69th Legislative Assembly in Action
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69th Legislative Session Update Week Eight - February 24 - 28
We made it through Crossover! Although the crossover date is today - February 28 - both the House and Senate wrapped up the bills on Tuesday.
Of the 1081 bills and resolutions needing vetting, 264 failed or were withdrawn. Thus, legislators have 817 bills and resolutions remaining to receive another hearing.
NDMA is tracking 164 bills and resolutions that have the potential to influence medicine. Of these, 25 failed, which means they're considered dead.
Failures can be great successes. Here is a summary of some of the greatest failures!
Failed Bill Successes - BIG WINS
NON-ECONOMIC DAMAGES CAP INCREASE - DEFEATED!
HB 1349 NDMA and its partners - the North Dakota Hospital Association, Long Term Care Association, the North Dakota Rural Health Association, and the Greater North Dakota Chamber - worked overtime to defeat HB 1349, which would have increased North Dakota's Non-Economic Damages cap from $500k to $1 million - doubling the amount.
The consequences of this bill passing would have substantially impacted malpractice insurance premium prices - up to as much as 30%.
REMOVAL OF MEDICAL SCHOOL MILL LEVY - DEFEATED!
HCR 3012 and SCR 4023 - Two identical resolutions - one in the House and one in the Senate - proposing to repeal section 10 of article X of the Constitution of North Dakota relating to the statewide property tax levy of one mill for support of the UND Medical School.
The resolutions sought to remove the one-mill levy set by the North Dakota Constitution to help fund the UND School of Medicine.
HCR 3012 was defeated on the House Floor by a vote of 43 yeas and 42 nays. The resolution failed because a constitutional majority was needed, meaning 48 votes were required to pass.
SCR 4023 was defeated in the Senate with 21 yeas and 24 opposing.
Some background on the mill levy: In 1948, the people of North Dakota voted to approve an amendment to the North Dakota Constitution that provided SMHS with dollars raised using a single mill levy to help finance its operations.
Vaccines - Failed Successes!
Health and medical experts have hailed vaccines as being one of the major achievements of the 20th century, but not everyone agrees.
In the past few years, opposition to vaccines has been discussed more frequently and surfaces in the form of many bills.
This session resulted in six vaccine bills. Fortunately, some of the bills were successfully defeated. Here is a summary.
VACCINE REPORTING REQUIREMENTS - DEFEATED
HB 1457 This bill related to vaccine exemptions and required the ND Dept. of Health and Human Services to post injuries or diseases caused by the vaccine on the department's website and publicize vaccine exemptions. The bill was redundant because vaccine exemptions are already publicized on the department's website, and adverse events are already reported to the Vaccine Adverse Event Reporting System (VAERS).
VACCINE REPORTING REQUIREMENTS - DEFEATED
HB 1467 was another bill relating to recording and reporting vaccine adverse event data. Again, this would be a duplication of efforts since the VAERS system is already capturing the data.
VACCINE DEATH REPORTING REQUIREMENTS - DEFEATED
HB 1519 This bill would have required the ND Dept. of Health & Human Services to produce data linking deaths to anyone that had any vaccines, regardless of other causes of death, such as cancer—suicide, overdoses, injuries, Alzheimer’s disease, etc.
SELF-SPREADING VIRUSES - CONVERTED TO A STUDY
HB 1458—This was an interesting bill as the terminology centered around prohibiting the release of a "self-spreading virus." Although not necessarily a victory of defeat, it was amended to a "shall consider study." If selected for a study, it will be assigned to an interim committee.
Crossover Priorities - Where NDMA Focuses Its Efforts
Several priority bills have successfully passed through the first chamber, but to become law, the bills must pass through the second chamber. Some priorities include:
RADON DISCLOSURE - SUPPORT
SB 2204 This bill adds language to the ND Century Code to require disclosure of radon hazards by a seller. This bill is one of NDMA's priority bills and comes with great passion from NDMA President Dr. Dahl.
