[{"_1":2,"_124":-5,"_125":-5},"loaderData",{"_3":4,"_26":27},"root",{"_5":6,"_17":10,"_18":19,"_20":21,"_22":10,"_23":-5,"_24":-5,"_25":10},"user",{"_7":8,"_9":10,"_11":10,"_12":-5,"_13":-5,"_14":15,"_16":-5},"roles",[],"isAuthenticated",false,"isPremium","planName","subscriptionStatus","featureFlags",{},"insightsBudget","isDevelopmentHost","userPreferences",{},"recaptchaSiteKey","6LcvOJcUAAAAAHsB-gPGfGktcRlKpH7OTIU_dMTD","isImpersonating","impersonation","affiliateStatus","isFreedomPortal","routes/v2/article/layout",{"_28":29,"_30":31},"notFound",true,"relatedArticles",[32,76,88,100,112],{"_33":34,"_35":36,"_37":38,"_39":40,"_41":42,"_43":44,"_45":46,"_47":48,"_49":50,"_51":52,"_53":54,"_55":56,"_57":58,"_59":60,"_61":62,"_63":64,"_65":66,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},"mediaId",6289984,"mediaKeyId","2531720-c13e87a96c9a50cd01f61aebc47c7303","parentId",2531720,"title","Representative Karls proposes ban on insurer accumulator policies for certain high-cost prescription drugs; lawmakers debate fairness and scope","audioSeconds",215,"startMs",11231000,"endMs",11446000,"viewUrl","/Search/View?dp=1&key=2531720-c13e87a96c9a50cd01f61aebc47c7303&start=11231&end=11446","thumbnailUrl","https://assets.pipeline.soar.com/2531720-c13e87a96c9a50cd01f61aebc47c7303/thumbnail_11231000.jpg","articleUrl","/articles/6289984/North-Dakota/Representative-Karls-proposes-ban-on-insurer-accumulator-policies-for-certain-high-cost-prescription-drugs-lawmakers-debate-fairness-and-scope","mediaUrl","https://secure.pipeline.soar.com/6289984-f95bf3677d3f42243adb481350f56baa/orig.mp4?Expires=1771206175&Signature=PGMgbLQhtYTFcVDB97WoJBFaEXvdl3RcEFOvR8KMhN9pH1vVoivZ414xg8c0Xhdof~KWMLNonQRENT9bUduSEULOAtBMrmxnXZQlkXq5IXnA~nvk57TBO8ur-jhQXz8t7dmIiDEr4l~yzvVkSK88y9Ki1Da5o8O3MSpg3gPma6YcE0Ig8gjiUfiTdfZNp6-i5OI3wxPniQZhI4wyIR1DJkA59KkAdbsI5fzBvNjlug1FiabD2oqxUKYmp~~ih4bmQGnbArh4Ao-Yc9BAB1jFNnMypHy7yhdGHP6SIZGSL6sgeX3UbJiiy98LKY-uZdemH0~xYHZX0utqmBK01n-DTA__&Key-Pair-Id=KUT5TJCACFTXG","author","North Dakota State Legislature","date","2025-03-10T00:00:00Z","article","Representative Karen Karls introduced House Bill 1216, which would require health benefit plans to count amounts paid by third parties on behalf of an enrollee — for specified high-cost prescription drugs that have no generic equivalent — toward the enrollee’s deductible and out-of-pocket maximum. Karls framed the bill with a constituent story: a patient with a rare disease who received manufacturer assistance at the pharmacy but later was billed the same amount because the insurer did not credit the manufacturer payment to the member deductible.

Sponsor testimony and advocates characterized accumulator or copay‑accumulator programs as a barrier to access for people with very high-cost specialty drugs. Representative Karls said the draft applies narrowly to prescription drugs without generic equivalents and only to third‑party patient‑assistance payments, not broader coupons. The bill also includes a provision to address future PERS self‑insurance status.

