs.
This issue was vetted at NDMA's policy form and voted on by the NDMA Council to bring forward and support efforts to reduce restrictions in the prior authorization process.
The bill initially came out of the Senate Human Services committee with a do not pass (4 1 1), then was later amended to a study. The amendment received a DO PASS through the committee (5 0 1) and also received a DO PASS on the Senate floor with a final vote of 47 yeas and no nays.
The bill came with considerable opposition from insurance providers who shared testimony that disagreed that prior authorization can be problematic. NDMA is hopeful that a study will bring clarity to the differences.
The amendment is as follows:
During the 2023-24 interim, the legislative management shall consider studying prior authorization in health benefit plans. The study must include consideration of:
a. The extent to which prior authorization is used by health insurance companies in this state, including the types of services and procedures for which prior authorization is required.
b. The impact of prior authorization on patient care, including the effects on patient health outcomes, patient satisfaction, health care costs, and patient access to care.
c. The impact of prior authorization on health care providers and insurers, including the administrative burden, time, and cost associated with obtaining prior authorization, and the appropriate utilization of health care services.
d. State and federal laws and regulations that may impact prior authorization.
e. Input from stakeholders, including patients, providers, and commercial insurance plans.
The study may include consideration of issues related to response times, retroactive denial, data reporting, clinical criteria and medical necessity, transparency, fraud and abuse, reviewer qualifications, exceptions, and an appeal process.
The legislative management shall report its findings and recommendations, together with any legislation required to implement the recommendations, to the sixty-ninth legislative assembly.
In summary it's important to keep in mind that this bill, if it passes through the house chamber, does not guarantee a study. The elective studies are vetted through a committee hearing at the close of the legislative session.
AMA survey data shows:
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93% of physicians report care delays because of prior authorizations.
- 34% of physicians report that prior authorization has led to a serious adverse event for a patient in their care, such as hospitalization, permanent impairment, or death.
- 91% of physicians see prior authorization as having a negative effect on their patients’ clinical outcomes.
- 82% of physicians indicated that patients abandon treatment due to authorization struggles with health insurers
February 13-17
Successes
Freedom of Choice
HB 1416 Relating to freedom of choice for health care services. This bill provides for patients to choose a health care provider outside of network, pending the provider is willing and fully qualified to meet the terms and conditions of participation, as established by the health insurer.
The bill was amended to provide focus on the integrated delivery network, meaning that a health insurer that is part of an integrated delivery network may not obstruct patient choice by excluding a health care provider.
On Thursday, the bill was heard on the House floor and successfully passed with 84 yeas and 4 nays. The bill will now transition to the Senate. Thank you to all who provided support.
Challenges
Prior Authorization
SB 2389 - a bill that attempts to reduce prior authorization restrictions - came out of the Senate Human Services Committee with a do not pass recommendation.
Dr. Ana Tobiasz showed support for SB 2389 during the Senate Human Services hearing. When it comes to women's healthcare and pregnancy complications, delays in treatment may cause serious injury or death to both the mother and baby.
Telehealth Payment Parity
SB 2160 Relating to health insurance coverage of telehealth; payment parity for behavioral health. When it comes to telehealth, NDMA's policy goal was to implement a policy for behavior health payment parity telehealth services. This policy could help close coverage gaps, particularly in rural areas. Unfortunately, the bill was defeated on the Senate floor. Failed to pass 4 yeas, 43 nays.
Dr. Gabriela Balf-Soran provided testimony on the importance of telehealth when it comes to providing behavioral health services.
According to Dr. Balf-Soran, behavioral health telehealth increases access to care:
- Elderly who otherwise would not be able to come for regular visits;
- People who depend on others for transportation;
- People who would need to find child or adult care for visits;
- Children/adolescents who would need to miss school, and have their parent miss work to bring them to the office;
- People with PTSD who avoid crowds, office settings, etc.
Vaccine Summary
Not a week goes by without having to address the issue of vaccines. Here is a summary of how it looks on the front line.
When reviewing the bill status, it's important to keep in mind that bills receiving a DO PASS will continue to move through the legislative process into the second half of the session to be heard on the other side (Senate vs. House). Bills that FAIL TO PASS, are considered dead.
HB 1406 Relating to studying vaccines and the medical liability of a governmental entity. This bill was defeated by 32 yeas and 59 nays.
HB 1207 Relating to publication of vaccine adverse event data. This does not necessarily impact the practice of medicine or patient care, but requires the ND Dept. of Health and Human Services to keep a website available to the public that reports vaccine adverse events. Passed 85 yeas, 5 nays.
HB 1502 Relating to medical certification requirements, prohibitions on hospitals and health care facilities requiring employees receive certain vaccinations, and access to hospital care. This bill was amended to say patient care cannot be denied because of vaccine status. Passed 87 yeas, 4 nays.
HB 1505 Relating to a prohibition on requiring a vaccination; and to provide a penalty. Notwithstanding law to the contrary, a person may not require an individual to undergo a vaccination, an inoculation, or any means of inducing an immune response as a condition for the individual to exercise any right, perform any duty, or enjoy any privilege. A violation of this section is a class C felony. Defeated 31 yeas, 60 nays.