PRIOR AUTHORIZATION REFORM - SUPPORT
SB 2280 Prior authorization—that's what this bill is all about. It is another attempt from the previous session to streamline the prior authorization process. This took a great deal of support and education from Senators Scott Meyer and Jeff Barta - the primary bill sponsors.
MATERNAL & CHILD HEALTH & WELFARE - SUPPORT
SB 2232 This bill creates an exemption for postpartum exposure to controlled substances and alcohol reporting requirements, including infant toxicology test requirements exemptions. The bill exempts the testing requirements, pending the patient complies with the health care provider's treatment and care plan.
HEALTHCARE WORKER ASSAULT PENALTY - SUPPORT
HB 1341 proposes to add "hospital worker" to the existing ND Century Code, which protects peace officers, correctional institution workers, emergency medical workers, and fire department workers from assault by making bodily injury a Class C felony. A similar bill has been attempted in previous sessions and was defeated.
69th Legislative Session Week Seven - February 17 - 21
Crossover - February 28 - is sneaking up on us quickly. To refresh your memory, crossover is when all bills must be acted on in their "bill of origin" chamber. Bills that fail - the red votes - are considered "dead" and do not get another hearing; bills that pass - the green votes - will proceed to the opposite chamber for another hearing.
The work at the Capitol has been intense this week as NDMA and its partners worked diligently on advocating for medicine. Here is a summary.
Success - BIG WIN
PRIOR AUTHORIZATION REFORM - SUPPORT
HB 2280 A bill to streamline the prior authorization process for patients and North Dakota commercial healthcare insurers passed out of committee with a 5-0 DO PASS recommendation.
HB 2280 successfully passed on the Senate floor with 43 supporting the bill and only 4 in opposition. Check out the vote here!
This prior authorization reform bill will help patients gain access to care more efficiently:
Full Disclosure and Transparency
- Eliminates unnecessary prior authorization requests by requiring insurers to post requirements and restrictions on the organization's website.
Standardized Review Period
- Urgent healthcare services: 72-hour turnaround response
- Non-urgent: 7-calendar day window
- Not meeting the timeline maximum results in automatic approval.
Review Process
- Requests are sometimes rejected because the reviewer lacks the experience necessary to determine the need. The bill requires that the reviewer be a licensed physician.
Effective Periods
- A prior authorization is valid for six months after approval.
- In the case of chronic or long-term conditions, the approval remains valid for 12 months.
Our work is not done, since the same process must be gone through on the House side after crossover. Stay tuned for more information.
More work to track
REMOVAL OF MEDICAL SCHOOL MILL LEVEL - OPPOSE
HCR 3012 and SCR 4023 - Resolutions to repeal section 10 of article X of the Constitution of North Dakota relating to the statewide property tax levy of one mill for support of the UND Medical School.
Good news. HCR 3012 was successfully defeated on the House Floor by a vote of 43 yeas, and 42 nays; The resolution failed since a constitution majority was needed, meaning 48 votes were needed for the resolution to pass.
Outstanding is SCR 4023 - which is expected to hit the Senate floor on Friday. The resolutions are identical - one in the House, and one in the Senate. The resolutions seek to remove the one-mill levy set by the North Dakota Century Code to help fund the UND School of Medicine.
Some background on the mill levy: In 1948, the people of North Dakota voted to approve an amendment to the North Dakota Constitution to provide SMHS with dollars raised using a single mill levy to help finance their operations.
A few other bills to keep an eye on:
INSTRUCTIONAL MANDATE - REQUIRING CME ON NORTH DAKOTA'S ABORTION LAW - OPPOSE
HB 1511 A BILL for an Act to create and enact a new subsection to section 43-17-27.1 of the North Dakota Century Code, relating to the development of an instructional course by the state board of medicine. This bill would require the ND Board of Medicine to post an instructional video on the website to further explain North Dakota's abortion control act.
Testimony from some supporting this bill states the obvious conditions, such as treating a patient for an ectopic pregnancy or molar pregnancy. An educational video could not legally address the areas of vagueness, which is why the law is temporarily stayed until the Supreme Court comes to a decision. It is our intent to defeat this bill but it did come out of the committee with a DO PASS. NDMA will continue to work on defeating this bill.
