Committee hears broad testimony on prior‑authorization reform; dental carve‑out debated

The House Industry, Business and Labor Committee reopened a hearing on Senate Bill 2280, which would set statutory timelines, transparency requirements and review standards for prior authorization in health and dental insurance plans. The committee heard hours of testimony from hospitals, clinics, patient advocates, cancer groups, dental groups and industry representatives and then held the bill over for further committee work and proposed amendments.

SB 2280 would require insurers to respond to urgent prior authorization requests within 72 hours after receiving all necessary information and to nonurgent requests within seven calendar days. The bill would make prior authorizations for maintenance medications valid for one year, require peer reviews to be performed by appropriately licensed clinicians for adverse determinations and appeals, restrict retrospective denials in certain circumstances, and require online disclosure of services that need prior authorization.

Providers and patient advocates said delays in prior authorization harm patients and complicate care. “92 percent of physicians report that prior authorization results in care delays posing a significant risk to patient health,” Shane Gedelen of the American Cancer Society Cancer Action Network told the committee, citing a 2023 American Medical Association survey. Gedelen and others emphasized that cancer treatments and other time‑sensitive care can be compromised by long authorization waits.

Rural hospital leaders said prior‑authorization delays create operational and financial burdens. Marcus Lewis, CEO of First Care Health Center in Park River, recounted administrative time spent on peer‑to‑peer calls and said hospitals sometimes absorb costs while continuing care: “When a hospital preauthorization is delayed and denied, that is not directly given to the patient by the insurance company. It is us as the hospital that has to deliver that to those patients,” Lewis said. Lewis said his facility added a full‑time staff position to handle prior‑authorization workloads.

Several stakeholders urged the committee to retain pharmacy benefits and prescription drug prior‑authorization rules within the bill. Opponents sought a dental exemption. The American Council of Life Insurers (ACLI) and the National Association of Dental Plans (NADP) argued that dental coverage uses a different pretreatment estimate process rather than medical prior authorization, and that imposing medical‑style prior authorization would raise administrative costs and premiums for a product that typically has low monthly premiums. “Requiring dental plans to utilize the prior authorization process would greatly disrupt how the dental market currently operates,” said Ricky Pelta of ACLI.

Dental organizations asked the committee to require dentist reviewers for dental adverse determinations and appeals. “For us, we would prefer that individual not to just be a medical professional, but to be a dentist,” William Sherwin of the North Dakota Dental Association said, and he described the pretreatment estimate process used in dentistry to confirm coverage and approximate patient out‑of‑pocket costs.

Committee members probed operational questions about the bill’s “72‑hour after receiving all information” standard, asking how disputes over completeness would be managed and whether providers or insurers would bear risk when records are incomplete. Representative Casper raised concerns that the bill must be clear when insurers can deem an application incomplete and stop the response clock. Supporters said the bill requires communicative recordkeeping and that most authorizations are complete on submission.

The committee’s chair said he will introduce an amendment under committee work to require standardized electronic submission via electronic health records to reduce submission errors and keep review timelines enforceable. He noted he had received draft language about potential cybersecurity implications and would circulate language to providers for review before committee work. The committee closed the public hearing on SB 2280 and held the bill for further committee work; no final vote was taken.

Testimony and issues highlighted in the hearing included: timelines for urgent and nonurgent requests, one‑year validity for maintenance medication authorizations, peer‑to‑peer review by licensed clinicians, a proposed dental carve‑out and concerns about premium impacts, and the proposal to standardize electronic submission to reduce administrative delays.