Senators pressed the sponsor on fairness: some argued that patients who receive manufacturer assistance should not have a lower effective deductible than others who pay full price, and asked why cost‑sharing help for drugs should be treated differently than assistance that reduces other healthcare costs. Representative Karls said the bill targets life‑saving and specialty drugs for which the market dynamics and manufacturer assistance are different, and she argued those patients face existential risk when access is interrupted.

Representative Karls said fiscal impacts in the fiscal note were overstated because the bill would affect only a small number of patients taking the highest-cost, limited‑market medications; she asked stakeholders to provide data. Committee members suggested follow‑up meetings with carriers and the PERS plan, and Representative Karls indicated her intent to continue refining the measure while the committee reviews testimony.

Ending: The committee recessed the hearing on HB 1216 for additional information and stakeholder meetings. Representative Karls and witnesses agreed to provide written materials and to return for further committee work.","mediaType","Video","parentTitle","Senate Human Services Monday, Mar 10, 2025 9:05 AM - 12:28 PM","oneSentenceSummary","House Bill 1216 would require insurers to count third‑party payments for specified high‑cost, no‑generic prescription drugs toward the insured’s deductible and out‑of‑pocket maximum; sponsor said the change is targeted to life‑saving specialty drugs, while some senators questioned fairness and scope.","taxTitle","Human Services, Senate, Legislative, North Dakota","taxId",28905,"location","North Dakota","headline","","shortSummary",{"_33":77,"_35":36,"_37":38,"_39":78,"_41":79,"_43":80,"_45":81,"_47":82,"_49":83,"_51":84,"_53":85,"_55":56,"_57":58,"_59":86,"_61":62,"_63":64,"_65":87,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6289989,"Bill to allow school districts to name CPS liaisons draws support, raises confidentiality and forensic interview concerns",658,7293000,7951000,"/Search/View?dp=1&key=2531720-c13e87a96c9a50cd01f61aebc47c7303&start=7293&end=7951","https://assets.pipeline.soar.com/2531720-c13e87a96c9a50cd01f61aebc47c7303/thumbnail_7293000.jpg","/articles/6289989/North-Dakota/Bill-to-allow-school-districts-to-name-CPS-liaisons-draws-support-raises-confidentiality-and-forensic-interview-concerns","https://secure.pipeline.soar.com/6289989-a9a3cc1fb9bb9123ec87419a69ffae33/orig.mp4?Expires=1771206175&Signature=LSOyrEo5FysFFPOT7gxTq2wzxjITQUdqF1pZ1VN1LTqC8nUT6RDl3Wo9G5yB7HtSoschA0CKeA46YQB~J1UFU3DH-~jy94txaAb~dUba4ukw5WQg3PoHkp9qN4c3EJiuPL3UEAo0E5OVgtoypQarlXmcFqrAPQ~3PrxdvRe4~BIqWC1hTklUSziz1VngFMkospjKaStJzveCPXyftexJN7FSJnaUNAwMaOjx5xo6wr3Lyq3bnvvhsAT3zmZxyDB~Dj3Jb-h~z9DqP9O0IMPgkbsn~X2JNVXHkLg2q47RaVUMq7JU5xWz4lbEZWd0F~W2NXykVPld~x0Pm-fESno4ag__&Key-Pair-Id=KUT5TJCACFTXG","House Bill 1095 would allow school districts to designate a child protective services (CPS) liaison to coordinate with CPS when the district’s students are involved in assessments or services. Amy DeCook of the North Dakota School Boards Association told the committee the measure is optional for districts and could clarify a point of contact to facilitate communication with CPS, coordinate services and support school staff.

Supporters said educators are often first to recognize signs of abuse or neglect and a designated liaison could ease coordination when legally permitted. The school boards association said language was amended in the House to add flexibility and to require CPS to provide liaison training; the bill does not obligate districts to designate a liaison.