MEDICAL PRACTICE EXAM ROOM REQUIREMENTS - OPPOSE
HB 1450 A BILL for an Act to create and enact a new section to chapter 14-10 of the North Dakota Century Code, relating to parent and guardian access to the medical examination room of a minor. This bill places an unhealthy strain on the minor and the providing medical professional, as it compromises the patient and physician relationship to provide effective care. This bill would impact a physician's ability to identify a patient's health issues.
This bill also came out of committee with a DO PASS. We are diligently working to defeat this bill.
69th Legislative Session: Week 6 - February 10 - 14
Week six was another extremely busy week layered with priority bills. Here is a summary:
Success - BIG WIN
NON-ECONOMICAL DAMAGES - MEDICAL MALPRACTICE - DEFEATED
HB 1349 NDMA and its partners - the North Dakota Hospital Association, Long Term Care Association, the North Dakota Rural Health Association, and the Greater North Dakota Chamber - worked overtime to defeat HB 1349, which would have increased North Dakota's Non-Economic Damages cap from $500k to $1 million - doubling the amount.
The consequences of this bill passing would have substantially impacted malpractice insurance premium prices - up to as much as 30%.
First, Thank you to everyone who sent messages to their representatives requesting a VOTE NO on the bill. This made a difference since we heard about it in the Capitol hallways.
Next, two strong House champions - Representatives Karen Karls (Dist. 35) Todd Porter (Dist. 34) - took a stand on the floor and shared comments on why this would hurt the practice of medicine. If these are your representatives, reach out to thank them! In fact, all House members who voted RED deserve to be thanked. Please reach out.
Here is a snapshot of the final floor vote - the RED VOTES WIN - with a final vote of 61 nays and 30 yeas. Watch the floor action here.
Success - BIG WIN
FERTILITY PRACTICES/ABORTION - DEFEATED
HB 1373 This personhood bill would have created a definition of a human being and carried heavy penalties of murder and assault and civil actions for death caused by wrongful acts. This bill would not allow for the IVF process to continue.
This bill was defeated with 77 nays and 16 yeas. Thanks to Dr. Ana Tobiasz, who stood up to oppose it. Nice work.
Prior Authorization Progress Continues
PRIOR AUTHORIZATION REFORM - SUPPORT
SB 2280—Prior authorization—that's what this bill is all about. It is another attempt from the previous session to streamline the prior authorization process.
It's been a big week working on a compromise on prior authorization reform. Many parties are involved in the process—19 statewide organizations—which all realize that reform is needed. The bill—SB 2280—did get a YES vote out of the Senate Industry and Business Committee, with all FIVE committee members supporting the amendments.
This bill includes working closely with the state's private healthcare insurers. Some negotiations include a 72-hour turnaround response for urgent health care services and a 7-day calendar window for non-urgent requests.
NDMA will send out a separate call to action asking you to contact your Senators to vote YES on the floor. The floor vote is expected to happen on Tuesday. Stay tuned for more information coming soon!
More work to track
REMOVAL OF MEDICAL SCHOOL MILL LEVY - OPPOSE
HCR 3012 and SCR 4023 - Resolutions to repeal section 10 of article X of the Constitution of North Dakota relating to the statewide property tax levy of one mill for support of the UND Medical School.
Two bills seek to remove the one-mill levy set by the North Dakota Constitution to help fund the UND School of Medicine.
NDMA joined UND Dean of the School of Medicine Dr. Marjorie Jenkins in opposing the bills. Dr. Joshua Wynne also participated in sharing insights.
Addressing property taxes is a major concern for the people of North Dakota, the Governor, and the legislature. However, this mill levy has an extremely small effect on individual tax bills but provides a stable and much-needed funding source for the state’s only medical school. Not knowing how or if the funds will be replaced could leave your school of medicine with a funding shortfall. This situation is serious when the school’s funding relies on educating North Dakota’s future and present healthcare workforce.