HB 1200 Relating to COVID-19 vaccinations and experimental vaccines for students at institutions of higher education and relating to school and day care immunizations. Government entities may not require documentation on Covid-19 vaccine status. Passed 78 yeas, 33 nays.
SB 2384 This bill would have prohibited the use of vaccines developed using messenger ribonucleic acid technology in the state; and to provide a penalty. Class A misdemeanor. AMENDED TO A STUDY so it will not have any policy ramifications. Passed 25 yeas, 22 nays.
SB 2274 This bill would have prohibited all vaccine requirements for health care facilities. Fortunately, the bill was successfully amended to be similar to HB 1200 which exempts health care facilities from the bill; furthermore the vaccines were amended to include only Covid 19 vaccines and Emergency Use Authorized drugs. We were hoping to defeat this bill and unfortunately lost by one vote. Passed 24 yeas, 23 nays.
NDMA member Dr. Fahn presented testimony in opposition to SB 2274. He shared compelling information on how a bill like SB 2274 in its original form would impact patient safety. In addition, NDMA extends a thank you to all NDMA physician members who submitted written testimony. Testimony can be viewed here.
February 6 - 10
Successes
Healthcare Transparency
HB 1221 Relating to professional transparency for health care practitioners, otherwise known as the Health Care Transparency Act submitted by NDMA.
This NDMA sponsored bill successfully passed on the house floor with 73 yeas and 20 nays. The bill will now transition to the Senate. Thank you to all who showed up to support the bill and provide testimony.
Seat Belt Usage
SB 2362 Relating to safety belt usage and enforcement of safety belt requirements; and to provide a penalty.
This bill successfully passed on the senate floor with 28 yeas and 18 nays and now transitions to the House for further vetting. The bill requires all passengers to buckle up and also makes the penalty for not buckling up a primary offense for all passengers.
Hearings
The following bills were heard in committees this past week.
Freedom of Choice
HB 1416 Relating to freedom of choice for health care services. This bill provides for patients to choose a health care provider outside of network, pending the provider is willing and fully qualified to meet the terms and conditions of participation, as established by the health insurer.
The bill was heard in the House Human Services Committee where Dr. Duncan Ackerman provided testimony. His compelling testimony shared how blocking out health care practitioners creates an inequity for those seeking care, particularly in rural areas.
No further action has been taken. Review Dr. Ackerman's presentation here. NDMA supports this bill.
Duncan Ackerman, MD
Vaccines
Two vaccine bills were heard this week. For both bills, there was a great deal of testimony opposing both bills.
Testimony in opposition included representations from many entities, including the ND Medical Association, the ND Hospital Association, ND Foundation for a Healthy North Dakota, ND Dept. of Health and Human Services, and North Dakota's Health Officer Dr. Nizar Wehbi.
Bills included HB 1505 - relating to a prohibition on requiring a vaccination; and to provide a penalty. A violation of this section is a class C felony. The committee reported back with a DO NOT PASS recommendation with a vote of 9 5 0.
The second bill - SB 2384 - unfortunately passed on the senate floor Thursday afternoon when an amendment was made on the floor by Senator Magrum. The amendment changes the bill into a study. Learn more here. NDMA and partners will continue to oppose the bill as it transitions to the house for further vetting.
Here is what the bill states regarding the study:
During the 2023-24 interim, the legislative management shall consider studying the long-term health effects on human beings of vaccines for respiratory syncytial virus and vaccines developed using messenger ribonucleic acid technology.
The bill in its original form proposed to prohibit the use of vaccines developed using messenger ribonucleic acid technology in the state; and provides a penalty of a Class A misdemeanor.
Providing testimony - a few snapshots:
| Joan Connell, MD |
Nizar Wehbi, MD, ND State Health Officer
| J'Patrick Fahn, DO |
Prescribing Practices: Naturopath ND Board of Medicine and Physician Oversight
On Thursday, SB 2221 was heard in the Senate Workforce Development Committee. The bill seeks to regulate naturopathic practices under the North Dakota Board of Medicine. The board will be charged with providing oversight when it comes to allowing naturopaths to prescribe, dispense, administer, and procure drugs and medical devices.
Dr. Robert Sticca, North Dakota Board of Medicine Chair, testified in support of transitioning naturopaths under the supervision of the ND Board of Medicine.
NDMA remains neutral on this bill.
Robert Sticca, MD, North Dakota Board of Medicine Chair
January 30 - February 3
Abortion: Protecting the Life and Health of Patients
SB 2150 Abortion Law Fix: North Dakota’s abortion trigger law does not allow for treatment of ectopic pregnancies, premature rupture of membranes, or pre-eclampsia without the threat of prosecution.
NDMA is working with all stakeholders to assure that North Dakota’s abortion law protects the health and the life of the mother and removes the affirmative defense stipulations.
On Tuesday, the bill PASSED on the Senate floor with favorable amendments. The vote was 43 yeas, and 4 nays. Some voting in opposition feel that when it comes to rape and incest, the six week restriction is prohibitive, since in many instances women do not know they are pregnant until later than the six weeks. Senator Kathy Hogan shared information on why the six week limit is not enough, based on her Cass County Social Services work experience. You can listen to the floor session here.