Senators raised several substantive concerns during the hearing. Senator Hogan and others said the juvenile-justice-era restructuring of child welfare had already reduced multi-agency teams and that this bill risked reintroducing complexities the prior reforms sought to avoid. The central questions were legal boundaries and confidentiality: who can receive or share what information, under what legal authority, and whether the liaison role might create expectations or liability beyond the district’s legal authority.

Greg Casalski, executive director of the Children’s Advocacy Centers of North Dakota, registered a narrow opposition: he said the bill’s language (section 3(c)) could be read to permit school employees to “assist CPS with a student case investigation” and that untrained school staff conducting interviews or probing children after disclosure risks contaminating forensic interviews, threatening law‑enforcement investigations and harming the child. Casalski recommended limiting any liaison role to coordination and requiring that forensic interviews remain with accredited interviewers at Children's Advocacy Centers or law enforcement.

Committee members asked how the proposal would intersect with behavioral health coordinators already placed in schools and whether a CPS liaison would duplicate or conflict with that role. Members and DeCook agreed the liaison idea is not a panacea and noted training and legal safeguards would be essential. The hearing was recessed and left open for further input from the state’s CPS zone directors and from Kim Jacobson, who was expected to attend but had been called away; senators asked Jacobson to return for committee work.

Ending: The committee left the bill open for additional input on confidentiality safeguards, training scope and forensic‑interview protections before deciding whether to move the measure forward.","House Bill 1095 would let school districts designate a child protective services liaison to coordinate with CPS on assessments and student services; school boards supported the option but CHILDREN’S advocacy representatives warned that the proposal could risk improper information sharing and untrained interviews.",{"_33":89,"_35":36,"_37":38,"_39":90,"_41":91,"_43":92,"_45":93,"_47":94,"_49":95,"_51":96,"_53":97,"_55":56,"_57":58,"_59":98,"_61":62,"_63":64,"_65":99,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6289993,"Panel endorses technical changes to Medicaid waivers to avoid program churn for young adults",179,6143000,6322000,"/Search/View?dp=1&key=2531720-c13e87a96c9a50cd01f61aebc47c7303&start=6143&end=6322","https://assets.pipeline.soar.com/2531720-c13e87a96c9a50cd01f61aebc47c7303/thumbnail_6143000.jpg","/articles/6289993/North-Dakota/Panel-endorses-technical-changes-to-Medicaid-waivers-to-avoid-program-churn-for-young-adults","https://secure.pipeline.soar.com/6289993-6c32973576c7ca1ec106a139dff9ff2f/orig.mp4?Expires=1771206175&Signature=JEJi1gJr0kZUcXZMm3viI6VqzPItsmu-59AwGk3m1Bmi-1W2fu1fJvW79WIrAsWGk8RI-Y7aE-eO3F4PtmYOIqYDoBRx01ko9ki2T~dllIYK6Yr0zrM3jsQVo28l~P~hjrVcbbFCxr3ReqJQAtdTxdncVGFC~uSi6fCxIJKAkJStnXO~UXYzICHSoZKi9i7-o3~xJ2w~LvJ1je563JrIDMaDfGQbeDzQ2YJ3gQKBsuM76vhMlvTU-n89zMd51aIICcaB8KbZRKj3HDX7pJC0eSHlf9pSHmAMAgpzcbWMTCVn-aMVtycvgSF7vqYxLIIK5ODPCQBZ0agemz4q7LjSig__&Key-Pair-Id=KUT5TJCACFTXG","Krista Framing from the Department of Health and Human Services explained House Bill 1067 to the Senate Human Services Committee. The bill’s amended section 1 directs the department to disregard certain income sources when calculating recipient liability for children in Medicaid 1915(c) waivers: Social Security survivor benefits and court-ordered child support would not count as income for these children. The change would take effect July 1, 2026 if enacted.

Framing said the department estimates a $62,000 fiscal impact in the 2025–27 biennium and about $125,000 in 2027–29, and notes the change would be phased in because of the delayed effective date. Section 2 would increase the age limit for participation in the children's autism and medically fragile waivers to age 20, allowing currently enrolled young adults to remain on those waivers at ages 19 and 20 rather than aging out at 18. Staff said there is no fiscal impact for that change because waiver slots are funded and already allocated.