Some background on the mill levy: In 1948, the people of North Dakota voted to approve an amendment to the North Dakota Constitution to provide SMHS with dollars raised using a single mill levy to help finance their operations.
It is the intention of the bill’s sponsors not to defund the medical school, but rather to shift the source of funding from property taxes to the general fund. However, state budgets are tight, and receiving a large increase in funding will be difficult. The fiscal impact or reduction in collections in the 2027-2029 biennium is estimated to be $14,738,688.
If either of these resolutions passes both chambers, the mill levy will be placed on the 2026 general election ballot, and voters will choose whether to keep the school funded using this mechanism.
Tobacco Tax Increase - DEFEATED AGAIN :(
HB 1570 was a proposal to increase the tobacco tax. NDMA provided supportive testimony. In addition, the room was filled with those supporting the increase. However, the bill came out of the committee with an 11 out of 13 in opposition. The bill went to the floor on Thursday night and was defeated - YEAS 32, NAYS 53.
Interesting Facts: Increasing tobacco taxes is one of the leading recommendations for states to use in preventing and treating tobacco addiction, particularly in adolescents. Therefore, preventing the uptake of tobacco use by making it less affordable is a better investment than waiting to treat smokers in adulthood. North Dakota's cigarette tax has not been increased since 1993, and North Dakota remains the 49th state with the lowest cigarette tax at 44 cents a pack.
A few other bills NDMA is keeping an eye on include:
SB 2222 involves healthcare workers certifying documentation for an assistance animal. The problem with this bill is that it includes a penalty for the physician or provider who does the certification. NMDA testified in opposition to the bill.
SB 2270 relates to the licensure of international physicians. NDMA testified in support of this bill.
Stay tuned for more progress!
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69th Legislative Session: Week 4 - January 27 - 31
Week four proved to be extremely busy providing testimony either in support of or in opposition to proposed bill that have the ability to impact healthcare and physician practices. Here is a summary:
TOBACCO TAX - SUPPORT
SB 2281 This proposes to increase taxes on cigars, other tobacco products, alternative tobacco products, electronic smoking devices, and electronic smoking device substances and introduces a tobacco tax distribution fund where a portion of the proceeds would go to local public health units and organizations providing 988 crisis hotline services.
HEALTH OFFICER - OPPOSE
SB 2255 This strips qualifications for the State Health Officer to be a physician and removes the three-member advisory committee. Qualifications now include public health or administrator experience.
CARDIAC TRAINING - SUPPORT
HB 1363 This relates to implementing a cardiac emergency response plan for public and nonpublic schools and athletic events.
HEALTHCARE WORKER ASSAULT PENALTY - SUPPORT
HB 1341 This proposes to add "hospital worker" to the existing ND Century Code that protects peace officers, correctional institution workers, emergency medical workers, and fire department workers from assault by making bodily injury a Class C felony. A similar bill has been attempted in previous sessions and was defeated.
HB 1341 was reported out of the House Judiciary Committee with a DO PASS by an 8 to 6 vote. The next action is to proceed to the House Floor for a full vote.
HEALTHCARE REPRODUCTIVE RIGHTS – SUPPORT
HB 1478 This bill relates to contraceptive healthcare rights. It protects the right to contraceptive practices.
MEDICAL MARIJUANA – OPPOSE
SB 2294 A medical marijuana bill that proposes to remove the written certification for those over the age of fifty. For NDMA, this is concerning due to possible drug interactions and feel physician oversight is needed.
HEALTHCARE – PROTECTING FERTILITY PRACTICES - SUPPORT
HB 1477 Similar to protecting the rights to contraceptive care (HB 1478) this bill seeks to protect reproductive rights.
North Dakota citizens and patients are concerned that our legislature may attempt to prohibit access to fertility treatment. Concerns are valid as there is a bill in front of legislators that would prohibit physicians from this practice. See HB 1373.
HEALTHCARE – FERTILITY PRACTICES – SUPPORT
HB 1282 This relates to public employee (PERS) fertility health benefit plan coverage.