As this bill crosses over to the House, our work is far from complete. But, for now, the bill does remove the affirmative defenses, and includes better options for treatment when it comes to the life and health of the mother.
Continue educating your legislators on the importance of being able to provide the necessary care to protect the health and life of patients.
Passing this bill took a great deal of team work from NDMA physician members across the state, and other partners, such as the North Dakota Hospital Association.
Thank you for your efforts.
Assault
HB 1121 Assault Against a Health Care Worker: This bill increases the simple assault penalty to Class C felony for all health care workers. Currently, only emergency room workers have the higher level of penalty. This expands that category to all health care workers. This is an NDMA sponsored bill.
This bill passed the House with 67 yeas, and 25 nays; it will now cross over to the Senate.
Corporate Practice of Medicine
SB 2148 Non-Profit Employment of Physicians: North Dakota's corporate practice of medicine law limits non-profit employment of physicians to hospitals, and non-profit hyperbaric clinics. NDMA is proposing policy to expand non-profit employment of physicians to include all non-profits, which would allow more flexibility for physician employment. This is an NDMA sponsored bill.
This bill passed the Senate without any opposition (received all 46 YEAS) and will now transition to the House.
January 23-27
Corporate Practice of Medicine
SB 2148 Relating to the corporate practice of medicine: to include nonprofits. This bill is spearheaded by NDMA.
The bill was introduced by bill sponsor Jonathan Sickler in the Senate Human Services Committee. Providing testimony were Courtney Koebele, Dr. Myra Quanrud and Dr. Bill Noyes.
Dr. Quanrud, medical director of Anne Carlsen of Jamestown, shared testimony about how Anne Carlsen is currently undergoing a major building project and one of the long-term goals is to open a clinic to meet the needs of this very specific population. Allowing non-profit employment of physicians would allow Anne Carlsen to hire physicians to improve multidisciplinary care, rather than providing fragmented care provided through contractors.
According to testimony from Dr. Noyes, the proposed change would allow physicians another employment choice whether it be nonprofit entities or charitable organizations and protect their ability to maintain an independent judgement in the practice of medicine. This is the standard in 40 other states.
The bill received a DO PASS recommendation out of the committee. All committee remembers were in support. Stay tuned for more information as the bill makes it way to the floor for a vote.
Myra Quanrud, MD
Bill Noyes, MD
Vaccines
It was a heavy week for vaccines. NDMA supports the science behind vaccines and the protections vaccines provide to the public. HB 1406 and HB 1207 were bills that targeted the ND Dept. of Health and Human Services. There was a great deal of testimony provided both to oppose and support the bills. NDMA will continue to monitor and provide testimony to oppose efforts that jeopardize public safety when it comes to vaccines and infectious diseases.
HB 1406 Relating to studying vaccines and the medical liability of a governmental entity.
HB 1207 Relating to publication of vaccine adverse event data.
HB 1502 Relating to medical certification requirements, prohibitions on hospitals and health care facilities requiring employees receive certain vaccinations, and access to hospital care.
HB 1200 Relating to COVID-19 vaccinations and experimental vaccines for students at institutions of higher education and relating to school and day care immunizations.
NDMA presented strong testimony opposing HB 1502, which would prohibit health care facilities from requiring vaccines as a condition of employment, which is a common policy initiated to protect patients from health care–acquired influenza and to protecting the workplace from the disruption and expense of worker illnesses.
This is against the free-market principle of allowing business owners to do what’s best for their business, workforce and patients. Healthcare facilities know the best course of action for their facility, and it should be their choice to determine what policies they enact.
NDMA also provided testimony opposing HB 1200. Although COVID-19 immunizations were probably the source of the bill, it applies to all vaccines, including those against measles, influenza, pertussis, and hepatitis B. The reason for this is the definition of experimental contained in section 2 of the bill. Most common vaccines are included in the National Vaccine Injury Compensation Program (VICP). Therefore, these vaccines would not meet this requirement and be deemed “experimental.”
Gender
Gender-related bills are big for this session. NDMA presented testimony on HB 1254 and HB 1301.
HB 1254 Relating to the prohibition of certain practices against a minor; to provide a penalty; and to declare an emergency. This bill makes evidence-based medical decision making and treatment of transgender individuals a violation of law. NDMA opposes this bill. The NDMA Policy Forum recently passed a policy opposing the criminalization of medical practice.
HB 1301 Relating to prohibiting medical gender transitioning procedures on a minor; to provide a penalty; and to declare an emergency. NDMA opposes this bill. North Dakota has existing laws governing medical negligence, comparative fault, and damages (including punitive). If this bill went to effect, it could have a strong effect on medical malpractice coverage. A thirty-year statute of limitations is highly unusual in any civil action. If this bill passes, it is unlikely anyone would be willing to offer this type of treatment, based on the extensive limitations in the bill. This bill makes evidence-based medical decision making and treatment of transgender individuals unavailable to North Dakotans.
January 16-20
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