Committee members asked how many children this would affect; DHHS told the committee approximately 10 children currently have the listed income types counted toward their client share. Senators asked clarifying questions about who would pay previously counted client liability if the income is disregarded; the department said the department would assume those costs rather than the families.

Ending: Committee expressed support for the targeted changes and closed the hearing; staff and lawmakers asked for the fiscal note details and implementation timing to be captured in bill language.","The committee heard and provisionally supported amendments in House Bill 1067 that will disregard certain income sources for children on Medicaid waivers and raise age limits so waiver participants can remain enrolled at ages 19 and 20; fiscal impacts to the biennium were modest and the department asked for the effective date to be July 1, 2026.",{"_33":101,"_35":36,"_37":38,"_39":102,"_41":103,"_43":104,"_45":105,"_47":106,"_49":107,"_51":108,"_53":109,"_55":56,"_57":58,"_59":110,"_61":62,"_63":64,"_65":111,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6289998,"Committee weighs extending PERS insulin cap to commercial plans as proponents cite lives saved and insurers warn of market costs",2594,6116000,8710000,"/Search/View?dp=1&key=2531720-c13e87a96c9a50cd01f61aebc47c7303&start=6116&end=8710","https://assets.pipeline.soar.com/2531720-c13e87a96c9a50cd01f61aebc47c7303/thumbnail_6116000.jpg","/articles/6289998/North-Dakota/Committee-weighs-extending-PERS-insulin-cap-to-commercial-plans-as-proponents-cite-lives-saved-and-insurers-warn-of-market-costs","https://secure.pipeline.soar.com/6289998-e37107dface590b3ae1c406dffd92f12/orig.mp4?Expires=1771206176&Signature=WgR6aZk~8C1wa-efVTeRLgFeypCdeY2BJOFdscWb-Fj8L13APB9YRx85OADilcbsxSGFK8-XV4NRuebTsGkU15NzFrtstirnVKpfrecDTB0s2Nd~6jNuGuPTjiWv~7KN6tBYrppOEUvxvy6UDdxYWyfb0xkmhSBxZrBcGWp9mqkWQbLh56zzZqiaj8OzA-9tDARNRwVNYK0qBm2fWFSm0NQ4TTgCyBS3~NHsUbXIftIAAEXoj65A6yxHnQd6oPkjfllzoeAAdqDgHbSdzM0dWWY-bbGpJWVQ~fO9v-R1Uhr31uQcYAVKCxwwPTRuCpgWANIaFdsWYfjgVKHkUPMGmg__&Key-Pair-Id=KUT5TJCACFTXG","Representative Carrie McLeod presented House Bill 1114, a bill drafted by the Public Employees Retirement System (PERS) board to continue a $25 monthly cost-sharing cap for specified insulin products and diabetic supplies and to extend comparable coverage to the commercial market.

McLeod and multiple advocates described the cap as life-saving for patients dependent on insulin. They cited a PERS pilot directed by Senate Bill 2140: PERS extended a $25 cap for its active group plan during 2023–24 and PERS staff and consultants reported limited utilization changes and measurable per-member savings while estimating a modest premium impact to continue the benefit in PERS plans.

Rebecca Fricke, executive director of the North Dakota PERS, told the committee the pilot (July 1, 2023–June 30, 2024) produced an estimated member savings of about $80.15 per affected member per month in the pilot year, and Deloitte priced continuation of the benefit for the 2025–27 biennium at roughly 0.12% of premium for PERS plans (fiscal note). Fricke said the insurer (Sanford Health Plan) found many diabetic supply claims cost less than $25 per month, and drug manufacturers reduced list prices for insulin during the pilot, which reduced the plan’s total reimbursements.