HOW IT WORKS: WHY BILLS ARE SPECIFIC TO PERS?
Since health insurance benefit bills have the potential to impact the state's medical insurance costs, STATE LAW REQUIRES THAT A NEW INSURANCE MANDATE IS REQUIRED TO BE VETTED THROUGH THE STATE HEALTH INSURANCE PLAN (PERS) for viability and affordability. This means that if the state legislature does not agree with the requested benefit, it will not be possible to introduce the coverage plan through the private health insurance market.
STEP THERAPY - SUPPORT
SB 2248 The PERS Step Therapy bills aim to improve access to care and treatment for more associated conditions that are common when treating or suffering through metastatic cancer.
STEP THERAPY - SUPPORT
SB 2249 This PERS step therapy protocol focuses on prescription drugs and includes a prior authorization section.
HEALTHCARE – REPRODUCTIVE SERVICES - SUPPORT
HB 1284 A PERS bill asking for fertility preservation health benefit coverage. If the covered individual has a diagnosed medical condition or genetic condition that may cause impairment of fertility.
NDMA member Dr. Ana Tobiasz testified in support of bills that impact access to fertility treatment.
Success - Radon Disclosure
SB 2204 A BILL for an Act to create and enact a new section to chapter 47-10 of the North Dakota Century Code, relating to the required disclosure of radon hazards by a seller.
This bill is one of NDMA's priority bills and also comes with a great deal of passion from NDMA President Dr. Dahl.
NDMA is pleased to report that the bill was reported out of the Senate Industry and Business Committee with a 5 to 0 vote - ALL IN FAVOR. On Thursday, the bill PASSED the Senate floor with a unanimous vote.
The bill now crosses over into the House where it will be given a committee hearing and floor vote. Stay tuned for more information.
What the Radon Bill Does
The North Dakota Real Estate Commission disclosure form mentions radon but merely asks if the house has been tested for radon. Radon is not included in the statute. SB 2204 includes radon in the statute and notifies home buyers that radon is a radioactive gas that may present health risks if exposed to high levels over time. It also notifies buyers that high levels of radon have been found in North Dakota residential real property.
69th Legislative Session: Week 3 - January 20-24
We are already in week three. The deadline for representatives to introduce bills was on Monday, January 20; the deadline for the Senate is coming up on Monday, January 27. As of today, there are a total of 983 bills, and NDMA is tracking 155 of these. Up until the last bill drops into the bill system, there may still be a few surprises lingering. NDMA's bill tracker is now tracking 156 - that's a lot of bills - here are some highlights from this week's in-the-trenches efforts.
Naturopathic Prescribing Practices - FAILED TO PASS
SB 2041 A BILL for an Act to amend and reenact section 43-58-08.1 of the North Dakota Century Code, relating to eligibility requirements for endorsement to prescribe independently of naturopathic doctors. The bill expands the options for a naturopathic doctor to receive prescribing privileges.
Last week we reported that this bill was given a DO NOT PASS out of the Senate Workforce Development Committee by a 5 0 vote. On January 17, the bill went to the Senate floor for a full vote and was defeated with 4 YEAS AND 43 NAYS.
Thank you to Dr. Heitkamp for providing testimony.
Radon Disclosure
SB 2204 A BILL for an Act to create and enact a new section to chapter 47-10 of the North Dakota Century Code, relating to the required disclosure of radon hazards by a seller.
This bill is one of NDMA's priority bills and also comes with a great deal of passion from NDMA President Dr. Dahl.
The bill was heard by the Senate Industry and Business Committee. NDMA was fortunate to have Committee Chair Senator Jeff Barta as the bill sponsor.
Testimony in support was provided by UND Professor and Chair, Dept. of Population Health Gary Schwartz, NDMA President Dr. Stephanie Dahl, and Courtney Koebele. Organizations that supported the bill included American Cancer Society Cancer Action Network and the North Dakota Association of Realtors.
There was no opposition to the bill. NDMA will keep you posted on further action.
If you would like to watch the hearing, it can be viewed here.