Patient advocates described real-world harms from high insulin costs and rationing. Several witnesses and patients told the committee that people had rationed insulin because of price and that rationing leads to dangerous outcomes and costly emergency care. Matt Prokop of the American Diabetes Association and Angela Kritzberger of advocacy group Breakthrough T1D provided national and personal context for the proposal, noting that many states have enacted insulin caps and that federal Medicaid and Medicare rules already cap insulin cost-sharing for those respective populations.

Sanford Health Plan and Blue Cross Blue Shield of North Dakota opposed extending a state-mandated commercial cap. Sanford’s representative said manufacturers adjusted prices during the PERS pilot and warned of carrier exit or premium increases if the commercial cap is imposed broadly; Blue Cross emphasized that many commercial plans already include low insulin cost-sharing (some carriers already impose $5 or $25 caps) and said ERISA self-funded employer plans would not be subject to a state mandate.

Committee members questioned the size of the population affected and asked proponents for data. Representative McLeod and witnesses said the exact share of the state population affected by the mandate is uncertain; some estimates circulated during testimony suggested tens of thousands could be left out if they are in self-funded plans. Senators asked for more precise counts of people who currently ration insulin and for actuarial detail about premium impacts; witnesses promised to provide supporting data from the PERS report (the Novarest actuarial memo was attached to testimony).

Ending: The committee did not take immediate action and members asked for further data from the PERS report, carrier filings and estimates of affected populations. The PERS representative and advocates pressed lawmakers to extend the modest cap to more North Dakotans, while carriers urged caution and said many insured residents already enjoy low out-of-pocket costs for insulin.","Supporters urged the committee to extend a $25 monthly cap on insulin and certain diabetic supplies to commercially insured North Dakotans; the PERS board’s pilot found modest plan costs and member savings, while insurers warned the mandate could raise premiums or be redundant where caps already exist.",{"_33":113,"_35":36,"_37":38,"_39":114,"_41":115,"_43":116,"_45":117,"_47":118,"_49":119,"_51":120,"_53":121,"_55":56,"_57":58,"_59":122,"_61":62,"_63":64,"_65":123,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6290004,"Senate Human Services hears lengthy debate over House Bill 1481 on dental insurance \"loss ratios\"",1799,47000,1846000,"/Search/View?dp=1&key=2531720-c13e87a96c9a50cd01f61aebc47c7303&start=47&end=1846","https://assets.pipeline.soar.com/2531720-c13e87a96c9a50cd01f61aebc47c7303/thumbnail_47000.jpg","/articles/6290004/North-Dakota/Senate-Human-Services-hears-lengthy-debate-over-House-Bill-1481-on-dental-insurance-loss-ratios","https://secure.pipeline.soar.com/6290004-1e55c7b2ce8a7eaa4f8b7bc0b10304b4/orig.mp4?Expires=1771206176&Signature=NZrGO6isWHmjWZ2My8m4~vOM7HC1EtQfo-09IP2T892JNFSrshnzp9I1Mu~RkgkjXVwn8PG8UgsnUYH0bIJbi4GdL4TnBQ43JZSdjvFoCy3NRHl9V2fQlIHYouCJHLXSVvnakmuJyLdR2iTFwNfRopDNxOIYwBLHf1S7ZyuAVcGJ2f1uHu2kzl1oAv6EPWYHmMCj7DZm3ouL1IXxVeEwjV0UiX1r5YRGx1j5TXC7LGXUqe9LXsdQUsdruU2zjwJt6jPvmwmD9jfIOiDHumPVDv0~b7NhzYKXhm7SEKgbFLgjElFxZ-jOm50cGYo-SXJqiJUcT1o98wrfLa86fl3Arg__&Key-Pair-Id=KUT5TJCACFTXG","Representative Jim Casper introduced House Bill 1481, which would set a minimum dental loss ratio for dental insurance plans and require rebate or credit when a plan fails to meet the threshold. The bill was the subject of extensive testimony from dentists, dental associations, brokers, insurers and regulators during the Senate Human Services Committee hearing.

The bill’s backers said the measure is intended to increase transparency and guarantee “value” for purchasers of dental coverage. William Sherwin, executive director of the North Dakota Dental Association, told the committee HB 1481 aims to ensure “83 or 75 percent of the patients’ dollars that are going into the premiums have to be spent on them,” and that the proposal includes a phase-in, an exemption for carriers with fewer than 1,000 lives, and an effective date of Jan. 1, 2027 so markets and the Insurance Department can prepare.

Representative Casper, a broker who sponsored the bill in the House, described the problem from brokers’ and patients’ perspectives: insurers do not routinely disclose plan- or group-level loss ratios to brokers or employers, and small-group plans can be skewed by single large claims. Casper said the bill originally sought an 83% loss ratio, the House amended it to 75% and the committee should decide which standard to adopt.

Supporters argued data from state filings show many large carriers are already at or above the levels sought in the bill. Sherwin and dentist witnesses said the change would reduce incentives to deny claims and return unused premium dollars to payers or as credits to buyers. Dr. Bradley King, a longtime dentist, described repeated denials and administrative burdens in dental offices and said guarantees on how premium dollars are spent would benefit employers and patients.

A number of insurers and insurance-industry groups testified in opposition or urged amendments. Ben Wagsland, vice president of government affairs for Delta Dental of Minnesota, and representatives of Blue Cross, ACLI and other national groups warned that a straight product-level mandate at a single percent across all market segments fails to account for differences between large-group, small-group and individual markets and could force carriers to exit the small-group or individual market. ACLI and others pointed to Massachusetts, where a ballot initiative-style loss-ratio mandate was followed by higher premiums and several carriers leaving the market.

Industry witnesses and national trade groups recommended an alternative used in other states: a reporting-based approach (NCOIL/NAIC-style models) that uses multi-year, segment-level aggregate data and allows insurance commissioners to identify and remediate outliers rather than imposing a fixed threshold across every plan. Representatives of the National Association of Dental Plans (NADP) and others said reporting and a commissioner-driven remediation process would provide transparency without the market disruption they fear.

Committee members pressed proponents and opponents on whether the bill applies to individual plans or to aggregated carrier filings. Representative Casper and William Sherwin said the intent is to protect each plan (per-plan basis) but acknowledged the aggregated data shows carriers can meet higher thresholds. Several senators cautioned that applying a fixed threshold to small-group plans could skew results and potentially reduce the availability of coverage for small employers.

The Insurance Department’s representative, Crystal Bartuska, told the committee the department is neutral and asked for more time; she offered to return in committee work to walk through regulatory and implementation questions. Several senators requested additional data and time to consider whether an aggregate approach, a reporting regime, or a product-level threshold would best protect consumers without shrinking the market.

The hearing produced no committee action on HB 1481; sponsors and committee members agreed to continue the conversation and review additional actuarial and state insurance filing data.

Ending: The committee left the bill under consideration after several hours of testimony, with supporters urging a standard to guarantee consumers a set portion of premium dollars be spent on care and opponents arguing for a reporting-and-remediation approach to avoid unintended market consequences.","Lawmakers, dental providers and insurers debated House Bill 1481, a proposal to require dental insurers to spend a minimum share of premium revenue on patient care. Dental groups pushed for a 83% threshold and an exemption for very small carriers; insurers warned of market contraction and urged a commissioner-led, market-based reporting approach.","actionData","errors"]

Article not found

Representative Karls proposes ban on insurer accumulator policies for certain high-cost prescription drugs; lawmakers debate fairness and scope

Bill to allow school districts to name CPS liaisons draws support, raises confidentiality and forensic interview concerns

Panel endorses technical changes to Medicaid waivers to avoid program churn for young adults

Committee weighs extending PERS insulin cap to commercial plans as proponents cite lives saved and insurers warn of market costs

Senate Human Services hears lengthy debate over House Bill 1481 on dental insurance "loss ratios"